Headache (primary and secondary headaches)
This is a brief video on strokes, covering pathophysiology, presentation, as well as acute and chronic management/treatments.
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ADDITIONAL TAGS:
Primary headaches
Secondary headaches (and do-not-miss red flag symptoms)
Tension
Migraine
Cluster
Analgesic rebound
Idiopathic intracranial hypertension
Trigeminal neuralgia
Shingles / postherpetic neuralgia
Giant cell arteritis
Subarachnoid hemorrhage
Tumor
Meningitis / abscess
Presentation
Bandlike', 'vice-like'; moderate pain; pressing, tightening, bilateral; 30 min to 7 days long
Sometimes: aura (transient sensory change: visual, positional, auditory, olfactory, delusions), photophobia, phonophobia, trigger. Pulsatile, disabling, unilateral, 4-72 hrs; moderate to severe pain; worse w physical activity; better w sleep; n/v
Episodic (cluster in time, with months btwn clusters); up to 5 hrs several times daily during a cluster; severe pain; rhinorrhea, lacrimation, ptosis, conjunctival injection, eyelid edema; pain is unilateral and be supraorbital, periorbital, or temporal in location
Withdrawal from any analgesic: NSAIDs, acetamin- ophen, ergots, opiates, triptans
Women, reproductive age, obese. Maybe taking OCPs
Severe face pain (knife-like, stabbing, ‘lancinating’) down the face (to ear or jaw), often precipitated by chewing, touching the face
Dermatomal rash and pain on the face; unilateral, sometimes line or patch, always in a dermatome
Fever, weight loss, face pain: swollen tender temporal artery
Thunderclap pain, 0 to max intensity immediately; 'worst headache of life', recent trauma; 0 to max intensity immediately, elevated blood pressure
Progressive HA worsening over weeks/months; cognitive impairment; maybe weight loss, night sweats, other systemic symptoms;
age 50;
pain awakening from sleep
Fever, headache, neck stiffness, focal neuro deficits; mental status change; meningeal irritation (Kernig's sign or Brudzinski's sign)
Diagnosis
Clinical
Clinical
Neuroimaging to rule out other etiologies
Clinical, history
CT or MRI;
LP with ↑ pressure;
CSF itself is nl
MRI to r/o spinal cord compression
Clinical
High ESR, biopsy
CT without contrast; LP for xanthochromia
Neuroimaging
LP or CT
Treatment
NSAIDS, acetamin- ophen
NSAIDS → triptans, ergotamine
O2 → triptans
Time (withdraw analgesic)
Acetazolamide Also steroids, serial LPs, shunt
Carbama- zepine
Acyclovir
Steroids ASAP (or risk blindness)
Neurosurg to coil or clip bleed; reduce BP; stop hydrocephalus with shunt or LPs or craniotomy
chemo, radiation
Antibiotics (ceftriaxone)
Prophylaxis
-
Propranolol, anticonvulsants (valproate, topiramate), amitriptyline
nCCB (verapamil, diltiazem)
Analgesics no more than 10 days / month
Weight loss
-
Zoster vaccine
-
Seizure prophylaxis with anticonvulsants; prevent vasospasm with CCB
-
Vax?
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