Good morning fellow medics,
I hope you are all well and looking after yourselves.
So not long way till the part 2 for CSA in May and part 1 later this year. You got this, just keep working hard.
Today, I am going to give a brief overview of headaches. As I always state - the whole point of this blog is not to teach you new information or make you read long and boring notes…you already have the notes. This is purely a recap of important aspects to remember. It is meant to be a relaxed read.
So read ahead for a fun packed headache summary…
Primary vs secondary
Headaches can be primary or secondary. This is important as secondary tend to be more worrying (i.e. a space occupying lesion). Use questions aimed at ‘red flags’ to help you think of the worrying differentials and also come to the most likely diagnosis.
Take a good history
This sounds obvious, but headaches (and other certain neurological conditions) diagnosis rely heavily on a good history as there may not be much to see on examination i.e. migraines or tension headache. So, get those SOCRATES or SQITARPS questions together and ask away.
Red flags
Rule out those red flags in headaches, ask the important questions- does it wake you up? is it getting worse? Is it worse when you cough/lean forward? Any red flag should get you thinking about a sinister cause of a headache.
Common headaches
There are a few common headaches which are: migraines, tension headache and sinusitis. There are a few uncommon but very important ones: SAH, SOL, GCA. This list is not exhaustive, but have a general understanding of each of them to be able to differentiate between them confidently.
Typical presentations
I use the word ‘typical’ with a pinch of salt as nothing in medicine is typical, but for the sake of the exam and a ‘typical patient’ here we go:
Migraine - one sided, throbbing, photophobia, lasts for a day, have to be in a dark room, +/- aura
Tension headache- ‘tight band around head’, worse in stressful situations, doesn’t stop ADLs
GCA- Temporal headache, scalp tenderness, jaw claudication, older patient
SOL- progressive headache, associated with N+V, worse in morning/leaning forward
Cluster - one sided, includes the eye, comes in clusters
Sinusitis - facial tenderness, associated with URTI symptoms, feel unwell
Meningitis (no typical) - fever, any age, may be associated with rash, acute onset, unwell, neck stiffness
Hoping as always you found this blog useful and it gave you something to inspire you to revise!
Keep working hard and think of the end goal.
Please contact me if you need any clinical skills help/revision. I provide communication and consultation skills training as well as covering the basics. Even if you want to spend an hour running through gastrointestinal conditions without any OSCE’s, we can do that. Email me below to enquire as to how I can best help you pass the exam!
Happy revising x