Head and Neck Section (General diagnosis)

What is acromegaly?

Excessive production of growth hormone beginning in middle age; results in abnormal growth in the hands, feet, and facial bones

What is gigantism?

Excessive production of growth hormone prior to skeletal maturation

What is hyperthyroidism?

Most commonly caused by Grave’s disease (autoimmune); thyroid stimulating hormone (TSH) production is decreased and the thyroid hormones (T3/T4) are produced in excess

What is hypothyroidism?

Hashimoto’s thyroiditis it the most common cause in the United States; congenital hypothyroid is called cretinism and causes a diminished physical and mental capacity

What are some characteristics of hyperthyroidism?

• Weight loss with increase appetite

• Irritable and nervous

• Intolerance to heat

• Moist skin and fine hair

• Exophthalmos

• Possible neck swelling due to goiter

• Increased T3/T4, Decreased TSH

What are some characteristics of hypothyroidism?

• Weight gain with decreased appetite

• Depression, weakness, fatigue

• Intolerance to cold

• Coarse, dry hair and skin

• Periorbital edema

• Macroglossia and loss of lateral 1/3 eyebrow

• Decreased T3/T4, Increased TSH

What is the site of a common migraine?

Unilateral or bilateral

What is the site of a classic migraine?

Typically unilateral

What is the site of a hypertension headache?

Occipital, vertex

What is the site of a cluster headache?

Unilateral, orbital, temporal

What is the site of a muscular tension headache?

Band-like

What is the site of a temporal arteritis (giant cell) headache?

Unilateral, temporal (prox mm pain/stiff)

What is the site of a cervicogenic (vertebrogenic) headache?

Occipital, upper cervical

What is the site of a sinus headache?

Localized and changes with body position

What is the site of a subarachnoid hemorrhage headache?

Basilar area

What is the site of a brain tumor headache?

Any place and changes with body position

What is the site of a meningeal irritation headache?

Neck

What is the site of a hypoglycemic headache?

Generalized

What is the site of a post concussive headache?

Localized general pain

What age/sex is most likely to have a common migraine?

Childhood and early adulthood; females

What age/sex is most likely to have a classic migraine?

Childhood and early adulthood; females

What age/sex is most likely to have a hypertension headache?

Adult

What age/sex is most likely to have a cluster headache?

Adolescent to adults; males

What age/sex is most likely to have a muscular tension headache?

Any age

What age/sex is most likely to have a temporal arteritis (giant cell) headache?

Over 50 years of age

What age/sex is most likely to have a cervicogenic headache?

Adult

What age/sex is most likely to have a sinus headache?

Any age

What age/sex is most likely to have a subarachnoid headache?

Any age

What age/sex is most likely to have a subdural hematoma headache?

Any age

What age/sex is most likely to have a brain tumor headache?

Any age

What age/sex is most likely to have a meningeal irritation headache?

Any age

What age/sex is most likely to have a post concusive headache?

Any age

What are characteristics of a common migraine?

Photophobia, throbbing, worse behind one eye, nausea and/or vomiting, familial, decreasing with advancing age, pregnancy, “sick”, “vascular”

What are characteristics of a classic migraine?

Photophobia, throbbing, worse behind one eye, nausea and/or vomiting, familial, decreasing with advancing age, pregnancy, aura

What are characteristics of a hypertension headache?

Throbbing, wake up with headache

What are characteristics of a cluster headache?

Wake up at night with headaches, lasts 15-180 minutes, rhinorrhea, lacrimation, facial sweating, red eye, miosis, not aggravated by exertion

What are characteristics of a muscular tension headache?

Pressure, muscle tightness

What are characteristics of a temporal arteritis headache?

Persistent burning, aching, throbbing

What are characteristics of a cervicogenic headache?

Often daily, decreased ROM in upper cervical and occiput, pain in neck referred to head

What are characteristics of a sinus headache?

Steady throb, local tenderness, worse in the morning

What are characteristics of a subarachnoid hemorrhage headache?

Abrupt onset, constant, stiff neck, excruciating pain like never before experienced

What are characteristics of a subdural hematoma headache?

Slow bleed following a trauma, symptoms evident days-weeks post injury

What are characteristics of a brain tumor headache?

Onset early morning and evening, mild to severe, throbbing, progressively gets worse

What are characteristics of a meningeal irritation headache?

Intense, deep pain, never experienced before, stiff neck

What are characteristics of a post concussive headache?

Loss memory, visual disturbances

What is a common migraine provoked by?

Bright light, chocolate, cheese, tension, red wine, menstrual cycle

What is a classic migraine provoked by?

Bright light, chocolate, cheese, tension, red wine, menstrual cycle

What is a cluster headache provoked by?

Alcohol, usually occurs together in “clusters”, seasonal

What is a muscular tension headache provoked by?

Fatigue, tension, stress, work

What is a temporal arteritis headache provoked by?

Scalp sensitive, tender arteries

What is a cervicogenic headache provoked by?

Head movement

What is a sinus headache provoked by?

Chronic sinusitis

What is a subarachnoid hemorrhage headache provoked by?

Hypertension, stress

What is a subdural hematoma headache provoked by?

Trauma

What is a brain tumor headache provoked by?

Tumor growth

What is a meningeal irritation headache provoked by?

Worse in flexion

What is a hypoglycemic headache provoked by?

Skipping meals

What is a post concussive headache provoked by?

Fall, MVA, whiplash injury, trauma

How would you follow up on a patient who presents with a common migraine?

Dietary log, adjust, avoid provoking/triggering factors

How would you follow up on a patient who presents with a hypertension headache?

Blood pressure, lipid panel

How would you follow up on a patient who presents with a temporal arteritis headache?

ESR elevated, biopsy

How would you follow up on a patient who presents with a cervicogenic headache?

Flexion/extension xrays, adjust

How would you follow up on a patient who presents with a subarachnoid hemorrhage headache?

High blood pressure, fever

How would you follow up on a patient who presents with a subdural hematoma headache?

Send to ER

How would you follow up on a patient who presents with a brain tumor headache?

MRI or CT of brain; refer to neurosurgeon

How would you follow up on a patient who presents with a meningeal irritation headache?

Kerning/Brudzinski, CSF tap

How would you follow up on a patient who presents with a hypoglycemic headache?

FBS

How would you follow up on a patient who presents with a post concussive headache?

Refer to neurologist/ER