CNS

Question 1

Primary headaches

Answer 1

Tension-type headaches (most common) and Migraines

Question 2

Secondary headaches

Answer 2

Caused by underlying cause e.g trauma, meningitis, sinusitis

Question 3

Symptoms of a tension-like headache

Answer 3

• Described as band of tightness around head
• Lasts up to 30 mins to 7 days
• Pain is bifrontal or bioccipital, generalised and non-throbbing
• Pain is gradual in onset and tends to worsen throughout the day
• Nausea and vomiting not associated + rarely causes photophobia or phonophobia

Question 4

Describe the 3 stages that headaches occur in

Answer 4

• Premonitory stage: Occurs hours or days before headache-> change in mood/behaviour, yawning, poor concentration, food cravings (ID of triggers present in this stage)
• Headache with aura or no aura
• Resolution stage

Question 5

What is a headache with aura?

Answer 5

• A classic migraine: less common and develops over 5 to 20 mins and can last up to an hour
• Can be visual: blind spots, zigzags, flashing
• Can be neurological: pins + needles starting in hand, migrating up arm to face then lips
• Within 60 mins of aura ending headache usually occurs

Question 6

Symptoms of migraines

Answer 6

• Pain is unilateral. throbbing and moderate to severe
• Pain can diffuse
• Physical activity + movement intensity
• Nausea but only 1/3rd will vomit
• Phonophobia and photophobia
• Fatigue
• Concentration is difficult and are irritable

Question 7

Treatment for Headaches

Answer 7

• First line: Simple analagesia e.g paracet, ibu, aspirin
• Migraleve: codeine + paracetamol
• Feverfew: medicincal herb used to relieve headache
• Sumatriptan: Can be prescribed by any healthcare practitioner to relieve migraine
• Buccastem M Buccal Tablets/Prochlorperazine Maleate: Nausea or vomiting relief associated with migraines

Question 8

Patient advice for headaches

Answer 8

• Mantain regular sleep pattern, regular exercise, relaxation techniques e.g yoga to relive stress
• Keep a food diary to identify foods that can be causing triggers
• Do not skip meals, eat regularly
• Recommend NHS website

Question 9

Treatment for insomnia

Answer 9

• Sedating Antihistamines: Diphenhydramine (Nytol) and Promethazine (e.g Phenergan) : aim is to reset sleep pattern
• Melatonin
• Therapy

Question 10

Patient advice for insomnia

Answer 10

• Mantain a good sleep hygeine: e.g no naps, caffeine containing drinls avoided, avoid watching TV before sleep
• Exercise throughout the day
• Deep breathing and mindfulness, yoga
• Chamomile
• Hot bath
• Acupuncture
• Lavender or peppermint oil