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Flashcards in LGD1 Other Headaches Deck (49)
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When should you think secondary headache?

headache reaches full intensity rapidly, abnormal neuro signs, progressive in intensity/duration over time, worse with standing, develops after age 50


What are 3 types of headaches you get while sleeping?

- brain tumor headache
- brain abscess headache
- idiopathic intracranial hypertension


What are type of headache with moving focal symptoms?

- headache with stroke


What type of headache that explodes?

subarachnoid hemorrhage
or: untruptured aneurysm, dissection,


What type of headache wtih autonomic features?

cluster headache


What type of headache that is worse with exertion?

giant cell arteritis
cardiac cephalgia
coital headache
cough headache


What type of headache with position?

orthostatic/low pressure headache
postural orthostatic tachycardia syndrome [POTS]


WHy type of headache that stabs?

trigeminal neuralgia


What is clinical presentation of migraine?

- pulsating
- one day duration [4-72 hrs]
- unilateral
- nausea [+ aura, vomit, photophobia, phonophobia, neck pain]
- disabling

women more than men
excaerbated by light, noise, activity


What is clinical presentation of tension headache?

pressing, bilateral headache
lats > 30 min, can be constant
no photophobia/phonophobia/aura, rare nausea


What is clinical presentation of cluster headache?

unilateral, repetitive brief headaches
excruciating periorbital pain with lacrimation [tears], rhinorhea, horners
more common in men
lasts ~ 15 min


How do you differentiate cluster headache from trigeminal neuralgia?

trigeminal neuralgia = repetitive shooting pain in distribution CN 5 that lats < 1 min
cluster = > 15 min usually


What is time signature of headache? if min? if hours/days? if wks/mos? if mos/years?

min = vascular
hours/days = infectious
weeks/mos = inflammatory/neoplasm
mos/yrs = primary headache


Patient is a 61-year-old woman with a 6-week history of headache. Pain would wake her up and lessen as the day progressed. Straining at stool increased the pain. At times, when she sat up, she experienced a transient loss of vision.

What should you think?

headache from brain tumor


What is clinical presentation of brain tumor headache?

worse in the morning, change from prior headache pattern
location = diffuse
other symptoms: transient vision loss, increased ICP [pain with straining], N/V
abnormal neuro exam

can be similar to tension headache


What is clinical presentation of headache from brain abscess?

same as with tumor + a fever in half
impaired sensorium, focal complaints, seizure


22 year old female, new frontal headaches which increase with straining and are awakening her out of sleep. Menstruation has become abnormal.

What should you think?

idiopathic intracranial hypertension?


What is clinical presentation idiopathic intracranial hypertension?

diffuse swelling of brain and increased ICP = same type of headache as brain tumor but without clinical consequences of tumor compressing adjacent structures

brain tumor headache + visual complaints, cranial bruits, noises in head, N/V, radiculopathies

confirm by normal imaging studies


Who usually gets idiopathic intracranial hypertension?

women who are obese and of childbearing age usually


What are laboratory tests for idiopathic intracranial hypertension

normal imaging studies
MRI: flattened post globes, protruding optic nerve heads
normal CSF except for increased pressure


82 year old woman who has been awakened at 3am and 5am nightly for 2 months with a bilateral pounding headache. Normal neurological examination.

What should you think?

hypnic headache syndrome


What is hypnic headache syndrome

rare disorder
age onset = 40-84
bilateral throbbing headache
recurs 1-3 times nightly
no associated symptoms


62 year old male, with the abrupt onset of numbness in his face, spreading down his left arm over 10 minutes, then receding over the next 10 minutes to involve the left side of his lip, then rapidly resolving. 5 minutes later he developed a throbbing headache in his right temple lasting 5 minutes.

What should you think?

stroke headache


What is clinical presentation of stroke headache?

most frequent in strokes of posterior circulation
can be abrupt or gradual
severity not related to size of infarction


32 year old woman, with tingling in her left thumb, then her entire left hand, then extending to her mouth over 5 minutes. As the tingling resolved, it was replaced by numbness of the hand, extending from her face extending down the left arm. All of this resolved in 25 minutes, after which she developed a moderately severe throbbing headache involving her entire head and associated with photophobia and phonophobia and lasting a day.

What should you think?

? stroke?


A 60 y.o. male with no prior history of migraine began experiencing episodes of “spreading “ right body numbness beginning in the right leg then extending to the arm and leg, lasting for 15 minutes, followed by left-sided pulsatile headache. His exam is normal

What should you think?

? stroke?


Patient is a 37-year-old woman who had abrupt onset of a severe occipital headache with mild nausea. Had transient diplopia, which resolved before she arrived at the hospital. Headache remained constant without any photophobia but with moderate nausea. Her neurological examination was normal and her headache and nausea responded well to sumatriptan; she was discharged

What should you think?

SAH headache


What is clinical presentation of SAH headache?

- sudden onset severe headache "worst headache of life"
- diffuse location
- associated with mild nausea, seizure, diplopia [seizure and diplopia not seen in thunderclap]
- no photophobia, phonophobia

- if suspect --> do non-contract CT --> if negative do LP; do angiography to find aneurysm


What are some causes of thunderclap headache?

- aneurysm/non-aneurysmal SAH
- un-ruptured aneurysm
- cerebral sinus thrombosis
- dissection
- acute intracranial hypotension
- sexual/exertion headache


Patient is a 23-year-old man. For the past 6 weeks has been awakened at 3 AM by pain in his right cheek and upper molars. No head pain
Pain very severe, lasting 45 minutes. Deep, not triggered by superficial cutaneous stimuli. One attack lasted 6 hours, but most shorter. A clear liquid has been coming out of his right nostril

What should you think?

cluster headache