Headaches

Question 1

What is a primary headache ?

Answer 1

A headache that has no underlying medical cause

Question 2

What are the 3 primary headaches ?

Answer 2

• Tension type headache
• Migraine
• Cluster headache

Question 3

What is a secondary headache ?

Answer 3

A headache that has an underlying medical cause

Question 4

What would the patient complain about if they had a TTH ?

Answer 4

• Bilateral headache
• Tightening feeling
• No other features
• Can last 30 minutes - days

Question 5

What is classed as infrequent episodic TTH ?

Answer 5

< 1 day per month

Question 6

What is classed as frequent episodic TTH ?

Answer 6

1 - 14 days per month

Question 7

What is classed as a chronic TTH ?

Answer 7

> 15 days per month

Question 8

How do you treat a TTH ?

What is the preventative treatment ?

Answer 8

• NSAID’s
• Aspirin
• Preventative treatment - Tricyclic Anti-depressants

Question 9

How many phases does a migraine have ?

Answer 9

5

Question 10

What are the phases of a migraine ?

Answer 10

Premonitory 
Aura
Early headache 
Advanced headache 
Postdrome

Question 11

What occurs in premonitory ?

Answer 11

• Behavioural changes/irritable
• Mood changes
• Food cravings
• Muscle pain

Question 12

What happens in the Aura phase ?

Answer 12

• Hearing or vision changes
• Funny smells
• Tingling

Question 13

What occurs in the Early headache ?

Answer 13

• Dull pain
• Nasal congestion
• Muscle pain.

Question 14

What happens during the Advanced headache ?

Answer 14

• Unilateral throbbing
• Photophobia
• Phonophobia
• Nausea
• Vomiting

Question 15

What occurs during the Postdrome ?

Answer 15

• Fatigue

- Muscle pain

Question 16

What is the definition of a Chronic Migraine ?

Answer 16

Headaches > 15 days per month with > 8 of these being Migraines. Must have occurred for 3 consecutive months.

Question 17

What is the treatment for migraines ?

What are the preventative treatments ?

Answer 17

• NSAID’s
• Aspirin
• Triptans
  Preventative measures include Tricyclic-Antidepressants, Anti-epileptics and Propranolol.

Question 18

What treatments can be given in pregnancy ?

Answer 18

Propanolol and Paracetamol

Question 19

What are the features of a cluster headache ?

Answer 19

• Orbital/temporal
• Unilateral
• Patients are agitated and restless
• Comes on quickly and stops quickly
• Usually lasts 1-2 hours

Question 20

Do cluster headaches show any patterns ?

Answer 20

They occur at the same time everyday

Question 21

What can be used to treat cluster headaches ?

Answer 21

• 100% oxygen

- Sumatriptan

Question 22

What is a medication overuse headache ?

Answer 22

Headache that has started and occurs > 15 days per month since talking regular symtomatic medication.

Question 23

What causes a medication overuse headache ?

Answer 23

• Simple analgesics > 15 days per month

- Combination analgesics/opioids > 10 days per month

Question 24

What is paroxysmal hemicrania ?

Answer 24

• Orbital and temporal
• Unilateral
• Rapid onset and rapid cessation
• Less than 30 minutes
• No circadian rhythm

Question 25

What can be used to treat paroxysmal hemicrania ?

Answer 25

- Indometacin

Question 26

What are the features of a SUNCT headache ?

Answer 26

- Unilateral - Supraorbital/temporal - Stabbing/pulsatile - Usually only lasts minutes - Cutaneous triggers - No refractory period

Question 27

How do you treat SUNCT ?

Answer 27

Gabapentin or Topiramate

Question 28

List the features of Trigeminal Neuralgia

Answer 28

- Maxillary or mandibular pain - Last seconds - Stabbing pain - Has a refractory period - Cutaneous triggers

Question 29

What is used to treat Trigeminal Neuralgia ?

Answer 29

- Carbemezapine | - Decompressive surgery

Question 30

What are some of the red flag symptoms with headaches ?

Answer 30

- First and worst headache - New symptoms - Changing symptoms - Visual changes - Comes on with changes to posture - Stiff neck/fever

Question 31

What is a thunderclap headache ?

Answer 31

- Peaks in less than one minute | - No differentiating features

Question 32

What is a thunderclap headache usually mistaken for ?

Answer 32

SAH, meningitis or a stroke

Question 33

What surgical treatment is needed in a SAH if due to a berry aneurysm ?

Answer 33

Coiling or clipping

Question 34

How do you investigate a SAH ?

Answer 34

CT scan, CT angiography if SAH found and LP if nothing found on CT scan (within 12 hours).

Question 35

How do you maintain a patient who has had a SAH ?

Answer 35

Three HHH rule : - Control Hypertension (BP) - Hydrate - Give plasma if needed to maintain volume

Question 36

What complications can arise from an SAH ?

Answer 36

- Hydrocephalus - Vasospasm - Seizures

Question 37

What medication is given for up to 3 weeks after to prevent Vasospasm ?

Answer 37

Nimodipine

Question 38

If headache comes on due to position changes or patient is having seizures, what would you suspect ?

Answer 38

Space occupying lesion

Question 39

What causes intracranial hypotension ?

Answer 39

CSF leak due to Iatrogenic/ spontaneous hole formation

Question 40

What makes hypotension worse ?

Answer 40

Standing up

Question 41

How would you investigate/treat intracranial hypotension ?

Answer 41

MRI of brain and spine - Epidural blood patch - Bed rest - Caffeine - Analgesia

Question 42

What is Giant Cell Arteritis ?

Answer 42

inflammation of the large arteries. Should consider this in any patient over 50.

Question 43

What do patients with Giant Cell Arteritis present with ?

Answer 43

- Scalp tenderness - Jaw claudication - Visual disturbances - Prominent temporal veins

Question 44

What tests are done and what do they show ? | Giant Cell Arteritis

Answer 44

Blood tests and should do a biopsy | High ESR and CRP

Question 45

What is used to treat Giant Cell Arteritis ?

Answer 45

Prednisolone