Headache

Question 1

what important questions should you ask when someone presents with a headache?

Answer 1

red flags:

• fever, neck stiffness, photophobia - meningitis
• new neurological symptoms - stroke, malignancy, haemorrhage
• dizziness- stroke
• visual disturbance - giant cell arteritis, glaucoma
• sudden onset occipital headache - SAH
• vomiting- ICP
• history of trauma - intracranial haemorrhage
• pregnancy - PET
• if it gets worse on bending over, coughing or sneezing - raised ICP
• if it’s bad enough to wake you up from sleep - raised ICP

Question 2

what examination should you perform on someone with a headache?

Answer 2

fundoscopy - check for papilloedema

Question 3

Tension Headache features

Answer 3

• very common
• dull ache
• starts in forehead and band-like distribution around head
• associations w dehydration, skipping meals, stress etc
• rX: reassurance, mild analgesia, hot towels to local area

Question 4

Secondary headache features

Answer 4

similar presentation to tension headache, but has a clear cause ie underlying medical condition, alcohol etc

Question 5

Sinusitis

• what is it caused by
• how does it present
• rx

Answer 5

• typically a viral illness

Presentation:

• headache with inflammation of sinuses
• facial pain around nose, behind eyes and in forehead
• O/E: tenderness in affected areas

Rx:

• resolves within 2-3 weeks
• nasal irrigation with saline can help, but if not nasal steroid spray given

Question 6

Analgesic headache features

Answer 6

• due to analgesic overuse long-term
• features similar to tension headache
• removal of analgesic important in treatment

Question 7

hormonal headache features

Answer 7

linked to LOW oestrogen

• around menopause
• couple days before and first few days of menstruation
• pregnancy- in first few weeks, should improve in last 6 months. If headache comes on in 2nd half of pregnancy, investigate for PET

OCP can can improve the headache

Question 8

cervical spondylosis features

Answer 8

• degeneration of cervical spine
• presents with neck pain that is worse on movement & headache