Acute Headache Assessment and Neurological Emergencies Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What percentage of emergency department attendances are due to headache?

1-4%

8-10%

5-7%

3-5% (correct)

What is the commonest neurological symptom?

Dizziness

Tremor

Numbness

Headache (correct)

In the acute setting, what is the majority of headache cases due to?

Primary causes (correct)

Secondary causes

Tertiary causes

Unknown causes

What is the primary focus of management of headache in the acute setting?

Excluding serious secondary causes Signup and view all the answers

What is the first line prophylactic treatment for cluster headache?

Verapamil Signup and view all the answers

What distinguishes tension-type headache (TTH) from migraine?

TTH is featureless and not disabling acutely Signup and view all the answers

What is the prevalence of Medication Overuse Headache (MOH) among primary headache disorders?

1% Signup and view all the answers

What is the recommended initial management in the emergency department for acute migraine?

Combination therapy of a triptan and high-dose NSAID Signup and view all the answers

What is the duration of untreated cluster headache attacks?

30 minutes to, at most, 4 hours Signup and view all the answers

What is the recommended acute treatment for cluster headache?

Sumatriptan 6 mg subcutaneous injections Signup and view all the answers

What is the characteristic duration of untreated migraine attacks in adults?

More than 4 hours and sometimes days Signup and view all the answers

What is the recommended initial management in the emergency department for acute tension-type headache (TTH)?

Opiates Signup and view all the answers

What is the critical focus during headache assessment?

Onset and evolution of symptoms Signup and view all the answers

When should investigations be requested in headache cases?

Only when necessary, as imaging is not a substitute for a robust clinical assessment Signup and view all the answers

What necessitates a brain CT scan and lumbar puncture during headache assessment?

Thunderclap headache, reaching maximum intensity within 60 seconds Signup and view all the answers

What should be considered for individuals frequently using analgesia for a primary headache disorder?

Medication overuse headache Signup and view all the answers

What is a common presentation of bacterial meningitis?

Fever, neck stiffness, altered mental status, and headache Signup and view all the answers

What percentage of people under 50 years old presenting with an isolated headache will have a brain tumor?

Fewer than 1 in 1,000 Signup and view all the answers

What should be particularly assessed during neurological examination in headache cases?

Vital sign disturbance, meningism, altered consciousness, and focal neurological deficit Signup and view all the answers

What is crucial during headache assessment in terms of ocular examination?

Ophthalmoplegia, ptosis, and pupillary abnormalities Signup and view all the answers

What is a common feature of medication overuse headache?

Frequent use of analgesia for a primary headache disorder Signup and view all the answers

What should be inquired about during history-taking for headache assessment?

Headache frequency before the current episode, duration, triggers, and associated symptoms Signup and view all the answers

What should be considered for individuals with headache and altered mental status?

Bacterial meningitis Signup and view all the answers

What is a common condition in the acute setting that requires positive diagnosis and treatment?

Primary headaches, especially migraines Signup and view all the answers

What percentage of cases of acute bacterial meningitis present with the classic triad of neck stiffness, fever, and altered mental status?

44% Signup and view all the answers

What percentage of cases of meningitis may be missed by multi-slice helical CT imaging within 6 hours?

20% Signup and view all the answers

What is the gold standard for diagnosing the absence of aneurysm in subarachnoid hemorrhage (SAH) despite negative CT or magnetic resonance angiography?

Catheter angiography Signup and view all the answers

What are thunderclap headaches often attributed to, besides meningitis?

Migraine Signup and view all the answers

In which age group should giant cell arteritis (GCA) be considered in adults with new chronic headache?

Over 50 years Signup and view all the answers

What are the common symptoms of carbon monoxide toxicity?

Headache, dizziness, nausea, and confusion Signup and view all the answers

How may acute angle-closure glaucoma present?

Frontal headache with nausea and visual phenomena Signup and view all the answers

In what percentage of cases do headaches occur in adults with malignant brain tumors?

50% Signup and view all the answers

What are the indications for neuroimaging before lumbar puncture in suspected bacterial meningitis?

