Sudden onset, First severe or worst ever, Onset during exertion, incl coughing, Focal neurology or papilloedema, Altered mental status, Toxic appearance, Meningism, Immunosuppression, New onset with age>50, morning headache
What is more common primary or secondary headache?
Primary, even in over 50s. (Primary = tension, cluster, migraine)
List some 'Not-immediately-life-threatening' headaches
Substance, or its withdrawal e.g. CO, EtOH, nitrates, MAOI, medication overuse; Trauma or structure of head & neck e.g. sinusitis, TMJ, pseudotumor cerbri (BIH); Low pressure headache – secondary to LP, Psychiatric problems
should be taken into consideration but PPV of location in diagnosis is low
What is temporal arteteritis?
Granulomatous inflammation of the intima and media of large BVs. Marked thickening of artery causes ischaemia.
Who does temporal arteritis affect?
Women, >50 years, associated with PMR
How does temporal arteritis present?
URTI in 10%, Severe headache 65%, Fever>39 in 15%, Swelling tenderness and nodularity of temporal a. Large vessel bruits, Neuropathies 15%, PMR
How many patients who get diagnosed with TA also have PMR?
What investigations do you order when suspecting temporal arteritis?
CRP: more accurate than ESR, ESR: >50 often >100. ESR <50 has a NLR of 0.2 of being TA (having a positive biopsy). FBC-leukocytosis, LFT abnormal 30%. MOST IMPORTANTLY - BILATERAL TEMPORAL ARTERY BIOPSY
What is the sensitivity of unilateral TA biopsy?
90%, bilateral is slightly higher
If affects other vessels how does it present?
Optic - Blindness 20% usually irreversible. Facial - Masseter/temporalis/tongue claudication. Subclavian - Arm claudication. Thoracic aorta - Aneurysmal-rare
Treatment of PMR?
1mg/kg prednisolone before results of biopsy are back or methylprednisolone 1g if recent blindness. aspirin may reduced thrombotic events