Headache

Question 1

What is the most common type of Primary headache?

Answer 1

Tension -type headache
(although this doesn’t present to doctors often).
Is not disabling.
Is a mild bilateral headache, feels like tightening or pressing.

Question 2

What should a Tension- type headache be treated with?

Answer 2

Acutely- paracetamol, Ibuprofen (NSAID’s)
Preventative - Tricyclic anti-depressants (e.g Amitriptyline)

And like with other primary headaches avoid triggers (lifestyle changes).

Question 3

What causes primary Headaches?

Answer 3

There is no structural or biochemical reason for it.

It is due to sensitisation of normal pain pathways.

Question 4

What is migraine?

Answer 4

It is a chronic primary headache disorder with episodic attacks. It is disabling.

Migraines can commonly be caused by medication overuse.

Question 5

What are the stages of migraine and give 2 symptoms for each.

Answer 5

Premonitory- Mood changes, fatigue, food cravings

Aura- fully reversible transient symptoms, could be visual, sensory, motor or speech symptoms.

Early headache- dull headache, Muscle pain

Advanced headache- unilateral, nausea, photophobia

Postdrome- fatigue, muscle pain

Question 6

How is Chronic headache classified?

Answer 6

headache present > or equal 15 days/month of which > or equal 8 have to be migraine for more than 3 months.

Question 7

How is Medication overuse migraine classified?

Answer 7

headache present > or equal 15 days/month which developed or worsened when taking regular symptomatic medication.

Question 8

Management of migraine

Answer 8

Anti-epileptics e.g sodium valproate
Propranolol (beta blocker)
Botox
Tricyclic antidepressants (amitriptyline)
Calcitonin gene receptor peptide monoclonal antibodies (CGRP ma’s)

Question 9

What is a neuralgia?

Answer 9

An intense burning or stabbing pain, which is usually brief but severe.
Pain extends along the course of the affected nerve.

Question 10

What is a neuralgia caused by?

Answer 10

Nerve irritation or damage.

Question 11

What is the most common cranial neuralgia?

Answer 11

Trigeminal

Question 12

What symptoms are seen in a neuralgia?

Answer 12

Intense spontaneous stabbing pain

Each stab is 5-10 seconds long

Question 13

Triggers of trigeminal neuralgia?

Answer 13

Wind
cold
Touch
Chewing

Question 14

what is a common cause of trigeminal neuralgia?

Answer 14

Vascular compression of the trigeminal nerve.

MS
brainstem lesions and intracranial tumour are all uncommon causes

Question 15

What are Trigeminal autonomic cephalagias?

Answer 15

This is a term for a collection of headache disorders.

Cluster headaches
Paraoxysmal hemicrania
SUNCT/SUNA
Hemicrania continua

Question 16

How are different types of TAC’s differentiated from one another?

Answer 16

Their frequency and duration

Question 17

Frequency and duration of Cluster headaches?

Answer 17

1-8 attacks a day

15mins to 3hrs long

Question 18

Frequency and duration of paraoxysmal hemicrania?

Answer 18

1-40 attacks per day

2-30 mins long

Question 19

Frequency and duration of SUNCT/SUNA?

Answer 19

3-200 attacks per day

5s to 5 minutes

Question 20

How are paroxysmal hemicrania and hemicrania continua defined?

Answer 20

They both respond completely to Indometacin but other NSAIDs do not have the same effect.

Question 21

How long do auras usually last?

Answer 21

15-60 minutes

Can be visual e.g. see flshing lights or zig zag lines
sensory- pins and needles
Motor
speech

(can be mistaken for TIA sometimes)