Neck pain and stiffness Signup and view all the answers

What is a common feature of most patients with chronic headache?

Seizures Signup and view all the answers

When is fundoscopy mandatory in chronic headache patients?

Particularly in obese, young women with raised intracranial pressure Signup and view all the answers

What is one of the characteristics of migraine?

Photophobia, phonophobia, and osmophobia Signup and view all the answers

Study Notes

Acute Headache Assessment and Diagnosis

A thorough clinical examination is crucial for excluding serious pathology in headache cases
Investigations should only be requested when necessary, as imaging is not a substitute for a robust clinical assessment
Patients often struggle to describe their headaches beyond intensity and location, requiring clinicians to draw out relevant features during history-taking
Onset and evolution of symptoms are critical focuses during headache assessment
Thunderclap headache, reaching maximum intensity within 60 seconds, necessitates a brain CT scan and lumbar puncture to rule out subarachnoid hemorrhage
Medication overuse headache should be considered for individuals frequently using analgesia for a primary headache disorder
Bacterial meningitis typically presents with fever, neck stiffness, altered mental status, and headache
Fewer than 1 in 1,000 people under 50 years old presenting with an isolated headache will have a brain tumor
Primary headaches, especially migraines, are common in the acute setting and require positive diagnosis and treatment
Neurological examination should particularly assess vital sign disturbance, meningism, altered consciousness, and focal neurological deficit
Useful questions during history-taking include inquiring about headache frequency before the current episode, duration, triggers, and associated symptoms
Ocular examination for ophthalmoplegia, ptosis, and pupillary abnormalities is crucial during headache assessment

Neurological Emergencies and Headaches: Key Points

Acute bacterial meningitis typically presents with a headache in 87% of cases, with the classic triad of neck stiffness, fever, and altered mental status occurring in only 44% of cases.
Multi-slice helical CT imaging within 6 hours may miss up to 20% of cases of meningitis, necessitating a lumbar puncture (LP) for spectrophotometric assessment of xanthochromia if the scan is negative.
Following diagnosis of meningitis, CT or magnetic resonance angiography is performed, and if no aneurysm is found despite subarachnoid hemorrhage (SAH), catheter angiography remains the gold standard.
Thunderclap headaches may be due to other vascular headaches, carotid artery dissection, vertebrobasilar dissection, or reversible cerebral vasoconstriction syndrome (RCVS), among others.
Giant cell arteritis (GCA) should be considered in adults >50 years with new chronic headache, especially if there is systemic malaise, and necessitates a full blood count, ESR, and CRP.
Carbon monoxide toxicity may cause non-specific headache, dizziness, nausea, and confusion, and requires a high index of suspicion for diagnosis.
Acute angle-closure glaucoma may present as frontal headache with nausea and visual phenomena, often misdiagnosed as migraine, and requires intraocular pressure measurement for diagnosis.
Headaches are common in adults with malignant brain tumors, occurring in >50% of cases, but are the sole presenting symptom in just 2% of cases.
Indications for neuroimaging before lumbar puncture in suspected bacterial meningitis include focal neurologic signs, presence of papilloedema, continuous or uncontrolled seizures, GCS < 15, age >40 years, thunderclap headache, headache onset during exertion, neck pain or stiffness, witnessed loss of consciousness, and limited neck flexion on examination.
Most patients with chronic headache also have seizures, focal neurologic deficits, or altered mental status, with headache characteristics varying but often manifesting raised pressure features.
Fundoscopy to exclude papilloedema is mandatory in all chronic headache patients, particularly in obese, young women with raised intracranial pressure and papilloedema with normal imaging, to consider idiopathic intracranial hypertension.
Migraine is one of the top 10 causes of disability worldwide, characterized by photophobia, phonophobia, osmophobia, motion intolerance, moderate to severe throbbing pain, and nausea and/or vomiting.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Assess your knowledge of acute headache assessment and neurological emergencies with this quiz. Test your understanding of key points related to diagnosing and differentiating between various headache presentations, including meningitis, thunderclap headaches, giant cell arteritis, and migraines.