This is a draft cheat sheet. It is a work in progress and is not finished yet.
Recurrent Headaches
Migraine |
Trigeminal autonomic Cephalgia |
Tension Type |
Daily/Constant Headaches
Chronic |
New |
Medication overuse |
SAH |
Hemicrania Contiua |
Meningitis |
Tumour |
Raised ICP |
| |
Low Pressure HA |
| |
Giant Cell Arteritis |
Difference between migraine + TIA
Migraine |
TIA |
Multiple previous episodes |
New Event |
Gradual onset |
Sudden Onset |
Short duration |
Lasts 24 hours |
Progression + regression pattern |
No increasing/decreasing symptoms |
Examination - MSK
Postural abnormalities: |
Flattened tx spine |
Forward Head |
Increased Lordosis |
Kyphosis/scoliosis |
Rotated Pelvis |
Upper Cervical Pain Sign |
Tenderness over C2/C3/Reproduction of HA = Cervicogenic |
Examination - Serious HA
Gait |
Stance |
Posture |
Temperature |
Blood Pressure |
General Obs |
CN Screening: |
Facial symmetry/drooping |
Ptosis |
Size & Shape of Pupils |
Active facial movements |
Pupillary light reaction & Accommodation |
Ocular position + EOM |
Fundoscopy |
TMJ Exam |
Otoscopy |
Cx Spine Screening |
Palpation of: Lymph nodes, scalp tenderness, temporal arteries and sinuses |
Upper & Lower Limb reflexes (Plantar Response) |
Upper and Lower Limb Strength Testing |
Nuchal Rigidity (Kernig's + Brudzinksis) |
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Red/Orange Flags
Orange Flags |
Red Flags |
Related HA |
Systemic Symptoms + Fever |
Neoplasm in history |
Neoplasms + metastasis |
| |
Neurological deficit |
Intracranial disorders |
| |
Onset - Sudden/Severe |
SAH/vascular |
| |
>50 years old |
Neoplasms,GCA, other vascular disorders |
| |
Pattern change/recent onset |
Neoplasms/vascular/nonvascular disorders |
| |
Positional HA |
Intracranial Hyper/hypotension |
| |
Precipitated by Valsalva movements |
Posterior fossa malformations |
| |
Papilloedema |
Intracranial hypertension |
| |
Progressive HA |
Neoplasms/nonvascular |
| |
Pregnancy |
Preeclampsia/cerebral sinus thrombosis/hypothyroidism, anaemia, diabetes |
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Painful eye + Autonomic features |
Posterior fossa pathology, pituitary/cavernous sinus |
| |
HA after trauma |
Subdural Haematoma + vascular HA |
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Pathology of immune system |
Opportunistic infections |
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Medication overuse |
Drug incompatibility, overuse HA |
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Systemic Symptoms |
- Infection/nonvascular intracranial disorders |
Further Investigations
FBC |
Infection + anaemia |
ESR/CRP |
Temporal artertis/infection/inflammatory, malignancy, multiple myeloma |
MRI |
CT |
Guidelines for CT & MRI
Unexplained/Abnormal Vital Signs |
Decreased Alertness/Cognition |
Onset of HA with exertion |
S&S of increased intracranial Pressure |
HA worsens under observation |
Nuchal Rigidity |
Focal Neuro Signs |
First Severe HA in patient >50y |
Sudden Onset of "worst HA ever" |
Referrals
Thunderclap |
REFER IMMEDIATELY TO HOSPITAL - 999 |
CNS infection |
REFER IMMEDIATELY TO HOSPITAL |
Raised ICP |
Refer Urgently for specialist assessment (A&E/urgent same day GP) |
Trigeminal autonomic Cephalgia |
Refer for specialist assessment - GP |
Giant Cell Arteritis |
Refer urgently for specialist assessment (urgent/same day GP) |
Intracranial Hypotension |
Refer for specialist assessment - GP |
Complicated Migraine |
Uncertain Diagnosis |
Headaches increasing in frequency |
Psychological factors |
Chronic, daily HA - needs multidisciplinary care |
Unresponsive to conservative care |
Referral Patterns
Type of Headache |
Site |
Radiation |
Migraine |
temporofrontal region - UNILATERAL |
Retro-orbital + occipital |
Cluster |
Over/above one eye |
Frontal + Temporal Regions |
Cervicogenic |
Occipital Region |
Parietal region - unilateral, vertex/skull, behind the eye |
Temporal arteritis |
Forehead & Temporal |
Down side of head |
Tension |
frontal, over forehead & temples |
occipital |
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