Headache

Question 1

Most common ?

Answer 1

tension headache

Question 2

if its Rapid onset (concerning)
• Want to rule out?
- what else could it be?

Answer 2

SAH (worst ever headache)
• Meningitis – fever, photophobia, stiff neck, purpuric rash, coma. (Do LP, start Abx).
• Encephalitis – fever, odd behaviour, fits or reduced consciousness. (Urgent CT and LP to look for signs of infection).

Question 3

if its gradual onset ?

Answer 3

• Venous sinus thrombosis – subacute headache, papilloedema
• Sinusitis – dull, constant ache over frontal or maxillary sinuses +/- postnasal drip, pain worse on bending over. Pain lasts 1-2 weeks.
• Intracranial hypotension – CSF leakage, worse on standing,

Question 4

if its throbbing/pulsatile?

if it feels like a tight band?

Answer 4

migraine

tension headache

Question 5

• Chronic, progressive headaches tend to indicate ?

Answer 5

Increased ICP

Question 6

Cluster Headache

Symptoms

Treatment

Prevention

Answer 6

Rapid onset of excruciating pain around one eye
unilateral and always affects same side.
Lasts 15-180mins, once or twice a day for about 4 weeks then disappears

• Give 100% oxygen for 15min via non-rebreathable mask (unless COPD)
• Sumatriptan S/C at onset.

avoid triggers like alcohol

Question 7

Migraine

Symptoms
- AURA?

Triggers
CHOCOLATE

Tx:

• pain relief?
• if nausea from meds?
• if vomiting from meds?
• do not use what?
• prevention meds?

Answer 7

moderate/severe throbbing Headache

Can occur with or without Aura

C – chocolate 
H – hangovers 
O – Orgasms 
C – cheese/caffeine 
O – oral contraceptives
L – lie ins 
A – alcohol 
T – Travel 
E – exercise 

Pain is treated using Triptan (Sumitriptan 50mg or 100mg)

Consider Nasal Preparation or “melt” preparation if causing nausea

Consider antiemetic (Metoclopramide) if nausea vomiting features

Do not use opioids

Topiramate 25mg PN or Propranolol 80mg OD as preventers

Question 8

Tension Headache

presents as?

Tx?

Answer 8

Bilateral band –

Simple Analgesia

Question 9

Hypertensive Encephalopathy

features?

Tx?

Answer 9

headache/visual blurring/papilledema

IV Labetalol

Question 10

Venous Sinus Thrombosis

Tx?

Answer 10

LMWH

Question 11

Temporal arteritis

features?

tx?

Answer 11

Ipsilateral blindness/ skin sensitivity –

Steroids (prednisolone)

Question 12

Migraines in women

increased incidence of migraine and ischaemic stroke by use of?

if migraines occur use what instead?

Answer 12

combined OCP

progesterone only pill