A Case Of Post traumatic Headache

A 45 year old gentleman presents with a history of headache for 3 weeks. His past history reveals a migraine headache since 20 years and a fall 3 weeks ago.

1. What further questions would you explore in the history?
2. List 3 most likely differentials?
3. Outline your management plan?

Question solved:



1. What further questions would you explore in the history?

Answer: The following questions are important to ask in the clinical history:

• The site of pain.
• Character and intensity of pain (compare with the previous migraine headaches)
• Is the headache constant or fluctuating
• Any aggravating or relieving factors
• Any injury to head following the fall.
• History of losing consciousness following the fall. 
• History of any seizures
• History of nausea or vomiting.
• Any memory loss or disorientation.
• Any weakness in the body, difficult in speech or visual problems. 
• History of fever. 
• Is the patient taking any medication (like blood thinners or anticoagulants e.g aspirin, warfarin)
• History of any bleeding disorder.

2. List 3 most likely differentials?

Answer:

1. Sub Dural Hematoma

2. Post concussion syndrome leading to Tension Headache

3. Meningitis

3. Outline your management plan?

Answer: The first step in management is to determine the underlying cause for the headache. 

• A detailed physical examination including the neurological assessment may help in determining the cause. 
• Check the vital signs (look for fever and high BP)
• Look for signs of body weakness and any disorientation.
• Check the signs of meningeal irritation (neck rigidity, Kerning and Brudzinkin's signs)
• CT scan or MRI of the head may detect a subdural hematoma which may need emergency treatment.
• Referral to Neurosurgeon in case of Subdural hematoma for immediate decompression and removal of blood clot.