12.10.30 Teaching notes

Headache Hx

• • How long have you had headaches?

  • How often do you have headaches?

    • Are they becoming more frequent?

    • If daily, how long have they happened every day?

  • Where in the head are they?

  • What quality do they have?

    • e.g. pressing, throbbing, pounding etc.

  • How long do they last?

  • Are there any visual or sensory symptoms, if so how long do they last?

  • Is the headache associated with nausea or aversion to light (photophobia)?

  • Do you take medications for the headaches including painkillers?

    • c.f. medication overuse

Blackout Hx

• • How many attacks have you had?

  • When did they start?

  • What were you doing when the attack started?

  • Where you standing or seated/ lying when the attack started?

  • Was there any warning, or did the attack come on suddenly?

  • What was the warning like?

  • What happened next?

  • Was there a witness?

    • Establish if the patient actually collapsed to the floor / lost consciousness

  • Did you shake? For how long?

  • How long did it take to recover?

Notes

• • Spasticity affects the agonist, Rigidity is in both

    • => Systematically check both directions at each joint

  • Pyramidal signs

    • Upper limb extensors

    • Lower limb flexors

  • Types of spasm

    • Adductor (cross legs)

    • Flexor (bend legs)

  • Corticospinal tract:

    • Goes through the internal capsule

    • Crosses at the medulla

  • Drugs linked to myopathy

    • Steroids

    • Statins

  • Myopathy tends to be proximal + symmetrical