Headache

Question 1

How do you differentiate a migraine from a SAH when both are meningeal origin?

Answer 1

A SAH is really sudden - the patient can remember exactly what they were doing when it hit eg getting something out of the fridge

Question 2

Who gets idiopathic intracranial pressure?

Answer 2

Overweight females on the OCP

Question 3

What is idiopathic intracranial pressure?

Answer 3

A neurological disorder of increased intracranial pressure that mimics of the present of a mass lesions but its etiology is not understood - related to venous pressure

Question 4

What are the clinical features of a raised ICP headache?

Answer 4

Global

Progressive

Nausea is prominent

Worsened by - valsalva

Present on waking

Better on standing

+/- Papilloedema

Diplopia

Question 5

What is the triad of symptoms of idiopathic intracranial pressure?

Answer 5

Headache

Visual disturbance

Intracranial noise - whooshing sound

Question 6

What other syndromes can cause thunderclap headache?

Answer 6

Sexual and exertional headache

Vasospastic headache

Primary thunderclap headache

Question 7

What do you look for when LP someone with ?SAH?

Answer 7

Xanthochromia

Question 8

How is idiopathic intracranial pressure Mx?

Answer 8

Weight loss

Carbonic anhydrase inhibitors - Acetazolamide

Loop diuretics

Topiramate

Surgical - optic nerve fenestration

• Venous stenting
• Shunting of CSF

Question 9

What is Todd’s paralysis?

Answer 9

Is a focal neurological defect (usually weakness) that follows a seizures - subsides after 48 hours

Question 10

What is scintillating scotoma?

Answer 10

An area of partial alteration in the field of vision

Question 11

Describe the clinical features of a tension-type headache

Answer 11

Band-like

Pressing

Mild to moderate pain

Not usually accompanied by nausea, photo/phonophobia or exercise induction

Question 12

What are some red flags for headache?

Answer 12

Hx cancer

Hx trauma

Immunosuppression

Rapid onset

Associated hard neurology

Recent recent

Present one waking

Systemic symptoms

Question 13

What do you do when there is clinical suspicion of a SAH but the CT is clear?

Answer 13

LP, no excuses!

Question 14

What proportion of migraines have an aura?

Answer 14

1/3

Question 15

Describe the clinical feature of migraine

Answer 15

Recurrent, episodic

Moderate to severe pain

Unilateral

Pulsating

Exacerbated by exercise

May be accompanied with: Nausea, vomiting, vertigo, photo or phonophobia

Question 16

How does the symptoms of migraine aura progress? How is it useful?

Answer 16

Creeping over minutes, taking a path over the cortex

It’s useful for differentiating the symptoms from those caused by a cerebrovascular event that all occur immediately