7814604
Descripción
Fichas por Ashutosh Kumar, actualizado hace más de 1 año
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Creado por Ashutosh Kumar
hace casi 8 años
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| Pregunta | Respuesta |
| Primary headaches: | Primary headaches: No underlying pathology. |
| Secondary headaches: | Secondary headaches: Due to underlying pathology. |
| Red flags in headache presentation: | Red flags in headache presentation: Age: Over 50 years at onset of new headache. Under 10 years at onset. Characteristics: First, worst or different from usual headache. Progressive headache (over weeks). Persistent headache precipitated by Valsalva manoeuvre (worse on coughing, sneezing, bending or exertion). Thunderclap headache (explosive onset). Additional features: Atypical or prolonged aura (>1 hour). Aura occurring for the first time in women on COCP. New onset headache in patient with a history of cancer or HIV. Concurrent systemic illness. Neurological signs. Seizures. Symptoms/signs of Giant Cell arteritis (e.g jaw claudication) Visual or other transient neurological signs presenting for the first time in older people raise the possibility of TIA. |
| DDx for headache: | DDx: Vascular: Subdural haematoma. Epidural haematoma. Subarachnoid haemorrhage. Venous sinus thrombosis. Tumour Toxins Infectious causes: Meningitis Encephalitis Abscess Giant cell arteritis Hydrocephalus Obstructive Acute Metabolic disorders |
| For all initial presentations of headache, examination includes: | For all initial presentations of headache, examination includes: Fundoscopy. Visual acuity. Blood pressure measurement. Examination of the head and neck for muscle tenderness, stiffness, range of movement and crepitation. |
| DDx for primary headache: | DDx for primary headache: Tension headache. Migraine with or without aura. Cluster headache. |
| Tension-type headache: Pain location Pain quality Pain intensity Effect on activities Other symptoms Duration of headache | Bilateral Pressing/tightening Mild or moderate Not aggravated None 30 min-continuous |
| Migraine (with or without aura) Pain location Pain quality Pain intensity Effect on activities Other symptoms Duration of headache | Unilateral or bilateral Pulsating (throbbing or banging in 12-17 year olds) Moderate or severe Aggravated causing avoidance Sensitivity to light, sound, exp nausea, vomiting Aura: Develop over 5 min, last 5-60 min, fully reversible. Flickering lights, spots or lines, partial vision loss; sensory symptoms such as numbness, pins and needles; speech disturbance. 4-72 hrs in adults 1-72 hrs in young (12-17) |
| Cluster headache: Pain location Pain quality Pain intensity Effect on activities Other symptoms Duration of headache | Unilateral (around the eye, above the eye and along the side of the head/face) Variable (sharp, boring, burning, throbbing or tightening). Severe or very severe Restlessness or agitation On the same side as headache: Red or watery eyes Nasal congestion, rhinorrhea Swollen eyelid Forehead and facial sweating Constricted pupil/drooping eyelid. 15-180 min |
| Management of tension-type headache: | Management of tension-type headache: General exercise Stress reduction. Treatment of any underlying MSK problem Complementary therapies; yoga, meditation and acupuncture. Analgesia Chronic use of medication carries high risk of medication overuse headache. Analgesia use, should therefore, preferably be limited to no more than two days per week. |
| Analgesia plan: | Analgesia plan: Analgesia no more than two days per week; high risk with opiates for med overuse headache. 3 week course of NSAID may break cycle of continuing pain and cover early management of predisposing and precipitating factors. If the above fails, prophylactic medication is amitriptyline; start low dose and increase slowly over 3 weeks until symptoms controlled. Nortriptyline is an alternative since fewer side effects. |
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