Headache

Question 1

Red flags for headache (x7)

Answer 1

New onset in >50YO
Neuro signs
Hx HIV
Hx Cancer
Postural headache
Sudden onset
Worse when cough/sneeze/bend/strain

Question 2

Tension headache pathology

Answer 2

Tension in scalp muscles

Neurovascular irritation

Question 3

Features of tension headache

Answer 3

Bilateral (despite unilateral pathology)
Tight band + pressure behind eyes
No aura
No change with movement
No neuro signs

Question 4

Cluster headache features

Answer 4

Unilateral + can awaken in night
Occurs in clusters then remission period
Precipitated by alcohol
30-60 mins to reach max intensity
Total duration 30-90 mins

Question 5

Additional symptoms in cluster headache

Answer 5

Unilateral Horner’s (ptosis and miosis)
Unilateral lacrimation
unilateral red eye and lid swelling
Unilateral post nasal drip with sinus congestion

Question 6

Pathology of cluster headaches

Answer 6

Hypothalamic grey matter changes

Question 7

Management of cluster headaches (acute)

Answer 7

100% O2 for 15mins
SC sumatriptan
Other analgesia not helpful

Question 8

Prophylaxis vs cluster headaches

Answer 8

Valproate
Lithium
Steroids

Question 9

Features f paroxysmal hemicrania

Answer 9

Short duration (10-30 mins)
Frequent >5x/day
Response to indomethacin

Question 10

Definition of chronic daily headache

Answer 10

> 15 days per month

Question 11

Features of high ICP headache

Answer 11

Worse when waken
Bad if cough/sneeze/bend over
Papilloedema
Do imaging before LP

Question 12

Idiopathic intracranial HT

Answer 12

Young, overweight women +/- PCOS
Papilloedema, headache, change in vision
Normal imaging
Tx- Acetazolamide, wt loss

Question 13

Reduced ICP headache

Answer 13

Postural (worse on sitting/standing) relieved by lying down
May be preceded by straining/coughing/valsalva
Tx- autologous blood into spinal extradural space (blood seal)