Headache

Question 1

Headache is caused by traction, displacement, inflammation, vascular spasm or distension of the pain sensitive structures in the head or neck. True or false?

Headaches that are new in onset and clearly different from any the patient has experienced previously are commonly a symptom of serious illness and therefore demand prompt evaluation. True or false?

The precipitating factors, associated symptoms and clinical findings on examination, together with the results of appropriate investigations, can provide a guide to the cause of the headache. True or false?

Answer 1

True

True

True

Question 2

Acute,
subacute and
chronic Causes of Headache 🤕

Answer 2

Causes

Acute:

1. Subarachnoid haemorrhage and other cerebrovascular diseases
2. Infections e.g. malaria, typhoid fever, viral infections
3. Meningitis or encephalitis
4. Ocular disorders (glaucoma, acute iritis, refractive errors)
5. Post-seizures
6. Post-lumbar puncture
7. Hypertensive encephalopathy

Subacute:

8. Lesions of the middle ear (otitis media, mastoiditis)
9. Intracranial mass (tumour, subdural haematoma, abscess)
10. Idiopathic intracranial hypertension
11. Trigeminal neuralgia
    11, Post-herpetic neuralgia
12. Severe hypertension
13. Atypical facial pain
14. Medication
15. Post trauma
16. Giant cell temporal arteritis

Chronic:

17. Migraine
18. Cluster headache
19. Tension headache
20. Cervical spine disease
21. Sinusitis
22. Dental disease
23. Psychogenic causes

Question 3

A headache is pain or discomfort in the head or face area. True or false

Answer 3

True

Question 4

Signs and Symptoms

Answer 4

Symptoms
y Visual e.g. photophobia, flashes of light, floaters
y Aura e.g. visual, auditory, gustatory, tactile
y Accompanying features e.g. nausea, vomiting, fever, collapse y Site of pain e.g. occipital, ocular, unilateral, bilateral
y Characteristics e.g. pulsating, throbbing, sharp, dull
y Relieving or exacerbating factors e.g. cough, coitus, lying flat

Signs
y Usually none
y Local tenderness
y Fever
y Neck stiffness
y Positive Kernigs
y Markedly elevated blood pressure
y Drowsiness
y Excessive lacrimation
y Conjunctival redness
y Papilloedema
y Focal neurologic deficit e.g. cranial nerve deficit, hemiparesis

Question 5

Investigations

Answer 5

Investigations
y FBC
y ESR
y Skull X-ray
y Cervical X-ray
y X-ray of the paranasal sinuses
y Lumbar puncture (meningitis, subarachnoid bleed) y Eye tests (tonometry, refraction, fundoscopy)
y Cranial CT scan or MRI if warranted

Question 6

Treatment

** Pharmacological treatment refers to book ( STG page 195)

Answer 6

Treatment
Treatment objectives
y To relieve pain
y To identify and treat underlying cause
y To prevent complications relating to the underlying cause y To improve quality of life
Non-pharmacological treatment
y Relaxation techniques
y Avoidance of stress
y Psychotherapy
y Identification and elimination of trigger factors

Question 7

Referral Criteria

Answer 7

Referral Criteria

Refer recurrent, unresolving or unexplained headaches to a specialist for evaluation and appropriate management.