Headache

Question 1

ΔΔ headache with no signs on examination?

Answer 1

• tension
• migraine
• cluster
• post-traumatic
• drugs (nitrates)
• CO poisoning
• SAH

Question 2

red flags to ask?

Answer 2

• first and worst
• thunderclap
• unilateral, eye pain
• unilateral, ipsilateral Sx
• cough-initiated
• worse in morning/bending forward
• persistent + scalp tenderness, >50
• fever +/- neck stiffness
• change in usual headaches
• ↓ LOC

Question 3

what to Ex in headache?

Answer 3

• meningism - photophobia, neck stiffness, fever, rash, pain + resistance on passive knee extension w/ hip flexed (Kernig’s sign)
• focal neurology - sensory/motor/visual deficit, seizures
• ↓LOC
• papilloedema
• eye P. (glaucoma)
• temples (GCA)

Question 4

ΔΔ headache with ↓LOC or localising signs?

Answer 4

• clot (stroke)
• infection (enceph, mening, abscess)
• bleed (SAH, subdural haematoma)
• SOL (tumour, TB)
• venous sinus thrombosis

Question 5

ΔΔ headache with papilloedema?

Answer 5

• tumour
• venous sinus occlusion (focal Sx)
• malignant HT
• IIH
• CNS infection > 2weeks (TB)

Question 6

Hx: headache, tender scalp over temporal arteries and high ESR?

Answer 6

GCA

Question 7

Hx: headache, neck pain, and cerebellar/medullary signs?

Answer 7

vertebral artery dissection

Question 8

Hx: headache, recent URTI, phlegm?

Answer 8

sinusitis

Question 9

Hx: first and worst headache like a thunderclap?

Answer 9

SAH

Question 10

Hx: unilateral headache with ipsilateral Sx?

Answer 10

• migraine
• tumour
• vascular

Question 11

Hx: cough-initiated headache, which is worse in morning/bending forward?

Answer 11

raised ICP/venous thrombosis

Question 12

Hx: headache, fever +/- neck stiffness?

Answer 12

meningitis