9.2 Headache

Question 1

primary headache disorders

Answer 1

tension type
migraine
cluster

Question 2

secondary headache

Answer 2

life threatening
-intracranial lesion (mets, benign, malignant)
-meningitis

site threatening
-GCA
-primary closed angle glaucoma

non
-sinusuitis
-trigeminal neuralgia
-CCBs/drugs
-medication over use
-HTN

Question 3

headache red flags

Answer 3

Systemic signs (meningitis, cancer)
Neurologic symtpoms (SOL, ICH, glaucoma)
Onset new/changes patient >50 (malignancy)
Onset thunderclap (vascular)
Papilloedema, positional, precipitated. by exercise (ICP)

Question 4

tension type headache features

Answer 4

-generalised
-tight/band like
-worse end of day
-better with analgesics
-maybe nausea
-normal examination
-usually young

Question 5

pathophysiology of tension type headache

Answer 5

tension in head and neck muscles

Question 6

pathophysiology of migraine

Answer 6

neurogenic inflammation of trigeminal sensory neurones innervating large vessels and meninges, alters way brain processes pain due to increased sensitivity

Question 7

migraine features

Answer 7

-unilateral
-throbbing, pulsating
-often disabling
-prolonges 4-72 hours
-photophobia, phonophobia, aura
-normal examination

Question 8

medication over use headache features

Answer 8

-at least 15 days per month, with analgesics used 10 days per month
-variable character
-linked to depression and sleep disturbance

-neede to discontinue meds

Question 9

cluster headache features

Answer 9

-males more
-smoking history
-unilateral around eye
-sharp, stabbing, night
-agitated
-15mins-3 hours clusters with remission
-analgesics don’t work
-red watery eye, blocked nose, ptosis
-autonomic features on examination during attack

Question 10

SOL headache features

Answer 10

-gradual prpgressive
-worse morning
-worse on leaning forward, coughing, straining
-n+v
-focal neurological signs, papilloedema

Question 11

trigeminal neuralgia headache features

Answer 11

-unilateral, divisions of CNV
-sharp, electric shock
-severe, few secs to 2 mins
-sudden
-worse from cold air, wind, combing hair
-tingling numbness precede
-normal examination

Question 12

pathophysiology of trigeminal neuralgia headache

Answer 12

compression of CNV due to aborrent loop of blood vessel

Question 13

why does GCA risk loss of vision?

Answer 13

involvement of blood vessels supplying CN2

Question 14

GCA symptoms

Answer 14

jaw claudication
headache
scalp tenderness temporal