Headache

Question 1

Tension Type Headaches features

Answer 1

F>M
usually bilateral
tight band
stress as trigger
tenderness in area
episodic >4hrs
doesn’t interfere with ADL

Question 2

Migraine Risk factors

Answer 2

Chocolate
Hangover
Orgasm
Cheese, caffeine
OCP
Lying
alcohol
Travel
Exercise

Question 3

Migraine features

Answer 3

F>M
usually unilateral frontal
throbbing
proceeded by sensory or visual aura
impaired or worsened by daily activities
sensitivity to light/smell
lasts 4-72 hours

Question 4

Migraine Mx

Answer 4

Avoid triggers; prophylaxis with Propranolol (CI: asthma) or Topiramate
managing an acute attack with an oral triptan such as Sumatriptan (CI: ischaemic heart disease) in addition to Paracetamol or an NSAID.

Ensure that female patients are not taking combined oral contraceptive pills as it increases their risk of ischaemic stroke.

Question 5

Cluster headache

Answer 5

M>F
Unilateral
intense
stabbing
autonomic symptoms- lacrimation, rhinorrhea
Pts are extremely restless and agitated, avoid being still
Attacks 1-8 a day each lasting 15-180 minutes over a period of 4-12 weeks

Question 6

Mx cluster headache

Answer 6

• Avoid triggers
• managing an acute attack with 100% oxygen via non-rebreathable mask (CI: COPD) * * with a subcutaneous or nasal Triptan (CI: ischaemic heart disease).
• prophylaxis with Verapamil

Question 7

Red flag : headache worse on standing

Answer 7

consider CSF leak

Question 8

Red flag: headache worse on lying down

Answer 8

consider space occupying lesion or cerebral venous sinus thrombosis

Question 9

Space occupying lesion headache

Answer 9

• recent onset
• progressive worsening
• worse in morning and on bending over
• improve after vomiting
• Focal neurological signs e.g. papilloedema

Question 10

Subarachnoid Haemorrhage

Answer 10

• Thunderclap headache (hyperacute)
• Accompanying neck pain and stiffness, nausea, vomiting, photophobia.

Question 11

Giant cell/ Temporal arteritis

Answer 11

• over 50 y olds
• Palpable thickened tender temporal arteries
• Jaw claudication and scalp tenderness
• Systemic features of fever, malaise, night sweats, insomnia, weight loss
• Failure to treat can result in visual loss - tx with aspirin and steroid

Question 12

Carotid or Vertebral Dissection

Answer 12

neck and head pain
Horner syndrome
stroke symptoms/signs may be delayed

Question 13

Infections e.g. meningitis, encephalitis

Answer 13

• Recent onset of headaches with progressive worsening
• Fever, Rash
• Impaired consciousness
• Seizure
• Focal neurological symptoms and/or signs

Question 14

Cerebral Venous Sinus Thrombosis

Answer 14

• uncommon
• Female, smokers, oral contraceptive pills
• Pregnancy, post-partum
• New onset of headache with features of raised intracranial pressure
• Seizure
• Focal neurological symptoms