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Headache


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B. Lee


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How is headache examined
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Blood pressure Palpation - temporal arteries - sinuses Temperature Neck examination Fundoscopy

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Headache - Details

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34 questions
🇬🇧🇬🇧
How is headache examined
Blood pressure Palpation - temporal arteries - sinuses Temperature Neck examination Fundoscopy
What is general approach for management of headache
Reassurance, hydration, optician review Headache diary - identify and avoid triggers
What are red flags for a headache
Age above 50 Thunderclap headache Progressive/persistent Previous head injury
Difference between primary and secondary headache
Primary - Non identifiable - Common (90%) - Generally not life threatening Secondary - Symptom of underlying disease - Uncommon - May be life threatening - Sinusitis, SOL, Haemorrhage, Meningitis
What is general approach for management of headache
Reassurance, hydration, optician review Headache diary - identify and avoid triggers
What are red flags for a headache
Age above 50 Thunderclap headache Progressive/persistent Previous head injury
How is headache examined
Blood pressure Palpation - temporal arteries - sinuses Temperature Neck examination Fundoscopy
NA
NA
What are red flags for a headache
Age above 50 Thunderclap headache Progressive/persistent Previous head injury
How is headache examined
Blood pressure (high contributes) Palpation - temporal arteries - sinuses Temperature Neck examination (movements) Fundoscopy - back of the eye
What is general approach for management of headache
Reassurance, hydration, optician review Headache diary - identify and avoid triggers
How is headache examined
Blood pressure Palpation - temporal arteries - sinuses Temperature Neck examination Fundoscopy
How is headache examined
Blood pressure Palpation - temporal arteries - sinuses Temperature Neck examination Fundoscopy
How is headache examined
Blood pressure Palpation - temporal arteries - sinuses Temperature Neck examination Fundoscopy
What is general approach for management of headache
Reassurance, hydration, optician review Headache diary - identify and avoid triggers
What is general approach for management of headache
Reassurance, hydration, optician review Headache diary - identify and avoid triggers
What is general approach for management of headache
Reassurance, hydration, optician review Headache diary - identify and avoid triggers
What is the cause of tension headache and how is it treated
Cause - Stress/depression Treatment - Simple analgesia - Does not reduce recurrence and may lead to secondary headache - Stress management - NSAIDS, aspirin, paracetamol
Where is migraine likely to occur
Unilateral, throbbing and disproportionally disabling
Difference between classical migraine and common migraine
Classical Migraine (10-30%) - Migraine with aura (neurological change, usually visual symptom) Common Migraine (70-90%) - Migraine without aura
What are managements for migraine
Analgesia Antiemetic Triptans
What are specific symptoms leading to diagnosis of cluster
Excruciating and restlessness Increased tear production Redness of eyes
Treatment for Cluster
DO NOT suggest simple analgesia - does not work Short burst of oxygen therapy Injecting or intranasal triptan
How would patient present with Trigeminal neuralgia
Sudden severe facial pain Shooting/Burning sensation Triggered by light touch
Treatment for Trigeminal neuralgia
Carbamazepine - If cannot use it, refer it to specialist
What drugs may lead to Medication overuse headache
Chronic use (over 10days) of these drugs - Paracetamol - NSAIDs - Opioids - Triptans
Treatments for medication overuse headaches
Rebound phenomenon - Pain gets worst when they stop painkillers However, resolves with discontinuation within 2 months
What differentiates from viral or bacterial infection of sinusitis
Bacterial infection (2%) - blood/pus production - Creamy discharge from nose or throat Majority is viral infection
What are symptoms of Sinusitis
Tenderness Fever Rhinitis
What is space occupying lesion
Primary/Secondary brain tumour (from Lung, breast, Bowel, Kidney, Skin) - primary way more common Abscess or Haematoma
What are symptoms and signs or SOL
Symptoms - Progressively worsening morning - due to raised intercranial pressure - Vomiting - Seizure Signs - Altered GCS - Cushing's triad (Low heart rate, respiratory rate, increased blood pressure) - Papilloedema
What is subarachnoid haemorrhage
Bleed into subdural space - following rupture of vein Neurological emergency It may be result of berry aneurysm, AV malformation, traumatic head injury
How would pateints present with subarachnoid haemorrahge
Thunderclap headache - worst headache in their life Meningism - neck stiffness, photophobia Nausea Altered vision Drowsiness
What are examinations for SAH
CT/MRI Cerebral spinal fluid becomes xanthochromic - Lysis of RBC resulting in haemoglobin breaking down to bilirubin
What is meningitis
Inflammation of meninges - bacterial or viral infection Life threatening which can mimic influenza
What are symptoms of meningitis
Headache Fever Stiff neck Non-blanching purpuric rash Opisthotonos - Arched body with neck hyperextended Kernig's sign - Pain when knee extended with hip flexed
What bacteria causes meningococcal Septicaemia
Neisseria Meningitidis (meningococcus)
Why is Meningococcal Septiciaemia a paediatric emergency
Impacts clotting cascade - Failure in coagulation Leads to risk of sepsis
What is Temporal arthritis (Giant cell arthritis)
Auto-immune inflammatory vasculitis
Why is temporal region painful for patients with temporal arthritis
Temporal region supplied by temporal artery Due to inflammation, pain Pain may radiate to temples and jaws May lead to Jaw claudication