9- headache

Question 1

cause primary headache disorder

Answer 1

tension, migraine, cluster

Question 2

secondary headache causes

Answer 2

intracranial lesion/haemorrage, meningitis, giant cell temporal arteritis, acute glaucoma

Question 3

SNOOP pneumonic

Answer 3

systemic signs, neurological symptoms, onset is new, onset in thunderclap presentation, papilloedeoma/positional provocation, precipitated by exercise

Question 4

what does systemic signs suggest

Answer 4

meningitis/pregnant/cancer/immunosuppressed

Question 5

what does neurological symptoms suggest

Answer 5

SOL, ICH, glaucoma

Question 6

what does onset is new suggest

Answer 6

malignancy, giant cell arteritis

Question 7

what does onset in thunderclap presentation suggest

Answer 7

vascular haemorrage

Question 8

what does papilloedeoma/positional provocation, precipitated by exercise suggest

Answer 8

raised ICP

Question 9

presentation tension headache

Answer 9

generalised frontal/occipital pain, band like, mild/moderate, worse at end of day, stress/posture/lack sleep/responds to simple analgesics.

Question 10

typical patient tension headache

Answer 10

female, young (teenager/young adult)

Question 11

possible causes migraine

Answer 11

neurogenic inflammation of trigeminal sensory neurone innervating large vessels and meninges,
brain sensitised to otherwise ignored stimuli

Question 12

typical patient migraine

Answer 12

female, early to mid life

Question 13

migraine presentation

Answer 13

unilateral temporal or frontal/throbbing/pulsating, moderate to severe, disabling, prolonged, triggers, response to analgesics or triptans, photophobia, nausea, aura

Question 14

typical patient medication overuse headache

Answer 14

female, 30-40

Question 15

presentation medication overuse headache

Answer 15

headache 15 days/month, pre-existing headache disorder, using regular analgesics 10days/month, dull/tension/migraine like

Question 16

how to treat medication overuse headache

Answer 16

discontinue painkiller use

Question 17

typical patient cluster headache

Answer 17

Male, smoking history, 30-40

Question 18

pathophysiology cluster headache

Answer 18

hypothalamic activation with secondary trigeminal and autonomic involvement

Question 19

presentation cluster headache

Answer 19

unilateral, around eye, sharp stabbing quality, severe often disabling, 15 mins-3 hours then months without an episode, triggered by alcohol/smells, ipsilateral autonomic symptoms, only triptans and o2 effective

Question 20

presentation space occupying lesion

Answer 20

gradual, dull, worse in mornings, worsened with leaning forward, nausea/vomiting/focal neuralgia, papillodema

Question 21

cause trigeminal neuralgia

Answer 21

female, 50-60

Question 22

presentation trigeminal neuralgia

Answer 22

unilateral pain in more than one CNV division, sharp/stabbing/electric shock, sudden onset, preceding numbness, tingling

Question 23

what is temporal arteritis

Answer 23

vasculitis of large and medium sized arteries of head. often temporal

Question 24

presentation of temporal arteritis

Answer 24

older than 50, abrupt onset of headache and visual disturbance with jaw claudication.

Question 25

risk of temporal arteritis

Answer 25

irreversible loss of vision due to involvement of blood vessels supplying CNII

Question 26

cause trigeminal neuralgia

Answer 26

compression of CN V due to loop of blood vessel, or rarely a tumour or AV malformation

Question 27

symptoms due to involvement of cranial vessels GCA

Answer 27

headache, jaw claudication, scalp tenderness, loss Vision, abnormalities of temporal artery. pain, nodules, absence of pulse.

Question 28

symptoms due to involvement of great vessels.

Answer 28

claudication. of extremities eg. arm

Question 29

symptoms due to systemic inflammation

Answer 29

fever, night sweats, weight loss

Question 30

symptoms due to polymyalgia rheumatica

Answer 30

proximal myalgia and stiffness of neck and shoulder and pelvic girdles