Here, we’ll take a look at headache, a big topic.
List of differentials.
We’ll be integrating many of the
neuropathologic issues 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.
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,
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?
Intracerebral, subdural, epidural, subarachnoid.
Any one of these types of hemorrhages may result in a secondary headache.
Remember, once again, meningitis,
pain sensitive, 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 extremely useful:
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.