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Acute headache

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. History Examination Investigations.

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Acute headache

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

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

  5. Headache pattern • Acute • Evolving • Intermittent • Chronic

  6. 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

  7. Headaches in A&E • 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 >4 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 • Male:female ratio 5:1 • 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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