Headache

Question 1

Headache history

Answer 1

• How and when did your headaches start?
  *

Question 2

Types of headache

Answer 2

• Primary
  
  • Tension headache
    
    • Constriction band
  • Migraine without aura (90%)
    
    • Bilateral or unilateral
    • Pulsatile
    • GI disturbance (nausea & vomiting, abdominal pain)
    • Photophobia
    • Lies in quiet dark place
    • Relieved by sleep
  • Migraine with aura (10%)
    
    • Preceded by aura (visual, sensory, motor)
• Secondary
  
  • Raised ICP and space-occupying lesion
    
    • Worse when lying down, coughing, straining
    • Wakes from sleep
    • Morning vomiting
    • Confusion
    • Visual disturbances
    • Change in personality, behaviour or educational performance

Question 3

Management of headaches

Answer 3

• Rescue treatments
  
  • Analgesia
    
    • Paracetamol
    • NSAIDs
  • Anti-emetics
    
    • Metoclopramide
• Prophylactic medication (headaches are frequent and intrusive)
  
  • Pizotifen (5-HT antagonist)
    
    • Weight gain
    • Sleepiness
  • Beta-blockers (propranolol)
    
    • Contraindicated in asthma
  • Sodium channel blockers (valproate)

Question 4

Investigations for headache

Answer 4

• BP
• Fundoscopy
• CT/MRI head (if red-flags)