402 - Neurology - Headache

Question 1

3 examples of primary headache

Answer 1

Migraine
Medication misuse headache
Tension headache

Question 2

What are the emergency headaches? The headaches not to miss (8)

Answer 2

• Raised ICP
• Thunderclap headache
• Idiopathic intracranial HTN
• Venous sinus thrombosis
• Carotid dissection
• Painful CN3 palsy
• Meningitis
• Encephalitis

Question 3

Typical area of a sinus headache

Answer 3

Pain is behind browbone and/or cheekbones, adjacent to where the sinuses are

Question 4

Typical feeling of a tension headache

Answer 4

Pain is like a squeezing band around the head

Question 5

Typical feeling of a cluster headache

Answer 5

Pain is in and around one eye
Often have prominent autonomic symptoms e.g. rhinorrhoea, lacrimation, red eye, ptosis, pupillary changes. These are less seen in migraine (another typically one-sided headache)

Question 6

Key questions to ask about the headache

Answer 6

Time course

Periodicity - frequency and duration of episodes

Triggers

Associated features

Question 7

Migraine criteria for diagnosis

Answer 7

Headache attacks lasting 4-72h with at least two of the following characteristics;

• Unilateral location
• Pulsating quality
• Moderate or severe pain
• Aggravation by or causing avoidance of routine physical activity

During the headache at least one of the following:

• Nausea and/or vomiting
• Photophobia and phonophobia

Question 8

Migraine with aura is predominantly which sensory format

Answer 8

Visual

Question 9

Aura in migraine

Answer 9

• Affects about 1/3 of migraine sufferers.
• Typically between 5-60m long prior to headache
• ## Visual transient hemianopic disturbance or a spreading scintillating scotoma

Question 10

Other kinds of aura in migraine (non-visual)

Answer 10

• Sensory disturbance e.g. unilateral paraesthesia of hand, arm or face (leg rarely affected)
• Dysphasia (speech difficulties) - may be mistaken for stroke