Headaches

Question 1

What are the 2 types of primary headache?

Answer 1

Tension type headache

Cluster headache

Question 2

How does a tension headache present?

Answer 2

• Tight band/pressure sensation around forehead
• Bilateral (migraine is unilateral)
• Comes on and resolves gradually
• No visual changes

Question 3

What is the difference between a migraine and a tension headache?

Answer 3

A tension headache is bilateral

A migraine tends to be unilateral

Question 4

Are there visual changes with a tension type headache?

Answer 4

No

Question 5

What is a tension headache associated with?

Answer 5

• Stress
• Depression
• Dehydration
• Alcohol

Question 6

What is the management of a tension headache?

Answer 6

• Reassurance

* Analgesia

Question 7

What can you give as prophylaxis for a tension headache?

Answer 7

Amitriptyline

Question 8

What analgesia can be given for a tension headache?

Answer 8

Aspirin
Paracetamol
NSAID

Question 9

What is now the recommended prophylaxis for a tension headahce?

Answer 9

10 sessions of acupunture

Question 10

What is a chronic headache?

Answer 10

A headache for 15 days or more per month

Question 11

How do cluster headaches appear?

Answer 11

They typically occur in clusters lasting several weeks, with the clusters themselves typically once a year

Question 12

How long do cluster headaches last?

Answer 12

15 mins to 2/3 hours

Question 13

What are the main triggers for a cluster headache?

Answer 13

Alcohol

Question 14

Who are cluster headaches more common in?

Answer 14

Older men

Smokers

Question 15

How do cluster headaches present?

Answer 15

• intense sharp, stabbing pain around one eye (recurrent attacks ‘always’ affect same side)
• accompanied by redness, lacrimation, lid swelling
• nasal stuffiness-nsasl discharge
• ptosis and meiosis

Question 16

How does a patient with a cluster headache attack appear?

Answer 16

Restless and agitated during attack

Question 17

What is the first line management of a cluster headache?

Answer 17

High flow oxygen

Question 18

What is the medical management of cluster headaches?

Answer 18

Sumatriptan

Subcutaneous triptan

Question 19

Who is sumatriptan contraindicated in?

Answer 19

People with CAD

Question 20

What is the prophylaxis for cluster headaches?

Answer 20

Verapamil

Question 21

What are forms of secondary headaches?

Answer 21

Giant cell arteritis

Trigeminal Neuralgia

Question 22

What does giant cell arteritis affect?

Answer 22

Temporal arteries

Question 23

What is giant cell arteritis a form of?

Answer 23

Systemic vasculitis

Question 24

How is giant cell arteritis diagnosed?

Answer 24

• Clinical
• ESR raised 50mm/hour
• Temporal artery biopsy

Question 25

What would you find with a temporal artery biopsy in someone with giant cell arteritis?

Answer 25

Multinucleated giant cells

Question 26

What is the management of giant cell arteritis?

Answer 26

40-60mg prednisolone per day | Review in 48 hours

Question 27

What are the 2 main causes of trigeminal neuralgia?

Answer 27

* Idiopathic | * Compression of trigeminal roots by tumours or vascular problems

Question 28

How does trigeminal neuralgia present?

Answer 28

* Unilateral severe pain * Sudden onset of brief electric shock-like pains * Occur in clusters * nasolabial fold or chin may be particularly susceptible to the precipitation of pain * usually last 2 seconds - 3 minutes

Question 29

Where is particularly sensitive to pain with trigeminal neuralgia?

Answer 29

• nasolabial fold or chin may be particularly susceptible to the precipitation of pain

Question 30

How long does the pain last with trigeminal neuralgia?

Answer 30

Usually last 2 seconds - 3 minutes

Question 31

What are triggers for trigeminal neuralgia?

Answer 31

* light touch, including washing, shaving, smoking, talking, and brushing the teeth * cold weather * spicy food * caffeine

Question 32

What is the management for trigeminal neuralgia?

Answer 32

• Carbamazepine

Question 33

What would you do if a patient with trigeminal neuralgia didn't respond to treatment?

Answer 33

Refer to neurology

Question 34

What are red flag symptoms of trigeminal neuralgia?

Answer 34

* Sensory changes * Deafness or other ear problems * Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally * Optic neuritis * A family history of multiple sclerosis

Question 35

What is the main neuroimaging used in someone presenting with a cluster headache?

Answer 35

MRI with gadolinium contrast

Question 36

What is the main complication of giant cell arteritis?

Answer 36

Permanent vision loss

Question 37

What is the main presentation of giant cell arteritis?

Answer 37

Patient over 60 Rapid onset Headache jaw claudication anterior ischemic optic neuropathy Tender, palpable temporal artery

Question 38

What is the main occular complication of temporal arteritis?

Answer 38

Anterior ischaemic optic neuropathy

Question 39

What might you see on a temporal artery biopsy in someone with temporal arteritis?

Answer 39

Skip lesions

Question 40

What is the management of giant cell arteritis if there is evolving vision loss?

Answer 40

IV methylprednisolone

Question 41

What are the main presenting symptoms of giant cell arteritis?

Answer 41

- headache over tender inflamed superficial temporal and/or occipital arteries - jaw claudication, scalp tenderness *(e.g. when combing hair)* - systemic features ⇒ fever, myalgia, malaise, weight loss - visual disturbance/loss