SECONDARY HEADACHES

POST TRAUMATIC HA

Severe, chronic, continuous or intermittent HA lasting several days or weeks seperable from HA immediately following head injury

POST CONCUSSION SYNDROME

• dizziness, fatigability, insomnia, nervousness, irritability and inability to concentrate

• persisent = > 3months

• requires supportive therapy

POST TRAUMATIC HEMORRHAGE

• Tenderness and aching pain sharply localized to scar of laceration or surgical incision

WHIPLASH INJURIES

• uni/bilateral retroaurical or occipiyal pain

• probably as a result of stretching or tearing of ligaments and muscles at the occipitonuchal junction or of a worsening of preexisting cervical arthropathy or involvement of cervical intervertebral discs and nerve roots

SUBARACHNOID HEMORRHAGE (SAH)

• thunderclap

• FND

• CT scan, MRI with MRA, CTA, LP, angiography

CERVICAL ARTERY DISSECTION (CAD)

• Tear in the intima of the vessel wall

• unilateral with ipsi neck pain

• Horner’s syndrome

• ptosis

• myosis

• anhidrosis

Horner’s syndrome

• intramural hematoma

• microemboli and stroke

CAD can cause what

VERTEBRAL ARTERY DISSECTION

• posterolateral

• accompanied by meningismus

GIANT CELL ARTERITIS/ INTENSE GRANULOMATOUS

• New onset - >50 yrs old- 65 yrs old

• UNI(bil) increasing intense non/ throbbing with sharp stabbing pains

• Temporal artery tenderness, decreased temporal artery pulsation

• Jaw claudication, unanticipated weight loss, fatigue, myalgia

• SUPERFICIAL TEMPORAL and other scalp arteries are thickened, tender

• opthalmic or posterior ciliary

in Giant cell arteritis there is threat of blindness from thrombosis of ________ or ________ arteries

high dose of corticosteroids

TX for giant cell arteritis

• elevated ESR and CRP

• temporal artery biopsy

• arteriography of ECA

• UTZ of temporal arteries

Diagnostics test of Giant cell arteritis (ETAU)

dark halo with irregularly thickened walls

UTZ of Giant cell arteritis

CEREBRAL VENOUS SINUS THROMBOSIS (CVST)

• 90% with HA

• SAFNDs

REVERSIBLE CEREBRAL VASOCONSTRICTION SYNDROME

• thunderclap resembling SAH

• (-) blood in CSF

• diffuse cerebral arterial vasospams

• benign course

• New onsent headaches

• caused or relieved by intracranial hypertension exceeding 250 mm

• papilledema

HEADACHE ATTRIBUTED TO INCREASE CSF PRESSURE

POST DURAL PUNCTURE HEADACHE

• low csf

• HA 5 days after dural puncture

• improvement of HA after CSF removal

SPONTANEOUS INTRACRANIAL HYPOTENSION

• low csf

• orthostatic HA, upright, valsalva, tredelenburg

• stick neck and nausea

• resolves upon lying supine

• pituitary hyperemia and sagging of the brain with cerebellar tonsil displacements

plain cranial mri of SIH

IDIOPATHIC INTRACRANIAL HYPERTENSION

• increased csf pressure

• pseudomotor cerebri

• Elevated ICP associated with normal brain imaging and CSF findings

• Worsening with Valsalva maneuver, awakening from sleep, intractable N&V

• Transient visual obscuration, photopsia, and pulsatile tinnitus

6th nerve palsy

in Idiopathic intracranial hypertension, there is Papilledema or cessation of venous pulsations, diplopia from _____

• obese

• women of childbearing age

idiopathic intracranial hypertension can occur to

• OCPs

• excessive vit A

• lithium

increased risk in Idiopathic intracranial hypertension

• HA developed to development of neopalsm

• HA worsened parallel with neoplasm

• HA improved parallel with neoplasm

• progressive, w: morning, supine, nausea/ vomiting

HEADACHE ATTRIBUTED TO INTRACRANIAL NEOPLASM

Brain tumor

• No specific features but tends to be deep seated, usually nontrhobbing (occasionally throbbing) and described as aching or bursting

• Sudden change in pattern of preexisting headache disorder

• Worsening of headache with valsalva and exertion nocturnal awakening

• FNDS

posterior fossa tumor

in brain tumor there is Unexpected forceful, projectile vomiting in later stages particularly in children or as early feature of ____

• Carbon monoxide

• Delayed alcohol induced

• Medication overuse (ETNOC)

HEADACHE ATTRIBUTED TO SUBSTANCE AND ITS WITHDRAWAL

• ergotamine

• triptan

• non opiod

• opiod

• combination analgesics

ETNOC

• bacterial meningitis/ meningocephalitis

• viral meningitis/ encephalitis

HEADACHE ATTRIBUTED TO INFECTION

MENINGITIS

• Triad: fever, stiff neck, Kernig and Brudzinski sign

• Cranial imaging (CT/MRI) followed by lumbar puncture

• hypoxia/hypercapnia

• high alt HA

Headache attributed to disorder of homeostasis

cervicogenic HA

Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure

CERVICOGENIC HA

Apophyseal (facet) arthropathy, C2 dorsal root entrapment, calcified ligamentum flavum, hypertrophied posterior longitudinal ligament and RA of the atlantoaxial region

ACUTE RHINOSINUSITIS

• Headache has significantly worsened/improved in parallel with worsening/improvement

• (+) forward bending test

SUBDURAL HEMATOMA

• Reported in 80% of cases

• More insidious onset than SAH

• Elderly

• tx: surgery