134. Is It Just a Migraine? Headache Red Flags

Hey everybody. Welcome to PT Snacks podcast. This is Kasey, your host, and if you're listening for the very first time, first of all, welcome. But what you need to know is that this podcast is meant for physical therapists and physical therapist students who are looking to grow your fundamentals and buy segments of time. Now, today we're gonna talk

about red flags with headaches, but before we do that, if you've listened to this show more than three times and you've found it to be beneficial. Please leave a review wherever you listen to your podcasts. That would be a huge help. And if you're not following the show, make sure you just hit that button to follow so that you don't miss out on any upcoming episodes.

Right now we're on a weekly schedule where I release on Tuesdays, but with that being said, let's jump right into headache red flags. So I don't know about you, but I find. Headaches can be very debilitating in a lot of my patients, but I also really wanna make sure that the headaches that I'm seeing are appropriate for physical therapy. Right.

So. Think the more cervicogenic blend, however, in our setting, because sometimes we are the first provider that someone is going to see whether it's just how it worked out in their schedule. I'm seeing them already for something else, or maybe they just don't wanna go in to see their doctor. Sometimes that happens. It's important for us to make sure that we understand who is not appropriate for physical therapy

so that we can get them help quickly. So we're gonna cover five headache red flags and remember, this is a really brief overview. If you have questions about them, you can reach out, but it's meant more so if something is jogging your memory or you wanna review a little bit more as a launchpad for you to do so. Okay? So number one outta five, we have our thunderclap headache. This is a sudden onset and severe, often described as the worst headache of my life.

And it can reach peak intensity within seconds to minutes. So this could indicate a subarachnoid hemorrhage often due to a ruptured aneurysm. So blood irritates the brain's meninges, causing very intense pain. Key signs in your patients could be sudden severe headache, often accompanied by neck stiffness,

nausea, vomiting, and it may follow exertion or a Valsalva, or it could even occur during their sleep. So it is an emergency. These have a high mortality rate, so immediate ER, emergency room referrals necessary. You are not treating this in the clinic. Number two. A new headache in patients over 50. A new onset headache in someone over 50 can be a sign of temporal arteritis, AKA giant cell arteritis.

It's an inflammatory condition of the cranial arteries, so what's happening is the inflammation in the arteries is reducing blood flow, including to the eyes, and if it's untreated, it can lead to permanent vision loss.

Things that you can ask about would include jaw pain with chewing like jaw claudication, scalp tenderness, blurred vision or visual changes, fatigue, weight loss, or malaise. So it is an, it is a medical emergency. It's treated with corticosteroids, not manual therapy. So number three, headache with neurological deficits. That just doesn't sound good, does it? When a headache is accompanied with focal neurologic signs, you wanna be suspicious of stroke, TIA brain tumor or mass lesion.

So these patients might present with numbness, weakness, or clumsiness. Speech disturbances like slurring or difficulty finding words, double vision or partial blindness,

and changes in consciousness or behavior. The symptoms point to intracranial involvement. So if symptoms are sudden and focal, call 9 1 1 or emergency services in whatever country you're listening to this end. Now number four is a headache with fever or neck stiffness. This could point to meningitis which is a serious infection of the brain and spinal cord membranes. So when the meninges get inflamed, it can be often from bacterial or viral infections.

Bacterial meningitis in particular, can progress rapidly and is life-threatening. So the classic triad, it's not always present, but they

can have fever, neck, stiffness, and headache. Other signs might include photophobia, confusion, nausea, or lethargy. So anytime somebody presents with systemic signs and a headache, you may wanna consider an infection. So get them to urgent care or an er. And then lastly, number five, positional or Valsalva aggravated headache. Headaches worsened by coughing, sneezing, bending over or laying down, suggest increased intra intracranial pressure.

So. If that can happen when something is occupying space inside the skull, whether it's a tumor cyst hydrocephalus, or a chiri malformation, and these activities momentarily increase pressure, making the pain even worse. So they might say things like, it hurts when I lay flat. More so sneezing or straining makes it

throb and it can sometimes be associated with blurred vision or imbalance. So this is not a musculoskeletal condition. It does require a neurological evaluation in imaging to rule out serious intracranial pathology. This may feel like a downer episode, but I do feel like it's really important to just consider things that are outside of our musculoskeletal realm. So we can more quickly get someone the help that they need.

So if you have any questions at all, feel free to reach out at pt Snacks podcast@gmail.com. Just please remember that this podcast is for educational purposes only, and it's not a substitute for clinical judgment or a medical referral. Now. That being said, if you have any questions at all, feel free to reach out at pt Snacks podcast@gmail.com. If you'd like to support the show, there's a link below in the show notes.

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But I hope you guys have a great rest of your day and end the next time.