Headaches ContinuedHeadaches Continued

ExaminationExamination

3 minute neurological test3 minute neurological test

Examination- 3 minute neurologicalExamination- 3 minute neurological

This was designed by neurologists to ensure This was designed by neurologists to ensure that sinister causes of headaches were not that sinister causes of headaches were not missedmissed

This is suitable for those patients whose This is suitable for those patients whose history suggsts migraine or tension-type history suggsts migraine or tension-type headacheheadache

ExaminationExamination NotesNotes

Romberg’s testRomberg’s test Patient falling with eyes closedPatient falling with eyes closed

Tandem gait testTandem gait test Heel-to-toe walkingHeel-to-toe walking

Walking on heelsWalking on heels Tests pyramidal tractTests pyramidal tract

Drift of outstretched armsDrift of outstretched arms Tests pyramidal tractTests pyramidal tract

Finger-nose testFinger-nose test Tests coordinationTests coordination

Fine finger movementsFine finger movements Tests pyramidal and extrapyramidal Tests pyramidal and extrapyramidal tractstracts

Hand TappingHand Tapping Cerebellar and brainstem diseaseCerebellar and brainstem disease

Visual Fields to confrontationVisual Fields to confrontation

Eye movementsEye movements

Face and tongue movementsFace and tongue movements

FundoscopyFundoscopy

ReflexesReflexes

How do we rate headaches?How do we rate headaches?

MIDAS ScoreMIDAS Score

Midas ScoreMidas Score

MIDAS QUESTIONNAIREMIDAS QUESTIONNAIRE INSTRUCTIONS: Please answer the following questions about ALL your headaches you have had over the last three months.  Write your INSTRUCTIONS: Please answer the following questions about ALL your headaches you have had over the last three months.  Write your

answer in the box next to each question.  Write zero if you did not do the activity in the last 3 months. Please 'tab' through all five boxes to answer in the box next to each question.  Write zero if you did not do the activity in the last 3 months. Please 'tab' through all five boxes to calculate your MIDAS score.calculate your MIDAS score.

11 On how many days in the last 3 months did you miss work or school because of your headaches?On how many days in the last 3 months did you miss work or school because of your headaches? 22 How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches? How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches? (Do (Do

not include days you counted in question 1 where you missed work or school)not include days you counted in question 1 where you missed work or school) 33 On how many days in the last 3 months did you not do household work because of your headaches?On how many days in the last 3 months did you not do household work because of your headaches? 44 How many days in the last 3 months was your productivity in household work reduced by half or more because of your headaches? How many days in the last 3 months was your productivity in household work reduced by half or more because of your headaches? (Do (Do

not include days you counted in question 3 where you did not do household work)not include days you counted in question 3 where you did not do household work) 55 On how many days in the last three months did you miss family, social or leisure activities because of your headaches?On how many days in the last three months did you miss family, social or leisure activities because of your headaches?

Your rating:   TOTAL:Your rating:   TOTAL:   

  

AA On how many days in the last 3 months did you have a headache? On how many days in the last 3 months did you have a headache? (If a headache lasted more than 1 day, count each day)(If a headache lasted more than 1 day, count each day) daysdays BB On a scale of 0-10, on average how painful were these headaches? On a scale of 0-10, on average how painful were these headaches? (Where 0 = no pain at all, and 10 = pain as bad as it can be)(Where 0 = no pain at all, and 10 = pain as bad as it can be)                 GradeGrade DefinitionDefinition ScoreScore I I Minimal or infrequent disability0-5Minimal or infrequent disability0-5 II II Mild or infrequent disability6-10Mild or infrequent disability6-10 IIlIIl Moderate disability11-20Moderate disability11-20 IVIV Severe disability21+Severe disability21+ © Innovative Medical Research 1997© Innovative Medical Research 1997 The MIDAS programme is sponsored by AstraZenecaThe MIDAS programme is sponsored by AstraZeneca

Other Causes of HeadacheOther Causes of Headache

Sinister HeadachesSinister Headaches

Causes of sinister headache that must not be Causes of sinister headache that must not be missed includemissed include

1. Meningitis1. Meningitis 2. Intracranial tumours (brain tumours)2. Intracranial tumours (brain tumours) 3. Subarachnoid haemorrhage3. Subarachnoid haemorrhage 4. Temporal arteritis4. Temporal arteritis 5. Primary angle closure glaucoma5. Primary angle closure glaucoma 6. Idiopathic intracranial hypertension6. Idiopathic intracranial hypertension. .

