Acute headache

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Acute headache

  1. 1. Acute headache Problems that can not wait until the post take ward round www.bradfordvts.co.uk
  2. 2. Neurological emergencies <ul><li>Subarachnoid haemorrhage </li></ul><ul><li>Raised intracranial pressure </li></ul><ul><li>Cerebral infection </li></ul>
  3. 3. Acute headache assessment <ul><li>History </li></ul><ul><li>Examination </li></ul><ul><li>Investigations </li></ul><ul><li>The most important investigation in the evaluation of headache is the history </li></ul>
  4. 4. Headache history <ul><li>Onset </li></ul><ul><li>Site </li></ul><ul><li>Character </li></ul><ul><li>Duration </li></ul><ul><li>Frequency </li></ul><ul><li>Diurnal pattern </li></ul><ul><li>Associated symptoms </li></ul><ul><li>Aggravating factors </li></ul><ul><li>Relieving factors </li></ul><ul><li>Treatment </li></ul><ul><li>Ideas </li></ul>
  5. 5. Headache pattern <ul><li>Acute </li></ul><ul><li>Evolving </li></ul><ul><li>Intermittent </li></ul><ul><li>Chronic </li></ul>
  6. 6. Headaches in A&E <ul><li>Prospective study of all patients with a primary diagnosis of headache </li></ul><ul><li>93 cases in 3 months </li></ul><ul><li>39 (42%) had sudden onset headache </li></ul><ul><li>30 (32%) had a CT scan </li></ul>
  7. 7. Headaches in A&E <ul><li>3 subarachnoid haemorrhages </li></ul><ul><li>1 intracerebral haemorrhage </li></ul><ul><li>3 meningitis </li></ul><ul><li>3 cerebral tumours </li></ul>
  8. 8. Other causes of acute headache <ul><li>Migraine </li></ul><ul><li>Cluster headache </li></ul><ul><li>Tension headache </li></ul><ul><li>Temporal arteritis </li></ul>
  9. 9. Migraine <ul><li>Migraine without aura: common migraine </li></ul><ul><li>Migraine with aura: classical migraine </li></ul><ul><li>Aura symptoms: visual (99%), sensory (31%), dysphasia (18%), motor (6%). </li></ul>
  10. 10. Migraine without aura <ul><li>Attacks lasting 4-72 hours </li></ul><ul><li>At least two of following characteristics: unilateral, pulsating, moderate to severe, aggravated by movement </li></ul><ul><li>At least one associated symptom: nausea or vomiting, photophobia, phonophobia </li></ul>
  11. 11. Migraine with aura <ul><li>One or more transient focal aura symptoms </li></ul><ul><li>Gradual development of aura symptom over >4 mins </li></ul><ul><li>Aura symptoms last 4-60 mins </li></ul><ul><li>Headache follows or accompanies the aura within 60 mins. </li></ul>
  12. 12. Migraine variants <ul><li>Hemiplegic </li></ul><ul><li>Basilar </li></ul><ul><li>Ophthalmoplegic </li></ul><ul><li>Transient migrainous accompaniments </li></ul>
  13. 13. Cluster headache <ul><li>Severe unilateral pain </li></ul><ul><li>Orbital, supraorbital, temporal </li></ul><ul><li>Associated conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating </li></ul><ul><li>Miosis, ptosis, eyelid oedema </li></ul><ul><li>Frequency: 1 alt days to 8 per day </li></ul>
  14. 14. Cluster headache <ul><li>Male:female ratio 5:1 </li></ul><ul><li>Cluster lasts 6-12 weeks </li></ul><ul><li>Seasonal variation </li></ul><ul><li>Circadian rhythmicity </li></ul>
  15. 15. Tension headache <ul><li>Acute or chronic </li></ul><ul><li>Bilateral </li></ul><ul><li>Suboccipital, over top of head </li></ul><ul><li>Tight or pressure pain </li></ul><ul><li>Poor concentration, dizziness, difficulty focusing </li></ul>
  16. 16. Raised pressure headache <ul><li>Non-specific </li></ul><ul><li>Bursting </li></ul><ul><li>Waking </li></ul><ul><li>Aggravated by bending, coughing, sneezing </li></ul><ul><li>Associated with vomiting, visual blurring, features due to underlying lesion </li></ul><ul><li>Papilloedema </li></ul>

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