CLIC

Question 1

Describe the features of a tension headache.

Answer 1

• Non-localised
• “Band-like” around the circumference, head feels heavy, “tight cap over skull”, “heavyweight on head and shoulders”
• Pericranial muscle tenderness
• Associated with stress

Question 2

Describe the features of a medication overuse headache.

Answer 2

• People who use acute pain-relief medicine more than two or three times a week or more than 10 days out of the month
• A dull constant headache which is often worse in the morning

Question 3

Describe the features of a migraine headache.

Answer 3

• Pain is unilateral, throbbing, and builds up over minutes to hours
• Associated symptoms - nausea, vomiting, photophobia, phonophobia
• Associated aura
• May last for days, made worse by physical exertion
• Precipitating factors include: hormones, coffee, food, weather, sleep
• Family history
• Comes in attacks

Question 4

Describe Giant Cell arteritis headache features.

Answer 4

• Pain in the temporal region
• ## Scalp tenderness (when brushing hair)

Question 5

Describe Cluster headache.

Answer 5

• Severe unilateral headache (usually around the eye area, miosis, ptosis, lacrimation, conjunctival injection)
• Men>women
• Short-lived attacks many times a day
• Agitation/pacing/restless patient

Question 6

Describe Angle-closure glaucoma headache.

Answer 6

• Severe pain surrounding the eye (sometimes it is poorly localised)
• Halos around lights
• A decrease in visual acuity
• Nausea and vomiting

(due to increase in intraocular pressure (IOP) - can damage the optic nerve)

Question 7

Describe meningitis headache.

Answer 7

Bacterial meningitis (viral clears up on its own and not dangerous):

• Severe generalised headache
• Confusion/Lethargy
• Pyrexial
• Nuchal rigidity (stiff neck, cant flex forward)
• Petechial rash (tiny purple and red spots, comes with other conditions too)
• Seizures

Question 8

Describe space-occupying lesion headache.

Answer 8

• Severe headache that can be unilateral of bilateral
• persistent
• worse with increased ICP (coughing, sneezing etc)
• nocturnal/early morning
• Associated with neurology - seizures, cognitive dysfunction, focal neurology

Question 9

Describe the features of a subarachnoid haemorrhage.

Answer 9

• Sudden onset! described as the “worst pain in my life” or as if someone has hit the person with a baseball bat on the back of their head
• loss of consciousness
• meningism
• Focal neurology

Question 10

State the red flags for a headache presentation.

Answer 10

SNOOP
S- Systemic Symptoms (fever, weight loss, pregnancy or post-partum, immunocompromised)
N- Neurological symptoms (confusion, impaired consciousness, papilloedema, meningism)
O- Onset new or rapid ( sudden? worsening? new at >50?)
O- Other associated conditions (Trauma, drug-use, wakes the patient up, worse with raised ICP)
P- Past history of headaches (is there differentiation from the usual pattern)

Question 11

How would you deal with an angry patient?

Answer 11

1 - Recognise the anger - from body language (standing up, clenching fists) and speech (tone, pitch)
2- Adjust communication - ensure a calm voice and a relaxed posture (don’t cross legs) and stay composed
3- Point out how the patient comes across “I can see you are looking very upset by this.” (it may diffuse the anger) will help confirm the emotion they are feeling
4- understand the anger - “why are you feeling this way?” “is there anything else that is making you feel this way?”
4- respond to the anger

Question 12

What would you do if a patient is angry and is refusing to sit down?

Answer 12

1- Stay standing up and speak to them on that level
2- DO NOT FIXATE ON THE FACT THEY DONT WANT TO SIT DOWN OR KEEP ASKING
3- If the patient relaxes as you communicate, then ask them to sit later on