Headaches Flashcards
History - (S)OCRATES
What pathology does the following sites indicate?
Bilateral
Unilateral
Occipital
Behind eye
Tension headache
Migraine, temporal arteritis (TA)
SAH
Cluster headaches
History - S(O)CRATES
What does the following indicate?
Sudden onset
Progressive onset
What does a prodrome or aura indicate?
What do patients experience in an aura?
What type of headaches does the following triggers trigger:
- sleep, dehydration, eyestrain
- alcohol, exercise, certain food
SAH
TA
Migraine
Flashing lights, wavy lines, or dots, or they may have blurry vision or blind spots
Tension headache
Migraine
History - SO(C)RATES
What does a throbbing headache indicate?
What does a pressure headache indicate?
What does a sharp headache suggest?
What does a pounding headache suggest?
TA
Tension headache
Cluster headache
Migraine
History - SOC(R)ATES
If the pain move to the jaw causing jaw claudication and scalp tenderness, what is the most likely diagnosis?
TA - temporal arteritis
History - SOCR(A)TES
Here is a list of some conditions:
- migraines
- meningitis
- SAH
- TA
- Raised ICP
- Subdural haematoma
Match the conditions to the list of associated symptoms:
- N&V - 3
- Fever - 2
- Stiff neck - 3
- Drowsy - 2
- Unusual sensations or autonomic signs - 1
- Morning joint stiffness - 1
- Visual symptoms - 3
N&V - migraine, meningitis, SAH
Fever - menignitis, TA
Stiff neck - meningitis, SAH, migraine
Drowsy - subdural, SAH
Unusual sensations or autonomic signs - migraine
Morning joint stiffness - TA
Visual symptoms - TA, raised ICP, migraine
History - SOCRA(T)ES
How long do tension headaches typically last?
What about migraines?
Any time course - very unpredictable
4-72 hours - can be very severe
History - SOCRAT(E)S
What exacerbates a migraine?
What exacerbates raised ICP?
What is medication overuse headaches mean?
Light, sound and movement
Coughing, bending, straining
The meds actually cause the headaches so you tell them to stop the meds and the headaches should go
Red flags:
What does a thunderclap headache mean?
Other red flags?
Sudden onset headache which peaks in seconds to minutes
1st and worst headache of life - SAH
Short progressive time course
Signs of cauda equina, raised ICP, systemic illness or focal neurological deficits
What do the following risk factors pre-dispose you to:
HTN
FH
Patent foremen ovale
Combined contraceptive pill
HTN - SAH
FH - SAH, migraine
PFO - migraine - shunting of blood causes microinfarcts in the brain, leading to irritation and a tendency for migraine
CCP - migraine - due to hormonal swing - they take inactive pills so oestrogen suddenly drops resulting in headaches
Tension headache:
Causes - 4
Presentation:
- bi/uni
- epi/continuous
- how is it described?
What is a good sign meaning it isn’t something more serious?
Stress
Lack of sleep
Dehydration
Eyestrain
Bilateral
Both episodic or continuous
Pressure quality
They can still function with the background headache
Tension headache:
Management:
Medical - 1
Why do you not give opiates for headaches?
Conservative - 1
Simple analgesia - NSAID’s/paracetamol
May cause overuse headaches
Stress relief
Differentials for single acute headaches:
Vascular causes
Non-vascular causes - think about lifestyle or what you could be doing
What is a severe form of HA’s that you watched a documentary on?
SAH
Intracranial venous thrombosis
Arterial dissection
Primary cough HA
Exercise-induced HA
Cluster HA
Differentials for single acute headaches:
What are the causes with fever?
Meningitis
Encephalitis
Abscess or empyema - focal signs
Differentials for single acute headaches:
What are some causes of post-trauma with drowsiness headaches?
Acute subdural haemotoma
Extradural haemorrhage
Important headaches not to miss: - mneumonic
SHIT - ME
(S)A(H) Raised (I)CP Temporal arteritis Meningitis Eyes - acute glaucoma and other site-threatening conditions such as anterior uveitis, optic neuritis
