HEAD AND NECK
common or concerning symptoms
◦ Headache
• change in vision; blurred, loss, floaters, flashes
• Eye pain, redness or tearing
• Double vision (Diplopia)
• Hearing loss, earache, tinnitus
• Dizziness and vertigo
• Epistaxis
- Sore throat, hoarseness
• Swollen glands
• Goiter
Headache Warning signs
• Progressively frequent or severe over a 3 month period
• Sudden onset like a 'thunderclap'
• New onset after age 50 years
• Aggravated or relieved by change in position
• Precipitated by Valsalva maneuver or exertion
• Associated symptoms of fever, night sweats or weight loss
• Presence of cancer, HIV infection or pregnancy
• Recent head trauma
• change in patterns from past headaches
• Associated papilledema, neck stiffness or focal neurologic
deficits
,Primary headaches: migraine, tension, cluster, chronic daily headaches
Secondary headaches: arise from • underlying structural, systemic or infectious causes
such as meningitis or subarachnoid haemorrhage and may be life threatening.
Thunderclap headaches reaching maximal intensity over several minutes occur in
70% of patients with subarachnoid haemorrhage and are often preceded by a
sentinel leak headache from a vascular leak into the subarachnoid space.
sudden and severe -consider subarachnoid haemorrhage or meningitis
New and persisting, progressively severe headaches raise concerns of tumour ,
abscess or mass lesion
Nausea and vomiting are common with migraine; also occur with brain tumours and
subarachnoid haemorrhage.
migraines
Photopsias (flashes of light) fortifications (rsig-zag arcs of light) Scotomast areas of
visual LOSS with surrounding normal vision.
Valsalva maneuvers and leaning forward may increase pain from acute
sinusitis.
Valsalva and lying down may increase pain from mass lesions due to
changing intracranial pressure.
, THE EYES
Hyperopia (farsightedness)
presbyopia (aging vision)
myopia (nearsightedness)
Sudden vision loss is unilateral and painless, consider vitreous haemorrhage from
diabetes. or trauma, macular degeneration, retinal detachment, retinal vein occlusion
or central retinal artery occlusion.
If painful, causes are usually in the cornea and anterior
chamber such as corneal ulcer, uveitis, traumatic hyphema and
acute angle closure glaucoma- optic neuritis from multiple sclerosis
may also be painful. Immediate referral is warranted.
If bilateral and painless, consider vascular etiologies such as
giant-cell arthritis or nonphysiologic causes. If bilateral and painful,
consider chemical or radiation exposures.
Gradual vision loss usually arises from cataracts or macular
degeneration.
slow central loss occurs in nuclear cataract. and macular degeneration,
peripheral loss in advanced open-angle glaucoma and one-sided
loss with hemianopsia and quadrantic defects.
moving specks or strands suggest vitreous floaters; fixed defects or
scotomas. suggest lesions in the retina or visual pathways.
common or concerning symptoms
◦ Headache
• change in vision; blurred, loss, floaters, flashes
• Eye pain, redness or tearing
• Double vision (Diplopia)
• Hearing loss, earache, tinnitus
• Dizziness and vertigo
• Epistaxis
- Sore throat, hoarseness
• Swollen glands
• Goiter
Headache Warning signs
• Progressively frequent or severe over a 3 month period
• Sudden onset like a 'thunderclap'
• New onset after age 50 years
• Aggravated or relieved by change in position
• Precipitated by Valsalva maneuver or exertion
• Associated symptoms of fever, night sweats or weight loss
• Presence of cancer, HIV infection or pregnancy
• Recent head trauma
• change in patterns from past headaches
• Associated papilledema, neck stiffness or focal neurologic
deficits
,Primary headaches: migraine, tension, cluster, chronic daily headaches
Secondary headaches: arise from • underlying structural, systemic or infectious causes
such as meningitis or subarachnoid haemorrhage and may be life threatening.
Thunderclap headaches reaching maximal intensity over several minutes occur in
70% of patients with subarachnoid haemorrhage and are often preceded by a
sentinel leak headache from a vascular leak into the subarachnoid space.
sudden and severe -consider subarachnoid haemorrhage or meningitis
New and persisting, progressively severe headaches raise concerns of tumour ,
abscess or mass lesion
Nausea and vomiting are common with migraine; also occur with brain tumours and
subarachnoid haemorrhage.
migraines
Photopsias (flashes of light) fortifications (rsig-zag arcs of light) Scotomast areas of
visual LOSS with surrounding normal vision.
Valsalva maneuvers and leaning forward may increase pain from acute
sinusitis.
Valsalva and lying down may increase pain from mass lesions due to
changing intracranial pressure.
, THE EYES
Hyperopia (farsightedness)
presbyopia (aging vision)
myopia (nearsightedness)
Sudden vision loss is unilateral and painless, consider vitreous haemorrhage from
diabetes. or trauma, macular degeneration, retinal detachment, retinal vein occlusion
or central retinal artery occlusion.
If painful, causes are usually in the cornea and anterior
chamber such as corneal ulcer, uveitis, traumatic hyphema and
acute angle closure glaucoma- optic neuritis from multiple sclerosis
may also be painful. Immediate referral is warranted.
If bilateral and painless, consider vascular etiologies such as
giant-cell arthritis or nonphysiologic causes. If bilateral and painful,
consider chemical or radiation exposures.
Gradual vision loss usually arises from cataracts or macular
degeneration.
slow central loss occurs in nuclear cataract. and macular degeneration,
peripheral loss in advanced open-angle glaucoma and one-sided
loss with hemianopsia and quadrantic defects.
moving specks or strands suggest vitreous floaters; fixed defects or
scotomas. suggest lesions in the retina or visual pathways.
