Headaches

Question 1

How common are appointment for headaches in primary care?

Answer 1

4.4 consultations per 100 registered patients

Question 2

What percentage of neurology referrals are due to headaches?

Answer 2

25-30%

Question 3

What are types of primary headaches?

Answer 3

Migraine, cluster, tension-type

Question 4

What are types secondary headaches?

Answer 4

Meningitis, SAH, giant cell arteritis, Intracranial HTN, medication overuse

Question 5

what are ‘other’ types of headaches?

Answer 5

Trigeminal neuralgia, painful cranial neuropathies

Question 6

What is important to ask in a headache history?

Answer 6

• Age over 50
• Hx of HIV, cancer, trauma?
• Personality change?
• cognitive dysfunction?
• Jaw claudication?
• Visual disturbance or eye pain?
• Sudden onset? thunderclap?
• focal neurological symptoms? - limb weakness?
• Exercise/valsalva? e.g. coughing, laughing, straining?

Question 7

What are red flags in a headache presentation?

Answer 7

• New headache with history of cancer
• Cluster headache
• Seizure
• Sig. altered consciousness, memory, confusion, coordination
• Papilloedema
• Abnormal neuro exam or symptom

Question 8

When does a headache warrant an immediate referral?

Answer 8

• Thunderclap headache
• seizure and new headache
• suspected meningitis or encephalitis
• acute glaucoma (red eye)
• headache with new focal neurology