Lecture 2- Headache (cephalalgia) Flashcards Preview

CHI303- Clinical Science And Diagnosis > Lecture 2- Headache (cephalalgia) > Flashcards

Flashcards in Lecture 2- Headache (cephalalgia) Deck (12):
1

Difference between primary and secondary headaches

Primary:
- no underlying pathology (idiopathic)
- recurrent and non-progressive
- Neurologic exam is unremarkable
- look for the absence of red flags
Secondary:
- underlying pathology
- sudden onset, constant, progressive
- red flags

2

RED FLAGS OF HEADACHES: SNOOP

- systemic symptoms or secondary risk factors
- neurologic symptoms
- older
- onset
- previous headache history

3

COMMON HEADACHE PRESENTATION

Primary headaches
- migraine
- tension-type
- cluster

4

COMMON MIGRAINE ( no aura)

- lasts 4-72 hours
- unilateral, pulsation, moderate to severe in intensity
- may be made worse by mild physical activity (walking)
- may experience nausea, vomiting, photo or photophobia

5

CLASSIC MIGRAINE: (aura)

- prodromal phase up to several hours before headache, causing unusual symptoms such as mood changes, food cravings and excessive thirst
- aura: one or more of the following symptoms which are all fully reversible
* visual symptoms: flickering lights, spots or lines
* sensory symptoms: pins and needles and/or numbness
* speech disturbance
NOTE: symptoms last 5-60 mins, headache occurs during aura or within 60 mins, postdromal phase of fatigue

6

TENSION TYPE HEADACHE

- most common
- can occur once a month or 15 times a month
- can last 30 mins- 7 days
- bilateral locations, pressing/tightening, non-pulsation, "band" quality, mild to moderate intensity
- not aggravated by routine physical activity e.g. Walking
- NO nausea, vomiting
- POSSIBLE photophobia or photophobia

7

CERVICOGENIC HEADACHE: primary or secondary???

- diagnosis usually through demonstration of clinical signs that implicate a source of pain from the cervical spine.. E.g. Disc lesion or myofascial referral
- SCM and TRAPEZIUS most common for myofascial
- symptoms made worse by neck movement or awkward head positions
- restricted ROM
- moderate, non-throbbing, usually posterior head, commonly unilateral
- mild dizziness, nausea or "aura" are UNCOMMON but may be present

8

Importance of the history and physical examination in a patient with headache

- S: so important as assists in diagnosis
- O: may indicate red flags, acute or chronic
- C: assist in diagnosis, may indicate neurogenic cause
- R:
- A: assists in diagnosis, may indicate red flags/ systemic cause
- T: provides an outcome measure for Rx
- E: may indicate red flags, produce clues for treatment, discuss how medication may be helping
- S: may indicate red flags, assist in diagnosis

9

MAKING THE DIAGNOSIS: PATIENT HISTORY
-location

location of headache:
- unilateral: migraine if anterior, cervicogenic usually posterior
- ocular or retro orbital: opthalamic cause or migraine
- para nasal: sinusitis (with local tenderness)
- "band-like" tensions
- occipital: TTH or meningeal, vascular or cervicogenic

10

MAKING THE DIAGNOSIS: THE PATIENT HISTORY
onset

- acute, subacute or chronic

11

MAKING THE DIAGNOSIS: THE PATIENT HISTORY
Character of the pain

- pulsation or throbbing is most common ( often migraine or TTH)
- SOLS can cause any type of headache (pattern is constant and progressive)

12

Causes of a headache

- subarachnoid haemorrhage
- meningitis
- opthalmic disorders
- sinusitis
- dental
- cervical