Headache

Question 1

What are the symptoms of trigeminal neuralgia?

Answer 1

Pain in face
Tingling
Worse with chewing/brushing hair (has triggers)
Unilateral

Question 2

What would you find on examination in trigeminal neuralgia?

Answer 2

Loss of sensation in affected side

Reduced tone in masseter and temporalis

Question 3

How would you treat trigeminal neuralgia?

Answer 3

Neuropathic pain drugs: gabapentin, pregabalin, TCAs

Question 4

In what demographic is benign intracranial HTN most common?

Answer 4

Obese pts

Pts on OCP

Question 5

Recall the symptoms of benign intracranial HTN

Answer 5

Gradually worsening headache

Increasing IOP causing visual changes

Question 6

How is benign intracranial hypertension treated?

Answer 6

Lumbar puncture

Acetazolamide

Question 7

Recall the classic signs of meningism

Answer 7

Fever
Neck stiffness
Photophobia

Question 8

What must be done before any LP?

Answer 8

CT head to check it won’t be dangerous

Question 9

What is the first line of management in suspected meningitis?

Answer 9

Empirical antibiotic treatment at outset whilst investigations continue

Question 10

Recall the type of leukocytosis in the CSF in a bacterial or a viral meningtits

Answer 10

Bacterial: high neutrophils
Viral: high lymphocytes

Question 11

What is the quickest way to determine the pathogenic organism in meningitis?

Answer 11

Gram stain of CSF

Question 12

What is the gram status of Neisseria meningitidis?

Answer 12

Gram negative

Question 13

What sort of meningitis are HIV patients particularly at risk of contracting?

Answer 13

Cryptococcal

Question 14

Describe the timing of a headache caused by a subdural haematoma

Answer 14

More commonn at night

Question 15

Which group of people are most at risk of subdural haematoma?

Answer 15

Elderly patients on anti-coagulation treatment

Question 16

Describe the positioning of a cluster headache

Answer 16

Unilateral

Periorbital

Question 17

In which demographic is giant cell arteritis most common?

Answer 17

White elderly females with PMR

Question 18

Other than headache, what symptoms does giant cell arteritis produce?

Answer 18

Sudden blindness

Jaw claudication

Question 19

What is the treatment for giant cell arteritis?

Answer 19

Very high dose prednisolone

Question 20

Recall the pattern of consciousness seen in extradural haematoma

Answer 20

Sudden loss in consciousness, followed by a lucent phase and then a rapid deterioration

Question 21

Describe the location of the pain in migraine

Answer 21

Unilateral headache

Question 22

How is migraine treated?

Answer 22

5HT agonists

Triptans

Question 23

What sort of headache is described as “thundercloud”?

Answer 23

Subarachnoid haemorrhage

Question 24

Which aetiology of headache can cause a 3rd nerve palsy?

Answer 24

Subarachnoid haemorrhage

Question 25

What is the most common cause of subarachnoid haemorrhage

Answer 25

Rupture of berry aneurysm in PCA

Question 26

What would be found in the CSF of someone who had a subarachnoid haemorrhage?

Answer 26

blood

Question 27

Which SOL are HIV patients particularly at risk of getting in the brain?

Answer 27

Toxoplasmosis

Question 28

Describe the variation of the headache caused by an SOL in the brain?

Answer 28

Diurnal and positional variation