Headache

Question 1

Migraine

Answer 1

Common: no aura
Classical: aura preceding headache
Complex: associated neurological deficit
Between 1 and 72 hours
Unilateral, throbbing
Nausea, vomiting, abdominal pain
Triggers - stress, relaxation, cheese, chocolate, citrus, nuts, caffeine
Family history
Examination normal

Question 2

Migraine management

Answer 2

No diagnostic test
Sleep - rest and simple analgesia
Severe/frequent attacks - prophylactic beta-blockers or pizotifen
In adolescents, serotonin agonists (eg sumitriptan) can be given during acute attack

Question 3

Tension headache

Answer 3

Symmetrical
Band-like
Gradual onset
<24hours
Worse towards end of day
No nausea or vomiting
Recur frequently
10% school children

Question 4

Tension headache management

Answer 4

Reassurance, sympathy, rest
Simple analgesia
Address underlying stress/anxiety
Minimise school absence

Question 5

Headache red flags

Answer 5

Sudden onset, severe headache
Headache lasting several days or progressing in severity
Weight loss
Associated with straining eg coughing or increased by lying down
Morning headache, especially associated with vomiting
Seizures or focal neurology

Question 6

Tumour

Answer 6

Raised ICP
Worse in recumbent position (night/early morning)
Nausea and vomiting
Pain mild and diffuse
May be personality changes
Focal neurological deficit (especially cerebellar - post fossa)
Blurred vision
Squint (VI nerve palsy)
Ataxia, clumsiness
Headtilt
Endocrine dysfunction
If papilloedema, hypertension, bradycardia, or focal signs present, urgent imaging