Headache

Question 1

What are some typical clinical features of migraine?

Answer 1

Family history
Onset before age 20
Prodrome
Unilateral
Throbbing
Less than one per week
Lasts less than 24 hours
Vomiting
Aggravated by OCP
Aggravated by alcohol

Question 2

What are some pointers to serious causes of headache in children?

Answer 2

Persistent
Present first thing in the morning
Wakes child at night
No past history unilateral
No family history
Associated poor health
Associated neurological symptoms
Unilateral

Question 3

What are some drugs that can cause headaches?

Answer 3

Alcohol
Analgesics (aspirin, codeine)
Antibiotics/ antifungals
Antihypertensives
Caffeine
OCP
Corticosteroids
Nicotine
NSAIDs

Question 4

What is the IHS criteria for tension type headache?

Answer 4

1. Patient should have had at least 10 of these headaches
2. Headaches last 30mins to 7 days
3. Headaches must have at least 2 of the following
   - non pulsating
   - mild or moderate intensity
   - bilateral location
   - no aggravation with routine physical activity
4. The headaches must have both of the following
   - no nausea or vomiting
   - photophobia and phonophobia are absent, or at least one is absent
5. There should be less than 15 days of headache per months and than 180 days per year
6. Secondary causes are excluded

Question 5

What is the IHS criteria for common migraine (without aura)?

Answer 5

1. The patient should have at least 5 of these headaches
2. The headaches last 4-72 hours
3. The headache must have at least two of the following
   - unilateral location
   - pulsing quality
   - moderate or sever intensity, inhibiting or prohibiting daily activities
   - headache worsened by routine physical activity
4. The headache must have at least two of the following
   - nausea and/or vomiting
   - photophobia and phonophobia
5. Secondary causes of headache are excluded (eg normal exam and/ or imaging study

Question 6

What is the IHS criteria for migraine with aura (classic)?

Answer 6

There should be at least two attacks, including at least three of the following:

• reversible brain symptoms (cortical or brain stem)
• gradual development over 4 minutes
• aura duration less than 60 minutes
• headache follows aura in less than 1 hour

Question 7

What are clinical features of temporal arteritis?

Answer 7

Unilateral throbbing headache in the temporal region and scalp sensitivity with localised thickening with or without loss of pulsation of the temporal artery
Related to polymyalgia rheumatica

Question 8

True or false: headache is an uncommon presenting symptom of a cerebral tumour

Answer 8

True

Question 9

How long can post traumatic headaches persist for?

Answer 9

6-12 months