Here, we’ll take a look at
headache, a big topic.
List of differentials.
We’ll be integrating many of the
that we’ve seen prior
when we get into the
topic of headache.
Pain sensitive structure of the head:
scalp blood supply,
head and neck muscles,
large cerebral arteries,
pain sensitive fibers in
cranial nerves V, IX, and X,
dura mater at the base of the brain.
Any one of these could
result in “headache.”
Brain parenchyma has no pain fibers, and
that’s important for you to understand.
the patient really is not so much
complaining about headache, is he or she?
Whereas, if it’s meningitis, there could
be headache because you are where?
Pain sensitive structures of
the head closer to the scalp,
blood supplies, and so forth.
Let’s spend a minute, make sure that
you have thoughts organized here
in terms of what’s pain sensitive and
not having pain receptors or fibers.
Primary headache syndromes:
migraine, cluster, tension,
spinal tap, or post coital.
We’ll take a look at these in
terms of differential diagnoses.
Was there a metastatic
or primary brain tumor?
Was it metastatic for melanoma?
Was it small cell lung cancer?
Was it breast cancer?
Was it kidney cancer?
And so forth.
Was it primary?
Glioblastoma multiforme resulting
in a secondary headache.
Abscesses, secondary headache.
What if there was a hemorrhage?
Any one of these types of hemorrhages
may result in a secondary headache.
closer to the scalp.
You have blood vessels, and all these are
pain sensitive causing secondary headache.
Think about that older lady
in which there is a
giant cell arteritis,
Who’s this patient?
A female in her reproductive age,
and all of a sudden,
there is a headache.
And upon fundoscopic examination, you
find papilledema but there’s no tumor,
absolutely no evidence of tumor.
Nowadays, it’s often
referred to as idiopathic.
Hypertension, hydrocephalus, glaucoma,
all differential diagnoses
for secondary headache.
H&P for headache:
the quality, severity, location,
duration and time course becomes
important as we shall see,
associated symptoms, and aggravating
and alleviating factors.
As you would with any type of questionnaire
when you are interviewing
a patient with headache.
General exam, general neurological exam,
fundoscopic exam becomes important,
palpation of superficial temporal artery if
you’re suspecting a giant cell arteritis,
palpation of cervical spine
and paraspinal muscles.
Always make sure you get a good history.
Your clinical approach.
Once again, it’s important that you pay
attention to quality, severity, location.
Next, time course is
acute, subacute, and chronic,
and we will divide it as such.
All I’m doing right now is quickly going
through how we shall approach headache
in this entire section.