FN: Headaches key features

Question 1

SAH

Answer 1

1. Sudden onset, worse ever, occiptal headache

2. Meningism, focal signs, reduced conciousness

Question 2

Venous sinus thrombosis

Answer 2

1. sagittal: headache, vomiting, seizures, reduced vision, papilloedema
2. Transverse: headache ± mastoid pain, focal CNS signs, seizures, papilloedema

Question 3

Cortical Vein thrombosis

Answer 3

1. thunderclap headache
2. Stroke - like focal symptoms over days
3. focal seizures are common

Question 4

Meningitis

Answer 4

Fever, photohobia, neck stiffness, kernigs +ve
Pupuric rash
Reduced consciousness

Question 5

Encephalitis

Answer 5

fever, odd behaviour, fits, focal neuro, reduced consiouness

Question 6

Acute glaucoma

Answer 6

1. Constant unilateral eye pain, radiating to forehead
2. reduced acuity, haloes, n/v
3. Red eye, cloudy cornea
4. dilated, non-responsive pupil

Question 7

Tension headache

Answer 7

Bilateral/vertex-bitemporal, non-pulsatile, band-like

Question 8

Migraine

Answer 8

Prodrome - aura - headache
Unilateral, throbbing
n/v, phono/photophobia

Question 9

cluster headache

Answer 9

1. Rapid onset very severe pain around/behind one eye
2. Red, watery eye, nasal congestion
3. Miosis, ptosis
4. Attacks last 15min-3hrs, 1-2 x/day, mostly nocturnal
   clsuters last 4-12 wks, remission lasts 3mo-3yrs. can be chronic vs. episodic

Question 10

Cluster headache Rx

Answer 10

100% Oxygen via non-rebreathe mask, sumotriptan

Question 11

Cluster headache prevention

Answer 11

Verapamil
Topiramate
Lithium

Question 12

Hemicrania

Answer 12

1. Paroxysmal hemicranias: cluster-like headache lasting 5-45min, 5-30 x/day
2. SUNCT: short-lasting unilateral neuralgia with conjunctival injection and tearing, attack last 15-60s, recur 5-30x/hr
3. Hemicrania continua: continous cluster-like headache

Question 13

Hemicrania Rx

Answer 13

All respond well to indomethacin

Question 14

Trigeminal neuralgia

Answer 14

1. Paroxysmas of unilateral intense stabbing pain in trigeminal distribution (usually V2/3)
2. Male > 50yrs
3. Secondary in 14% compression of CNV, MS, Zoster, Chiari malformation

Question 15

Trigeminal neuralgia Triggers

Answer 15

Washing area, shaving, eating, talking

Question 16

Trigeminal neuralgia Ix

Answer 16

Exclude secondary cause by MRI

Question 17

Trigeminal neuralgia Rx med

Answer 17

CBZ
Lamotrigine
Gabapentin

Question 18

Trigeminal Rx surg

Answer 18

Microvascular decompression

Question 19

Analgesia Overuse

Answer 19

1. episodic headache becomes daily chronic headache

2. Use OTC analgesia on 6 days/month max

Question 20

ICP rise

Answer 20

Worse in AM, stooping, visual probs (papilloedema), obese women

Question 21

ICP reduced

Answer 21

Worse sitting or standing

Question 22

TMJ dysfunction

Answer 22

Periauricular pain on chewing
Asociated with crepitus
Earache, headache

Question 23

Giant cell arteritis

Answer 23

> 60 yrs, ESR>60, pred 60mg)

1. Unilateral temple/scalp pain and tenderness
2. Thickened, pulseless temporal artery
3. Jaw claudication, amaurosis fugax, sudden blindness
4. Assocation with PMR in 50%

Question 24

GCA investigation

Answer 24

ESR very high
Platelets increased
ALP increased
HB low
Temporal artery biopsy

Question 25

GCA Rx

Answer 25

High dose pred (60mg/d PO) for 5-7 d
guided by symptoms and ESR
Give PPI + bisphosphonates

Question 26

GCA prognosis

Answer 26

2yr course then complete remission