Headache

Question 1

What could fever, photophobia or neck stiffness be indicative of?

Answer 1

Menignitis

Encephalitis

Question 2

What could new neurological symptoms be indicative of?

Answer 2

Haemorrhage

Malignancy

Stroke

Question 3

What could dizziness be indicative of?

Answer 3

Stroke

Question 4

What could visual disturbance be indicative of?

Answer 4

Temporal arteritis

Glaucoma

Question 5

What could sudden onset occipital headache be indicative of?

Answer 5

Subarachnoid haemorrhage

Question 6

What could headache worsening on coughing or straining be indicative of?

Answer 6

Raised ICP

Question 7

What could postural headache worse on standing, lying or bending over be indicative of?

Answer 7

Raised ICP

Question 8

What could vomiting with headache be indicative of?

Answer 8

Raised ICP

Carbon monoxide posoning

Question 9

What could headache with history of trauma be indicative of?

Answer 9

Intracranial haemorrhage

Question 10

What could headache be indicative of during pregnancy?

Answer 10

Pre-eclampsia

Question 11

What could headache with papilloedema be indicative of?

Answer 11

Raised ICP

Question 12

What is a secondary headache?

Answer 12

Similar presentation to tension headache but with a clear cause

Question 13

Causes of secondary headache

Answer 13

Underlying medical conditions e.g. infection, obstructive sleep apnoea or pre-eclampsia

Alcohol

Head injury

Carbon monoxide poisoning

Question 14

Symptoms of migraine

Answer 14

Unilateral throbbing headache preceded by an aura, such as visual or sensory (paraesthesia spreading from fingers to face) symptoms

4-72hrs

Photophobia & phonophobia

Question 15

Diagnosis of migraine

Answer 15

Presence of aura confirms diagnosis

When no aura, following criteria required:
At least 5 headaches lasting 4-72 hours with nausea/vomiting or photo/phonophobia

AND 2 of:
Unilateral headache
Pulsating character
Impaired or worsened by daily activities

Question 16

Management of migraine

Answer 16

Avoid triggers

Prophylaxis with propanolol or topiramate

Question 17

Symptoms of tension headache

Answer 17

Bilateral, non-pulsatile headaches

Tight band around head

May be associated scalp muscle tenderness

Question 18

Management of tension headache

Answer 18

WHO pain ladder

Question 19

Symptoms of cluster headache

Answer 19

Recurrent attacks of sudden-onset unilateral periorbital pain

Watery and bloodshot eye, lacrimation, rhinorrhoea, miosis, ptosis, lid swelling, and facial flushing

Last 15 minutes to 3 hours, occur once or twice a day, over a period of 4-12 weeks

Followed by a pain-free period of months before the next cluster begins

Question 20

Management of cluster headache

Answer 20

Avoid triggers

Prophylaxis with verapamil

Question 21

Management of cluster headache acute attack

Answer 21

100% oxygen via non-rebreathable mask

Subcutaneous or nasal triptan

Question 22

Management of migraine acute attack

Answer 22

Triptan (+ paracetamol or NSAID)

Question 23

Symptoms of trigeminal neuralgia

Answer 23

Recurrent short episodes of severe stabbing pain, affecting one side of the face, in the trigeminal nerve distribution

Pain may be triggered by touching the face, eating, or talking

Question 24

Investigations in trigeminal neuralgia

Answer 24

MRI to exclude secondary causes e.g. tumour/aneurysm

Question 25

Management of trigeminal neuralgia

Answer 25

Carbamazepine first-line Surgery: microvascular decompression

Question 26

Symptoms of raised ICP

Answer 26

Headaches which are worse in the morning and upon bending over, and improve after vomiting and lying down May be associated with neurological deficits due to compression of cranial structures by a space-occupying lesion, such as a tumour or haemorrhage

Question 27

Diagnosis of raised ICP

Answer 27

CT head

Question 28

Management of raised ICP

Answer 28

Treat underlying cause e.g. surgery and chemo for cancel, clot evacuation for haemorrhage

Question 29

Sinusitis symptoms

Answer 29

Inflammation in the ethmoidal, maxillary, frontal or sphenoidal sinuses Facial pain behind nose, forehead and eyes Often tenderness over affected sinus Usually resolves within 2-3 weeks

Question 30

Management of sinusitis

Answer 30

Nasal irrigation with saline can be helpful Prolonged symptoms can be treated with steroid nasal spray Antibiotics are occasionally required

Question 31

Occipital, sudden onset, high intensity headache

Answer 31

Subarachnoid haemorrhage

Question 32

What is meningism a red flag symptom for?

Answer 32

Haemorrhage Meningitis

Question 33

Present on waking, worse on laying down, social neurological signs, higher cortical dysfunction, autonomic instability, papilloedema

Answer 33

Raised ICP SOL

Question 34

What are visual changes and red eye red flag symptoms for?

Answer 34

Acute glaucoma Surgical 3rd nerve palsy

Question 35

Temporal with associated changes

Answer 35

GCA