Which patient is most likely to have a secondary headache?
1. 16 year old diabetic
2. 24 year old female
3. 35 year old hypertensive male
4. 48 year old female - ANS ✓4.
The patient > age 40. ("Neurology considers age > 40 elderly" -Amelie)
What are the two most common presenting symptoms of brain tumor in
adults?
•Headache Red flags in History: - ANS ✓o Sudden onset in seconds or mins:
SAH
o "First or worst" HA: Haemorrhage, infection
o Focal neuro symptoms: Mass, AVM
o Fever: Infection
o Change in personality, mental status, LOC
NEUROLOGY - FNP
, 2
NEUROLOGY
Headache Exam - ANS ✓Majority have normal physical and neuro exam
(includes funduscopic exam)
• Don't Forget to Check:
o BP, pulse
o Palpate head, neck, shoulders, spine
o Bruits (AVM)
• Red Flags on Exam - ANS ✓o Age (> 40 or 50 years old)
o Neck stiffness
o Neuro deficits
o Papilledema
Papilledema - ANS ✓• Swelling of the optic disc due to increased ICP
• Almost always bilaterally
When to Image a Patient with Headache: - ANS ✓• "Red Flag" headache
• Change in pattern, frequency or severity of HA
• Worsening of HA despite therapy
• Neuro symptoms (abnormal exam)
• Onset of HA with exertion, cough, intercourse
• New onset > 40 years
CT vs MRI Contrast? - ANS ✓Contrast?
CT: Radiation, Looks at cavities, Looks at "hard" things (bone), Limited to
2/year, quick
MRI: No Radiation, Looks at "soft" tissue, Excellent discrimination of soft
tissue
NEUROLOGY - FNP
, 3
NEUROLOGY
Etiology of Headaches - 90% of headaches that come to your office: - ANS ✓•
Migraines (up to 45%)
• Tension (most prevalent, but doesn't come to your office frequently)
• Cluster Headache (<1% but disabling)
Specific Headache Clues - ANS ✓
Unilateral 60-70%; bifrontal or global 30%
Crescendo
Patient desires a cool, quiet, dark room
4-72 hours
N, V, photophobia, ? aura - ANS ✓Migraine
Bilateral
Pressure, tightness bandlike, waxes and wanes
May continue day's activities or not
Varies
None - ANS ✓Tension
Always unilateral; begins around temple or eye
Pain peaks within minutes; excruciating, explosive
Varies
30-90 minutes usually (up to 180 minutes)
Eye becomes red, tears, rhinorrhoea, EtOH can trigger - ANS ✓Cluster
Headache
Jaw claudication (with chewing), fever, visual loss, pain in temple area -
ANS ✓Temporal arteritis (Giant Cell arteritis, GCA)
NEUROLOGY - FNP
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