Headaches typical presentations

Question 1

• Bilateral tight band
• Recurrent
• Occurs late in day
• Associated with stress

Answer 1

Tension headache

Question 2

• Sudden onset retro-orbital pain
• Excessive lacrimation
• Eye redness
• 6-12 weeks followed by period of remission
• Occur at same time every day

Answer 2

Cluster headache

Question 3

• Unilateral pulsating headache
• Aura
• Prodromal symptoms
• Photophobia
• Nausea + vomiting (only once or twice)
• Can wake patient in the night
• Paraesthesias

Answer 3

Migraine

Question 4

• 2 seconds of stabbing pain in face
• Electric shock in nature
• Face screws up in pain
• Triggered by cold wind, light touch, eating, talking

Answer 4

Trigeminal neuralgia

Question 5

• Stiff neck
• Photophobia
• Systemic symptoms - fever, rash

Answer 5

Meningitis

Question 6

• Unilateral throbbing pain
• Scalp tenderness
• Jaw claudication
• Visual problems

Answer 6

Temporal arteritis

Question 7

• Thunderclap headache/worst headache ever

* Very sudden onset

Answer 7

Subarachnoid haemorrhage

Question 8

• Worse in morning
• Worse with coughing/change in posture
• Vomiting many times
• Reduced GCS

Answer 8

Raised intracranial pressure (tumour, hypertension, hydrocephalus)

Question 9

• Nausea and vomiting

* History of hypercoagulability

Answer 9

Venous sinus thrombosis

Question 10

• Pain around one eye
• Swollen red eye
• Visual blurring
• Haloes

Answer 10

Acute closed-angle glaucoma

Question 11

• Facial pain
• Exacerbated by leaning forward
• Nasal congestion

Answer 11

Sinusitis

Question 12

• Most common cause of stroke in young adult - caused by hitting chin and hyperextending neck
• Dull/pressure occipital headache
• Neck/facial pain

Answer 12

Carotid artery dissection