1.1.2

Question 1

Worrying features of a headache

Answer 1

Short history
Continuous
Worsening
General malaise (sickness, other things making HA worse)
Other associated factors

Question 2

Less worrying features

Answer 2

Long history/ been going on for a while
Intermittent - comes and goes
Steady - stable/ not getting worse
Good
No other problems

Question 3

Single acute

Answer 3

Raised ICP
Subarachnoid haemorrhage
Referred pain from sinus, teeth, eye
Herpes zoster

Question 4

Acute recurrent

Answer 4

Migraine
Cluster HE
Trigeminal neuralgia

Question 5

Subacute

Answer 5

Temporal arteritis
Raised ICP

Question 6

Chronic

Answer 6

Tension
Psychiatric
Ankylosing spondylitis

Question 7

Causes of headaches (threatening)

Answer 7

GCA-AAION
Acute angle closure glaucoma
Increased intracranial pressure
Ocular ischemic syndrome
Malignant hypertension
Infectious CNS disorder (meningitis or brain abscess)
Structural abnormality of the brain
Subarachnoid haemorrhage
Epidural or subdural hematoma

Question 8

Causes of headaches (less serious)

Answer 8

Refractive error/asthenopia
Convergence insufficiency
Accommodative spasm
Migraines
Cluster
Tension
Sinus disease

Question 9

Management

Answer 9

Advice: refer to GP (if not ocular issue), refractive error, anti reflective coating, regular breaks (20-20-20) etc
Migraines- avoid cheese, chocolate, alcohol, caffeine/excess sleep/stress/long intervals without food; treat with aspirin, codeine, ergotamine (not for pregnant women)/ prophylactic measures- beta blockers, ACE inhibitors
Convergence insufficiency- exercises or even prism
Accommodative spasm
Cluster- hard to treat due to sudden onset but many resolve after few weeks/months
Tension- less stress, anxiety, poor sleep; paracetamol and glasses may help