Headache

Question 1

What are the types of acute single episode headaches?

Answer 1

• With meningism
• Head injury
• Venous sinus thrombosis
• Sinusitis
• Tropical illness
• Low pressure headache
• Acute glaucoma

Question 2

What is meningism?

Answer 2

Acute headache, severe, felt over most of the head accompanied by a stiff neck (meningeal irritation)

Question 3

What must you exclude in headache with suspected meningism? How would you investigate

Answer 3

1) Meningitis - fever, photophobia, stiff neck, purpuric rash, coma
2) Encephalitis - fever, odd behaviour, fits, reduced consciousness
3) Subarachnoid haemorrhage - SUDDEN onset, ‘worst ever’ headache, often occipital, stiff neck, focal signs, reduced consciousness.

Admit immediately for urgent head CT, and if CT negative then lumbar puncture to look for signs of infection or blood products.

Question 4

What must you exclude in head injuries and how?

Answer 4

Head CT to rule out subdural and extradural haemorrhage.

Question 5

What are the characteristics of venus sinus thrombosis ?

Answer 5

Subacute or sudden headache, papilloedema,