Headache

Question 1

Red flags for headache?

Answer 1

• New onset headache > 55
• Known/previous malignancy
• Immunosuppressed
• Early morning headache
• Exacerbation by valsalva

Question 2

Describe the headache in migraine.

Answer 2

Usually unilateral 
Throbbing and pulsatile in nature 
Lasts 4-72hours 
Made worse by movement 
Associated with at least 2 of photophobia, phonophobia or osmophobia (smells)

Question 3

Management of migraine?

Answer 3

1st line: NSAIDs and paracetamol +/- antiemetic

Take NSAID at onset of headache (60% see a significant reduction in pain at 2 hours)

2nd line: aspirin + triptan (triptans are serotonin agonists that should not be taken more than 2x per week as patients can become dependent and experience rebound headaches)

Question 4

Prophylactic management of migraine?

Answer 4

Consider prophylactic management if >3 attacks per month that are associated with considerable disability. Options include:

• Propanolol (avoid if asthma)
• Amitriptyline (dry mouth, postural hypotension, sedation)
• Topiramate (carbonic anhydrase inhibitor)

Drink at least 2 litres per day, avoid caffeine. Healthy balanced diet. Decrease stress and exercise regulatory.

Question 5

Tension headache presentation?

Answer 5

Bilateral pressure or tightness in the head that is mild to moderate in severity and lasts 30mins to 7 days.

Absence of: nausea/vomiting
- Photophobia/phonophobia
Not made worse by activity or movement

Question 6

Managament of tension headaches?

Answer 6

Paracetamol / NSAIDs.

Try not to use analgesia more than 3x per week.
Use relaxation therapies.

Question 7

What is the presentation of cluster headaches?

Answer 7

Headache commonly occurs at night. Severe unilateral headache around the orbital area.

Lasts 30mins to 3 hours.

Associated autonomic symptoms e.g. lacrimation, mitosis, conjunctival injection.

Question 8

Management of an acute cluster headache?

Answer 8

High Flow oxygen.

2nd line triptan. (Sub cut)

Prednisone can also be five

Question 9

Prophylactic management of a cluster headache?

Answer 9

1st line = verapamil

2nd line = topiramate

Question 10

What is SUNCT and what is the mmanagement?

Answer 10

Short lived (15-120s)
Unilateral
Neuralgiform headache (trigeminal)
Conjunctival injections
Tearing 

Treatment = lamotrigine, gabapentin

Question 11

Trigeminal neuralgia, presentation and management?

Answer 11

Women>men, triggered by touch (V2/V3)
Severe, stabbing, unilateral pain.
Duration1sec - 90s
Frequency 10-100 per day.

Management = Carbamazepine, Gabapentin, phenytoin, baclofen.

Surgical = ablation vs decompression.