HISTORY TAKING-HEADACHE.ppt
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HEADACHE-HISTORY TAKING
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HISTORY TAKING-HEADACHE.ppt
- 1. HEADACHE OF THE HISTORY
- 3. • How to take a medical history from a patient that presented mainly with headache?
- 4. • A headache or cephalagia is pain anywhere in the region of head or neck • Can be a symptom of a number of different conditions of head and neck
- 5. • Headache in itself is not a disease but merely a symptom of a disease. • A symptom which may accompany many different types of conditions. May be sight threatening or life threatening
- 7. Ocular causes of Headache Three categories • a) headache due to refractory error and eye muscle weakness • b) headache due to secondary diseases of eye • c) those due to systemic disorders having prominent ocular symptom
- 8. A) Refractory error and muscle weakness • Mainly in afternoon or evening at the end of work • Hypermetropia and astigmatism • Low grade refractory error is main cause • Ocular muscle imbalance as latent squint ,convergence insufficiency & accommodative insufficiency also causes headache
- 9. B) Secondary to eye diseases • Acute angle closure glaucoma • Acute iritis • Keratitis • Ocular ischemic syndrome
- 10. C) Systemic disorders with visual symptoms • Raised intra cranial pressure • Migraine • Temporal arteritis • Psychogenic
- 11. Analysis of headache (History Taking) • Site • Onset? • Characteristics? • Radiation? • Associated symptoms • Timing? • Exacerbating & relieving factors? • Severity? SOCRATES
- 12. 1. Site • Unilateral ? – Migraine – Cluster • Bilateral? – Tension headache • Ocular? – Cluster – Migraine – Cluster
- 13. 1. Site • Paranasal? – Sinusitis • Mass – Localized then become diffuse (bifrontal, bioccipital) due to elevated ICP • Occipit? – Meningeal – Hemorrhagic – Joints
- 14. 1. Site • Post herpetic neuralgia along the 1st division of Trigeminal V nerve. • Trigeminal neuralgia along the 2nd and 3rd divisions of Trigeminal V nerve. • Unilateral (e.g. migraine) / frontal Bilateral (e.g. tension headache)
- 15. 2. Onset • Acute? – Meningeal – Hemorrhagic • • Subacute? – Intracranial mass • • Chronic? – Migraine
- 16. 3. Characteristics • Pulsatile = tension headache or migraine • Tightness = tension headache • Dull + steady = mass • Sharp = neuritic, neuralgia
- 17. 4. Radiation • Tension headache may arise in the occipital region and radiate to all head • Neck (meningitis) / face (e.g. trigeminal neuralgia) / eye (e.g. acute closed angle glaucoma)
- 18. 5. Associated symptoms In headache analysis, • asking about the ASSOCIATED SYMPTOMS is very very important in order to reach a DIAGNOSIS
- 19. 5. Associated symptoms • Weight loss Mass • Fever + chills systemic infections OR meningitis • Vision Ocular, Migraine, Optic nerve and visual pathway lesions.
- 20. 5. Associated symptoms • Nausea + vomiting Migraine OR Mass • Diarrhea Migraine • Photophobia Migraine, Meningitis • Myalgia + tension Viral infection • Ipsilateral rhinorrhea and lacrimation cluster
- 21. 6. Timing • Maximal on awaking sinus, mass • Awake the patient, 30-90 minutes on same time each day exacerbated by alcohol cluster • End of work (weekend, month end, day end) tension • Episodic, lasting 4-72 hours migraine
- 22. 7. Exacerbating and relieving factors • Foods • Position • Sleep • Cough Mass • Sneezing Mass
- 23. 8. Severity • Measured by interfering with Eating Talking Sleeping • A better approach to measure severity is to ask the patient to give the pain point out of 1 to 10 (scale method)
- 24. Past medical history • Previous episodes of headache/migraine? • Previous intracranial bleeds? (e.g. subarachnoid haemorrhage) • Head trauma in last three months? • History of malignancy? • Other medical conditions? • Previous surgery? – e.g. CSF shunting (blocked/infected shunts present with headache)
- 25. Drug history • Regular prescribed medication? • Anticoagulants or antiplatelets? – e.g. Warfarin / Aspirin
- 26. Family history • Neurological diagnoses in first degree relatives? – e.g. migraine
- 27. Social history • Smoking – How many cigarettes a day? How long have they smoked for? • Alcohol – How many units a week? – be specific about type / volume / strength of alcohol • Recreational drug use – headache may be withdrawal related
- 28. Systemic enquiry • Cardiovascular • Respiratory • GI • Urinary • Musculoskeletal • Dermatology
- 29. Examination • Detailed OCULAR and SYSTEMIC examination • A) Visual Acuity –decrease vision with Headache i) refractory errors ii) acute angle closure glaucoma iii) anterior uveitis iv) ocular ischemic syndrome
- 30. • Transient loss of vision (Amaurosis Fugax) i) migraine ii) severe hypertension iii) papilledema B) Ocular motility restricted in Ophthalmoplegic migraine C) Cover test/uncover test – to rule out PHORIA and TROPIA
- 31. • Conjunctiva –congestion( to R/O glaucoma, uveitis • Cornea - edema • Anterior chamber- depth, cells and flares Pupil - RAPD ( compressive neuropathy) dilated ( cerebral aneurysm • Intraocular pressure
- 32. • Fundus examination - look for the signs of i) Papilledema ii) Glaucoma iii) ocular ischemic syndrome
- 33. • Refraction – both with and without cycloplegic • Orthoptic - for evaluation of convergence,accommodative and fusional insufficiency and phorias • Visual field • Gonioscopy • Detailed neurological, ENT, dental, and psychiatric evaluation will be needed according to associated symptoms
- 34. Opening the consultation • Introduce yourself – name/role • Confirm patient details – name/DOB • Explain the need to take a history • Gain consent • Ensure the patient is comfortable
- 35. Presenting complaint • open questioning • “So what’s brought you in today?” or “Tell me about your headache” • Allow the patient time to answer • “Ok, so tell me more about that” “Can you explain what that pain was like?”
- 36. History of presenting complaint • SOCRATES
- 37. Investigations • Should be done according to suspected cause and associated symptoms • i) x ray PNS - to R/O sinusitis • ii) ESR /temporal artery biopsy • iii) CT or MRI - to R/O intra cranial pathology • iv) Carotid flow study - ocular ischemia • v) Lumbar puncture - meningitis
- 38. ഇനി ചെറിയ കളികൾ ഇല്ല. േലിയ കളികൾ മാത്തം
- 39. ശുഭം
- 40. Thank You….