Headache

Question 1

What are possible causes of acute, single headaches?

Answer 1

• febrile illness, sinusitis
• first attack of migraine
• head trauma
• subarachnoid haemorrhage
• meningitis
• tumour
• drugs, toxins
• stroke
• thunderclap
• low pressure

Question 2

What are the possible causes of a dull headache, increasing in severity?

Answer 2

• benign
• overuse of medication
• contraceptive pill
• HRT
• neck disease
• temporal arteritis
• benign intracranial hypertension
• cerebral tumour
• cerebral venous sinus thrombosis

Question 3

What tends to cause a dull headache, unchanged for months?

Answer 3

• chronic tension headache
• depressive, atypical facial pain

Question 4

What are different forms of recurrent headaches?

Answer 4

• migraine
• cluster headache
• episodic tension headache
• trigeminal/post-herpetic neuralgia

Question 5

What are the red flags for a secondary headache?

Answer 5

• age
• onset
• systemic symptoms
• neurological signs

Question 6

What types of onset are red flags?

Answer 6

• thunderclap
• acute
• subacute

Question 7

Which systemic symptoms are red flags?

Answer 7

• fever
• rash
• weight loss
• neck stiffness

Question 8

Which neurological symptoms are red flags?

Answer 8

• confusion
• impaired consciousness
• focal neurological deficit
• swollen optic disc

Question 9

What does orthostatic mean?

Answer 9

the headache is better when lying down

Question 10

How does migraine disorder present?

Answer 10

• tendency of repeated attacks
• triggers
• easily hung over
• visual vertigo
• motion sickness

Question 11

What are the different forms of migraine attacks?

Answer 11

• pain only
• pain and focal sings
• focal symptoms only

Question 12

What are the 5 phases of a migraine?

Answer 12

• premonitory
• aura
• headache
• resolution
• recovery

Question 13

What is the premonitory phase of a migraine?

Answer 13

• yawning
• polyuria
• mood change
• light sensitivity
• neck pain
• difficulty concentrating

Question 14

What is the aura phase of a migraine?

Answer 14

• visual changes
• sensory numbness/paraesthesia
• weakness
• speech arrest

Question 15

What is the headache phase of a migraine?

Answer 15

• head and body pain
• nausea
• photophobia

Question 16

What is the resolution phase of a migraine?

Answer 16

• rest
• sleep

Question 17

What is the recovery phase of a migraine?

Answer 17

• disturbed mood
• food intolerance
• hungover feeling
• can take up to 48hrs

Question 18

What visual symptoms happen during the aura phase of a migraine?

Answer 18

positive and negative symptoms simulatenously:

• scintillations
• blindspots
• expanding C’s
• elemental visual disturbances

Question 19

What is the treatment for an acute migraine attack?

Answer 19

• NSAIDS (aspirin, ibuprofen)
• Anti-emetic (paracetamol, metoclopramide)
• prokinetics
• triptans (tablets, melts, nasal sprays, sc injection)

Question 20

How does TMS help treat acute migraine attacks?

Answer 20

interrupts complex networks that trigger and perpetuate migraines - caused by spreading electrical depression across the cerebral cortex

Question 21

What are the long term treatments for migraines?

Answer 21

• lifestyle issues due to overstimulation
• identify and avoid triggers
• hydrate and avoid caffeine
• avoid ready meals and take-aways
• good sleep
• exercise
• mindfulness

Question 22

What prophylaxis can be taken for migraines?

Answer 22

• over the counter
• tricyclic antidepressants
• beta-blockers
• serotonin antagonists
• calcium channel blockers
• anticonvulsants
• greater occipital nerve blocks
• botox
• suppress ovulation
• Erenumab

Question 23

What is the new treatment for migraines?

Answer 23

CGRP antibodies

Question 24

What is a risk of using painkillers for headaches?

Answer 24

Medication overuse headaches

Question 25

What does a tension headache feel like?

Answer 25

tight muscles around the head and neck bilaterally

Question 26

What is the treatment for tension headaches?

Answer 26

- simple analgesics e.g. paracetamol and aspirin - reassurance that it will pass

Question 27

What is a cluster headache?

Answer 27

- severe unilateral pain lasting 15-180 minutes untreated - trigeminal autonomic cephalgia

Question 28

How does a cluster headache present?

Answer 28

- forehead and facial sweating - miosis and/or ptosis - restlessness or agitation - 1-8 daily - (at least one) ipsilaterally: conjunctival redness and/or lacrimation nasal congestion and/or rhinorrhea eyelid oedema (most common site of pain is the eye)

Question 29

What is the acute treatment of a cluster headache?

Answer 29

- inhaled oxygen (inhibits neuronal activation in the trigeminocervical complex) - s/c or nasal sumatriptan

Question 30

What can prevent a cluster headache?

Answer 30

- Verapamil (calcium channel inhibitor) - greater occipital nerve block - need ECG first

Question 31

What is the difference in distribution between migraines and cluster headaches?

Answer 31

migraines are more common in women, vice versa for cluster headaches

Question 32

What are the most common primary headaches?

Answer 32

- migraine - tension headaches - cluster headaches

Question 33

What should NOT be given to treat cluster headaches according to NICE?

Answer 33

- paracetamol - NSAIDS - oral triptans - ergots - opioids

Question 34

What are secondary headaches?

Answer 34

- Headache is percipitated by another condition / disorder - local os systemic - Serious causes of secondary headache are uncommon

Question 35

What are the two types of primary headache?

Answer 35

Long-lasting (>4 hours) and short lasting (<4 hours)

Question 36

Which headaches are long lasting?

Answer 36

Migraine and tension headache

Question 37

Which headaches are short-lasting?

Answer 37

Trigeminal autonomic cephalagias e.g cluster headaches

Question 38

What are red flags for headaches?

Answer 38

Presences indicates secondary rather than primary headache

Question 39

What are the age related red flags?

Answer 39

New onset or different headaches in a person >50yrs

Question 40

What are the characteristics of migraines?

Answer 40

- Unilateral - Pulsating - Moderate or severe pain - Aggravation by routine physical activity - Last hours and sometimes days - premonitory symptoms - last 4-72hr

Question 41

What causes aura?

Answer 41

Focal cortical or brainstem dysfunction

Question 42

What are the characteristics of tension headaches?

Answer 42

- bilateral - mild to moderate - not aggravated by movement - no added features