Headache

Question 1

Red flags for headache

Answer 1

New onset headache >55
Known/previous malignancy
Immuno-suppressed
Early morning headache
Exacerbation by valsalva*

Question 2

Headaches more common in m:f?

Answer 2

f

Question 3

is a migraine likely to be associated with an aura or not?

Answer 3

without aura

Question 4

migraine without aura criteria

Answer 4

at least 5 attacks
4-72hr duration
2 of:mod/severe, unilateral, throbbing pain, worst movement
1 of: autonomic features, photophobia/phonophobia

Question 5

most common cause of headache

Answer 5

tension headache

Question 6

Acute single severe episode with neck stiffness

Answer 6

Meningitis

Question 7

Things to exclude meningitis in a headache history

Answer 7

fever, photophobia, stiff neck, purpuric rash, coma

Question 8

Ix for head trauma headache

Answer 8

CT - helps to exclude potential subdural or extradural haemorrhage

Question 9

Signs of a subdural or extradural haemorrhage

Answer 9

drowsiness, lucid interval, focal signs

Question 10

Venous sinus thrombosis sign

Answer 10

subacute or sudden headache accompanied with pappilloedema

Question 11

Sinusitis signs as cause of headache

Answer 11

dull constant ache over frontal/maxillary sinuses, + tenderness and postnasal drip
pain often worse when bending over
CT can confirm diagnosis but not required
Hx of coryza

Question 12

AAC glaucoma signs

Answer 12

visual halo, vomiting, radiating to forehead

Question 13

Common migraine presentation

Answer 13

unilateral, nausea +/- vomiting, photophobia/phonophobia

Question 14

When, if a patient experiences an aura, have it ?

Answer 14

within a one hour window preceding the migraine - the aura is often visual and lasts for 15-30minutes

Question 15

potential triggers for migraine

Answer 15

CHOCOLATE

chocolate, hangovers, orgasms, oral contraceptive, lie-ins, alcohol, tumult, exercise

Question 16

Cluster headache symptoms/signs

Answer 16

severe pain around one eye - will become blood shot, watery, lid swelling
its always unilateral and will usually always occur at this side

Question 17

How long does a cluster headache last

Answer 17

15-160mins // once or twice a day and is often nocturnal -often lasts for a period of 4-12 weeks (can be chronic or episodic)

Question 18

Tx for cluster headache

Answer 18

100% oxygen via non rebreather for 15 minutes and sumatriptan 6mg at time of onset

Question 19

Examples of chronic headaches

Answer 19

tension headache, RICP, medication overuse headache, cluster (sometimes), migraine

Question 20

Tension headache Hx

Answer 20

bilateral, non-pulsatile headache +/- scalp muscle tenderness

Question 21

Raised ICP Hx

Answer 21

worse on waking, lying, bending forward, coughing
vomiting, papilloedema, seizure, strange behaviour

Do imaging to rule out idiopathic intracranial hypertension

Question 22

GCA Hx

Answer 22

> 50, headache lasted a few weeks, scalp tenderness, pulseless temporal arteries, jaw claudication

Question 23

Tx acute for migraine

Answer 23

NSAID (Aspirin, naproxen, ibuprofen)

Triptans CI if coronary Hx

Question 24

Most common type of aura

Answer 24

Visual

Question 25

Tx prevention for migraine

Answer 25

1. propranolol (avoid in asthma, PVD, heart failure)

2. Topiramate, valporate, gabapentine…(if they don’t work in 3 months just try another)