Headache

Question 1

what is the most common cause of headache

Answer 1

tension headache

Question 2

what could be the causes of an acute single episode with meningism

Answer 2

if headache is severe, acute, felt over most of the head, neck stiffness- meningitis; encephalitis; subarach haemorrhage. admit urgently for CT head, do LP

Question 3

symptoms meningitis

Answer 3

fever, photophobia, stiff neck, purpuric rash, coma

Question 4

symptoms encephalitis

Answer 4

fever, odd behaviour, fits, decr conciousness

Question 5

symptoms subarach haemorrhage

Answer 5

sudden onset, worst ever, often occipital, stiff neck, focal signs, consciousness decr

Question 6

what happens to the headache in head injury

Answer 6

localised to site of injury but may be more generalised. often resistant to analgesia

Question 7

symptoms venous sinus thrombosis

Answer 7

subacute or sudden headache, papilloedema

Question 8

symptoms sinusitis

Answer 8

dull, constant ache- frontal and maxillary sinuses; tenderness and postnasal drip. pain worse on bending over.

Question 9

what is low pressure headache due to

Answer 9

CSF leak

Question 10

what can acute glaucoma cause

Answer 10

acute single episode headache

Question 11

acute glaucoma symptoms

Answer 11

typically elderly, long sighted people. constant aching pain develops rapidly around one eye radiating to the forehead. reduced vision, N/V

Question 12

signs acute glaucoma

Answer 12

red, congested eye; cloudy cornea; dilated non responsive pupil; decr acuity. treat- start acetazolamide 500 mg over several mins

Question 13

what are headaches that recurrently attack

Answer 13

cluster headache, migraine, trigeminal neuralgia

Question 14

headaches of subacute onset

Answer 14

giant cell arteritis- exclude in all >50 yrs- if headache lasted a few weeks. tender thickened pulseless temporal arteries, jaw claudication.

Question 15

chronic headache types

Answer 15

tension, raised ICP, medication overuse (analgesic rebound)

Question 16

what is tension headache

Answer 16

usual cause bilateral non pulsatile headache with scalp muscle tenderness without vomiting or sensitibity to head movement. stress relief

Question 17

what happens in raised ICP

Answer 17

typically worse on waking, lying, bending forward, coughing. vomiting, papilloedema, seizures, false localising signs, odd behaviour.

Question 18

what is contraindicated in raised ICP

Answer 18

LP until after imaging

Question 19

what medications can cause headache

Answer 19

mixed analgesics- paracetemol + codeine/opiates, ergotamine and triptans.

Question 20

what may be the cause of cluster headache

Answer 20

superficial temporary artery smooth muscle hyperreactivity to 5HT. hypothalamic grey matter abnormalities. commoner in smokers, onset any age. male: female 5:1

Question 21

symptoms cluster headache

Answer 21

rapid onset excruciating pain around one eye that may become watery and bloodshot with lid swelling, lacrimation, facial flushing, rhinorrhoea, miosis and ptosis.

Question 22

is pain uni or bilateral in cluster headache

Answer 22

strictly UNILATERAL- almost always affects the same side. lasts 15-160 min occurs once or twice a day often nocturnal.

Question 23

how long can clusters last

Answer 23

4-12 weeks followed by pain free periods of months or even 1-2 years before the next cluster

Question 24

treat acute attack cluster headache

Answer 24

100% O2 for 15 min via non re breathable mask, sumatriptan SC 6mg at onset

Question 25

preventatives cluster headache

Answer 25

suboccipital steroid injections, intranasal civamide, verapamil, lithium, melatonin

Question 26

trigeminal neuralgia symptoms

Answer 26

paroxysms of intense, stabbing pain lasting seconds in the trigeminal nerve distribution. unilateral affects mandibular and maxillary divisions. face screws up in pain

Question 27

trigeminal neuralgia- triggers

Answer 27

washing affected area, shaving, eating, talking, dental prostheses

Question 28

trigeminal neuralgia secondary causes

Answer 28

compression trigeminal root by aneurysmal intracranial vessels or a tumour, chronic meningeal inflammation, MS, zoster, skull base malformation

Question 29

treatment trigeminal neuralgia

Answer 29

carbamazepine (100mg/12h PO), lamotrigine, phenytoin, gabapentin