Acute headache

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Information about Acute headache
Health & Medicine

Published on February 6, 2009

Author: MedicineAndHealthNeurolog

Source: slideshare.net

Acute headache Problems that can not wait until the post take ward round www.bradfordvts.co.uk

Neurological emergencies Subarachnoid haemorrhage Raised intracranial pressure Cerebral infection

Subarachnoid haemorrhage

Raised intracranial pressure

Cerebral infection

Acute headache assessment History Examination Investigations The most important investigation in the evaluation of headache is the history

History

Examination

Investigations

The most important investigation in the evaluation of headache is the history

Headache history Onset Site Character Duration Frequency Diurnal pattern Associated symptoms Aggravating factors Relieving factors Treatment Ideas

Onset

Site

Character

Duration

Frequency

Diurnal pattern

Associated symptoms

Aggravating factors

Relieving factors

Treatment

Ideas

Headache pattern Acute Evolving Intermittent Chronic

Acute

Evolving

Intermittent

Chronic

Headaches in A&E Prospective study of all patients with a primary diagnosis of headache 93 cases in 3 months 39 (42%) had sudden onset headache 30 (32%) had a CT scan

Prospective study of all patients with a primary diagnosis of headache

93 cases in 3 months

39 (42%) had sudden onset headache

30 (32%) had a CT scan

Headaches in A&E 3 subarachnoid haemorrhages 1 intracerebral haemorrhage 3 meningitis 3 cerebral tumours

3 subarachnoid haemorrhages

1 intracerebral haemorrhage

3 meningitis

3 cerebral tumours

Other causes of acute headache Migraine Cluster headache Tension headache Temporal arteritis

Migraine

Cluster headache

Tension headache

Temporal arteritis

Migraine Migraine without aura: common migraine Migraine with aura: classical migraine Aura symptoms: visual (99%), sensory (31%), dysphasia (18%), motor (6%).

Migraine without aura: common migraine

Migraine with aura: classical migraine

Aura symptoms: visual (99%), sensory (31%), dysphasia (18%), motor (6%).

Migraine without aura Attacks lasting 4-72 hours At least two of following characteristics: unilateral, pulsating, moderate to severe, aggravated by movement At least one associated symptom: nausea or vomiting, photophobia, phonophobia

Attacks lasting 4-72 hours

At least two of following characteristics: unilateral, pulsating, moderate to severe, aggravated by movement

At least one associated symptom: nausea or vomiting, photophobia, phonophobia

Migraine with aura One or more transient focal aura symptoms Gradual development of aura symptom over >4 mins Aura symptoms last 4-60 mins Headache follows or accompanies the aura within 60 mins.

One or more transient focal aura symptoms

Gradual development of aura symptom over >4 mins

Aura symptoms last 4-60 mins

Headache follows or accompanies the aura within 60 mins.

Migraine variants Hemiplegic Basilar Ophthalmoplegic Transient migrainous accompaniments

Hemiplegic

Basilar

Ophthalmoplegic

Transient migrainous accompaniments

Cluster headache Severe unilateral pain Orbital, supraorbital, temporal Associated conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating Miosis, ptosis, eyelid oedema Frequency: 1 alt days to 8 per day

Severe unilateral pain

Orbital, supraorbital, temporal

Associated conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating

Miosis, ptosis, eyelid oedema

Frequency: 1 alt days to 8 per day

Cluster headache Male:female ratio 5:1 Cluster lasts 6-12 weeks Seasonal variation Circadian rhythmicity

Male:female ratio 5:1

Cluster lasts 6-12 weeks

Seasonal variation

Circadian rhythmicity

Tension headache Acute or chronic Bilateral Suboccipital, over top of head Tight or pressure pain Poor concentration, dizziness, difficulty focusing

Acute or chronic

Bilateral

Suboccipital, over top of head

Tight or pressure pain

Poor concentration, dizziness, difficulty focusing

Raised pressure headache Non-specific Bursting Waking Aggravated by bending, coughing, sneezing Associated with vomiting, visual blurring, features due to underlying lesion Papilloedema

Non-specific

Bursting

Waking

Aggravated by bending, coughing, sneezing

Associated with vomiting, visual blurring, features due to underlying lesion

Papilloedema

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