headache

Question 1

red flags in headaches

Answer 1

age <4 years
ealry morning
wakes child from sleep
triggered or aggrevated by coughing, sneezing, or positional changes
sudden onset and severe
occipital region
associated vomiting without clear cause
significant change in established headache pattern or progressive worsening
focal neurological symptoms
new onset seizures
developmental regression
features of meningitis/encephalitis
recent Hx of head injury
known systemic disorder
medications: anticoagulants, antiplatelets
presence of ventriculoperitoneal shunt

Question 2

acute reccurent headaches

Answer 2

migraine

Question 3

chronic non-progressive headaches

Answer 3

tension-type
anxiety, depression
somatisation

Question 4

chronic progressive headache

Answer 4

tumour
benign intracranial hypertension
brain abscess
hydrocephalus

Question 5

acute on chronic non progressive headache

Answer 5

tension headache with co-existant migraine

Question 6

common migraine triggers

Answer 6

illness
poor sleep
exercise
menstruation
stress
heat
sun glare
foods: citrus, MSG, artificial sweeteners, nuts, onions, salty foods, caffiene, chocolate
skipped meals
missed medications or medication overuse

Question 7

red flag findings on examination

Answer 7

aletered conscious state
increasing head circumference centiles
abnormla head pposition
new focal neurological abnormlaities
signs of raised ICP (pappilloedema, ataxia, bradycardia with hypertension)
signs of meningism (photophobia, neck stiffness)

Question 8

tension type headache features

Answer 8

all ages
bilateral
pressing/tightening (non-pulsatile)
mild to moderate
chronic non-progressive
non execerbated by activity
no associated symptoms
may be precipitated by stress
lasts hours to days

Question 9

migraine features

Answer 9

all ages
unilateral or bilateral
pulsatile
moderate to severe pain
acute recurrent
associated with nausea, vomiting, photophobia, phonophobia

Question 10

cluster heedache

Answer 10

typically >12 years of age
unilateral, often around the eye
viariable (sharp, burning, throbbing, or tightening)
sever to very severe
acute recurrent
can cause restlessness and agitation
lasts minutes to hours

Question 11

associated symptoms in cluster headache

Answer 11

autonomic symptoms
ipsilateral conjunctival injection, tearing, rhinorrhoea, eyelid swelling, facial sweating, meiosis or ptosis

Question 12

how long do migraines last

Answer 12

30 minutes in young children, up to 72 hours in adolescents

Question 13

common secondary headache causes

Answer 13

infectious
trauma
raised ICP
vascular
drug related
psychiatric disorder

Question 14

general advice for headaches

Answer 14

ensure adequate hydration
encourage good sleep hygiene and a healthy exercise pattern
to prevent medication overuse in headache, limit use of simple analgesics and triptans
avoid triggers
adress emotional stressors

Question 15

specific treatment for paediatric migraine

Answer 15

simple analgesics
rest in a dark/quiet room
rizatriptan
avoid opoiods

Question 16

cluster headache specific treatment

Answer 16

simple analgesia has not been shown to be effective
administer oxygen
rizatriptan
may have secondary cause, low threshold for neuroimaging