Acute headache - PowerPoint PPT Presentation

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Acute headache

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Migraine without aura. Attacks ... Migraine with aura. One or more transient ... Migraine variants. Hemiplegic. Basilar. Ophthalmoplegic. Transient ... – PowerPoint PPT presentation

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Title: Acute headache


1
Acute headache
  • Problems that can not wait until the post take
    ward round
  • www.bradfordvts.co.uk

2
Neurological emergencies
  • Subarachnoid haemorrhage
  • Raised intracranial pressure
  • Cerebral infection

3
Acute headache assessment
  • History
  • Examination
  • Investigations
  • The most important investigation in the
    evaluation of headache is the history

4
Headache history
  • Onset
  • Site
  • Character
  • Duration
  • Frequency
  • Diurnal pattern
  • Associated symptoms
  • Aggravating factors
  • Relieving factors
  • Treatment
  • Ideas

5
Headache pattern
  • Acute
  • Evolving
  • Intermittent
  • Chronic

6
Headaches in AE
  • 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

7
Headaches in AE
  • 3 subarachnoid haemorrhages
  • 1 intracerebral haemorrhage
  • 3 meningitis
  • 3 cerebral tumours

8
Other causes of acute headache
  • Migraine
  • Cluster headache
  • Tension headache
  • Temporal arteritis

9
Migraine
  • Migraine without aura common migraine
  • Migraine with aura classical migraine
  • Aura symptoms visual (99), sensory (31),
    dysphasia (18), motor (6).

10
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

11
Migraine with aura
  • One or more transient focal aura symptoms
  • Gradual development of aura symptom over gt4 mins
  • Aura symptoms last 4-60 mins
  • Headache follows or accompanies the aura within
    60 mins.

12
Migraine variants
  • Hemiplegic
  • Basilar
  • Ophthalmoplegic
  • Transient migrainous accompaniments

13
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

14
Cluster headache
  • Malefemale ratio 51
  • Cluster lasts 6-12 weeks
  • Seasonal variation
  • Circadian rhythmicity

15
Tension headache
  • Acute or chronic
  • Bilateral
  • Suboccipital, over top of head
  • Tight or pressure pain
  • Poor concentration, dizziness, difficulty
    focusing

16
Raised pressure headache
  • Non-specific
  • Bursting
  • Waking
  • Aggravated by bending, coughing, sneezing
  • Associated with vomiting, visual blurring,
    features due to underlying lesion
  • Papilloedema
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