Headache

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of headache

Onset ‍gradualsuddenrapidly progressive, ‍thunderclap, started ‍whileafter ‍

Location is ‍diffuse

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍, ‍worst headache

Described as ‍dullthrobbing

Pattern ‍persistentintermittent, worse during the ‍day

Episodes last for ‍ ‍, recur ‍ times per ‍

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective

Overuse of analgesics (> 10-15 days/months):



Associated symptoms: *Try using right-click for negatives*

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍visual disturbance

‍scotoma

‍photophobia

‍phonophobia

‍neck pain

‍facial pain

‍runny nose, ‍clearcolored

‍nasal congestion

‍jaw claudication

‍dizziness

‍vertigo

‍fever, up to ‍°, over ‍ ‍hoursdays

‍altered mental status

‍loss of consciousness

‍seizures

‍weakness

‍numbness

‍tingling

‍difficulty speaking

‍difficulty swallowing

‍loss of balance



Contributing factors:

‍recent head trauma

‍stress

‍sleep disorders

‍caffeine withdrawal

‍IVDU

no history of: ‍immunodeficiency, ‍cerebral aneurysm, ‍migraine, ‍tension-type headache, ‍sinusitis, ‍traumatic brain injury, ‍malignancy, ‍anxiety, ‍depression

no use of: ‍anticoagulants, ‍new medication, ‍overuse of medication

no family history of: ‍cerebral aneurysm





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: ‍normocephalicatraumatic, scalp ‍normalrashlesion

Eyes: conjunctiva/sclera ‍normal, lids/lashes ‍normal, cornea ‍intact, ‍PERRL, extraocular movements ‍intact, OD 20/‍, OS 20/‍

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Cervical spine: ‍tenderness on ‍, range of motion ‍fulllimited

Neurologic:

- Mental status: ‍alert, oriented to ‍3 spheres, speech ‍intact

- Cranial nerves: ‍all intact

- Strength: ‍intact 5/5 throughout except for ‍4/5 on ‍rightleft ‍, ‍pronator drift

- Sensation: ‍intact throughoutdecreasedabsent to ‍light touch on ‍

- Reflexes: ‍intact 2+ throughout except for ‍1+ on ‍rightleft ‍, ‍plantar downward

- Cerebellar function: ‍intact, ‍normalimpaired finger-nose, ‍normalimpaired rapid alternating movements, ‍normalimpaired heel-shin, Romberg ‍negative, Dix-Hallpike ‍negative

- Gait: ‍steadyunsteady, ‍intactimpaired tandem gait, ‍intactimpaired heel walk and toe walk





ASSESSMENT:

‍Tension-type headache ‍likelysuspectedpossible

DDx: tension-type headache, migraine, cluster headache, chronic daily headache, medication overuse headache, viral infection, sinusitis, temporomandibular joint disorder, giant cell arteritis, subarachnoid hemorrhage, meningitis, encephalitis, brain tumor, intracranial hemorrhage, pseudotumor cerebri, glaucoma, carbon monoxide poisoning, hypertension, anemia, caffeine withdrawal, dehydration, sleep disorders





PLAN:

Investigations:

- CT scan of the brain

- MRI of the brain

- Blood work: ‍CBC, ‍TSH, ‍CRP, ‍ESR

Treatments:

- ‍Analgesics

- ‍Triptans

- ‍Prophylaxis medications

- Regular exercise

- Stress management techniques

- Sleep hygiene

- Avoidance of triggers (e.g. caffeine, alcohol, stress)

- Avoidance of overuse of analgesics

Further care:

- Referral to neurologist

- Referral to psychologist

- Follow-up in ‍ ‍weeksmonths

- Return if headaches worsen, if new symptoms develop such as vision changes or weakness, or if symptoms do not improve with treatment