HISTORY TAKING-HEADACHE.ppt

HEADACHE-HISTORY TAKING

1. HEADACHE OF THE HISTORY

2. തലവേദന ഒരുചെറിയ
കളിയല്ല!!!

3. •How to take a medical history from
a patient that presented mainly
with headache?

4. •A headacheorcephalagiais painanywherein
theregionofheadorneck
•Can be asymptomof anumberofdifferent
conditionsofheadand neck

5. •Headacheinitselfisnota diseasebut
merelya symptomofadisease.
•A symptomwhich mayaccompany
manydifferent typesofconditions.May
besight threateningorlifethreatening

7. OcularcausesofHeadache
Threecategories
•a)headacheduetorefractoryerror and eye
muscleweakness
•b)headacheduetosecondary diseasesof eye
•c)thoseduetosystemicdisordershaving
prominentocularsymptom

8. A)Refractoryerrorandmuscle
weakness
•Mainlyinafternoonoreveningat theendof
work
•Hypermetropiaandastigmatism
•Lowgrade refractoryerrorismaincause
•Ocular muscleimbalanceaslatent
squint,convergenceinsufficiency&
accommodativeinsufficiencyalsocauses
headache

9. B)Secondarytoeyediseases
•Acuteangleclosureglaucoma
•Acuteiritis
•Keratitis
•Ocularischemicsyndrome

10. C) Systemicdisorderswithvisual
symptoms
•Raisedintra cranialpressure
•Migraine
•Temporalarteritis
•Psychogenic

11. Analysis of headache (History Taking)
•Site
•Onset?
•Characteristics?
•Radiation?
•Associated symptoms
•Timing?
•Exacerbating & relievingfactors?
•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 2
nd
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
angleglaucoma)

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
•Ipsilateralrhinorrheaand lacrimationcluster

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
withheadache)

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
longhave 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
•DetailedOCULARand SYSTEMICexamination
•A) VisualAcuity–decreasevisionwith
Headache
i) refractoryerrors
ii)acuteangleclosureglaucoma
iii)anterior uveitis
iv) ocularischemicsyndrome

30. •Transientlossofvision(AmaurosisFugax)
i)migraine
ii)severe hypertension
iii)papilledema
B)Ocularmotility
restrictedinOphthalmoplegicmigraine
C) Covertest/uncovertest–toruleoutPHORIA
andTROPIA

31. •Conjunctiva–congestion( toR/O glaucoma,
uveitis
•Cornea-edema
•Anteriorchamber-depth,cellsand flares
Pupil-RAPD( compressiveneuropathy)
dilated( cerebral aneurysm
•Intraocularpressure

32. •Fundusexamination-lookforthesigns of
i)Papilledema
ii)Glaucoma
iii)ocularischemicsyndrome

33. •Refraction–both withandwithout cycloplegic
•Orthoptic-forevaluationof
convergence,accommodativeandfusional
insufficiencyandphorias
•Visualfield
•Gonioscopy
•Detailedneurological,ENT,dental,and
psychiatricevaluationwillbe neededaccording
toassociatedsymptoms

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
•Shouldbedoneaccording to suspectedcause
and associatedsymptoms
•i) x rayPNS-toR/Osinusitis
•ii)ESR/temporalarterybiopsy
•iii)CTor MRI-to R/Ointra cranialpathology
•iv)Carotidflowstudy -ocularischemia
•v) Lumbarpuncture-meningitis

38. ഇനിചെറിയ കളികൾ ഇല്ല.
േലിയ കളികൾ മാത്തം

39. ശുഭം

40. Thank You….