7. Subacute carbon monoxide poisoning7. Subacute carbon monoxide poisoning

MeningitisMeningitis

Usually accompanied by fever and Usually accompanied by fever and neck stiffness in an obviously ill patient.neck stiffness in an obviously ill patient.

Intracranial TumoursIntracranial Tumours

produce headache when they are large enough to produce headache when they are large enough to cause raised intracranial pressure, which is usually cause raised intracranial pressure, which is usually

apparent from the history. Papilloedema or focal apparent from the history. Papilloedema or focal neurological signs, or both, will usually be present. neurological signs, or both, will usually be present.

Fortunately these are very rare. Fortunately these are very rare.

Subarachnoid haemorrhage Subarachnoid haemorrhage

headache is often described as the worst ever, and is headache is often described as the worst ever, and is usually (but not always) of sudden or ictal onset. Neck usually (but not always) of sudden or ictal onset. Neck stiffness may take hours to develop. In elderly patients stiffness may take hours to develop. In elderly patients

particularly, classic symptoms and signs may be particularly, classic symptoms and signs may be absent.absent.

Temporal arteritis Temporal arteritis

headache is persistent but often worse at headache is persistent but often worse at night and sometimes severe, in a patient over night and sometimes severe, in a patient over 50 who does not feel entirely well. It may be 50 who does not feel entirely well. It may be accompanied by marked scalp tenderness accompanied by marked scalp tenderness

Primary angle closure Primary angle closure glaucoma glaucoma

rare before middle age, may present dramatically with acute rare before middle age, may present dramatically with acute ocular hypertension, a painful red eye with the pupil ocular hypertension, a painful red eye with the pupil

midodilated and fixed and, essentially, impaired vision, and midodilated and fixed and, essentially, impaired vision, and nausea and vomiting. In other cases, headache or eye pain is nausea and vomiting. In other cases, headache or eye pain is

episodic and mild. The diagnosis is suggested if patient episodic and mild. The diagnosis is suggested if patient reports coloured halos around lights. reports coloured halos around lights.

Idiopathic intracranial Idiopathic intracranial hypertension hypertension

rare cause of headache; occurs especially rare cause of headache; occurs especially with obese young women. May not be evident with obese young women. May not be evident on history alone; papilloedema indicates the on history alone; papilloedema indicates the

diagnosis. diagnosis.

Subacute carbon monoxide Subacute carbon monoxide poisoning poisoning

uncommon but potentially fatal. Symptoms uncommon but potentially fatal. Symptoms include headaches, nausea, vomiting, include headaches, nausea, vomiting,

giddiness, muscular weakness, dimness of giddiness, muscular weakness, dimness of vision, and double vision. vision, and double vision.

ScenariosScenarios

I need 8 volunteers- 4 girls and 4 boysI need 8 volunteers- 4 girls and 4 boys 4 doctors and 4 patients4 doctors and 4 patients

BrendanBrendan

Brendan 19 year old music student and Brendan 19 year old music student and amateur rock musician recently moved to amateur rock musician recently moved to area so no records received as yetarea so no records received as yet

JenniferJennifer

Jennifer is a 67 year old- retired shop Jennifer is a 67 year old- retired shop assistant, She seldom visits the doctor assistant, She seldom visits the doctor although has a life long history of migraine, although has a life long history of migraine, her medical records include very few her medical records include very few consultations for headachesconsultations for headaches

DuncanDuncan

Duncan is a 38 year old . He is a freelance Duncan is a 38 year old . He is a freelance editor and is married with one child. His editor and is married with one child. His medical records contain no other previous medical records contain no other previous consultation for migraine.consultation for migraine.

MandyMandy

Mandy is 29 years old. She is an air Mandy is 29 years old. She is an air hostess. She does have a previous history hostess. She does have a previous history of migraine, possibly linked to menstruation. of migraine, possibly linked to menstruation. She is in a stable relationship and has no She is in a stable relationship and has no childrenchildren