Headache

Question 1

Types

Answer 1

Acute single episode- mening, enceph, malaria, SAH, sinusitis, inj.
Acute recurr attacks with full recov btw- mig, cluster (unilat and lacrimat).
Subacute onset esp in eld- temporal arteritis.
Chronic- tension, RICP, analgesia induced eg codeine, pagets.

Question 2

Temporal arteritis

Answer 2

Subacute onset headache with raised ESR.

Question 3

Red flags

Answer 3

Vis distrub, photophobia, jaw claudication
New, persis, unexpl in over 50 or under 10. 
Early morning esp if wakes. 
Assoc with posture. Vomiting. 
Alt personality. 
Neurol deficit. 
Recent head inj. 
Imm supp, hx of malig.

Question 4

Migraine

Answer 4

-px-
4-72 hr, NV, photophobia, unilat, pulsating.
-triggers-
Choc, alc, orgasm, cheese, OCP, exercise.
-tx-
NSAIDs eg asp, triptans (5HT1 agonists), ergotamine.

Question 5

Cluster

Answer 5

• px- rapid onset, around eye, 2hr at time, clusters last 4-12wk, eye watering, blood shot, facial flushing, rhinorrhoea, ptosis, miosis.
• tx- O2, triptans.

Question 6

Trigeminal neuralgia

Answer 6

Tx- carbamaxepine, lamotrigine, phenytoin, gabapentin, surg.

Question 7

Tension

Answer 7

Px- bilat, non pulsatile, musc tend ove scalp.

Tx- stress eg massage, antiD.