Headache assessment 1

Question 1

What are the symptoms for dangerous headaches?

Answer 1

• thunderclap
• fever
• focal symptoms
• persisting / progressing / provoked
• new onset

Question 2

What are most recurrent/chronic headaches?

Answer 2

Migraines

Question 3

What is a thunderclap headache?

Answer 3

• very sudden onset
• very painful headache
• can last between hours and days
• worrying prognosis is subarachnoid haemorrhage

Question 4

What is the usual cause of sudden onset fever/focal headache?

Answer 4

• influenza
• headache comes along with lots of fevers
• worrying prognosis is bacterial meningitis

Question 5

is bacterial or viral meningitis worse?

Answer 5

bacterial

viral is self-limiting

Question 6

What is migraine aura?

Answer 6

• get migraines which last a few minutes
• spreads, evolves then resolves by itself
• will have focal disturbance

Question 7

What is the worrying diagnosis of sudden onset persisting headache?

Answer 7

• CO poisoning (ask about there work and home)
• temporal arteritis (age over 50 and ESR over 50)
• intracranial hypertension (overweight women, daily headaches due to high pressure, often hear whoosing noise in head)

Question 8

What are non-dangerous symptoms of sudden onset persisting headache?

Answer 8

• neck stiffness

- dental pain

Question 9

What are the diagnoses of sudden onset provoked headache?

Answer 9

• CSF leak (only felt when standing)
• Cortisol / exertional (peak then go away, often benign)
• cluster headache (severe pain, runny nose, suddenly resolve, treatable with high O2)
• trigeminal headache (symptom of MS, intense pain, triggered by touching trigeminal nerve)

Question 10

What headache type do patients with brain tumours usually present with?

Answer 10

• isolated headache
• tension headache
• along with focal neurology/epileptic seizures
• papilloedema (causing vomiting in mornings)

Question 11

What are the types of safe headache?

Answer 11

• episodic migraine

- chronic migraines

Question 12

What two things do you always need to do for a headache assessment?

Answer 12

• Headache history to get type
• normal neuro exam
• scans not usually required

Question 13

How do you diagnose migraine?

Answer 13

• nausea
• pain severe enough to stop you wanting to do anything
• recurrent
• make you want to lie down
• pain is frontal
• normal neuro exam

Question 14

What are the risk factors of migraines?

Answer 14

• neck stiffness
• myopia
• family history
• female more common
• tempomandibular joint dysfunction

Question 15

What are the sensory symptoms of migraines?

Answer 15

• light
• noise
• smell
• movement
• touch
• nausea

Question 16

What are the common prodromal symptoms of migraine?

Answer 16

• depression
• hunger/thirst
• elation/energy
• apathy
• diarrhoea

Question 17

What can migraines cause?

Answer 17

• vertigo
• difficulty word-finding
• low concentration
• tingling / heaviness
• visual loss

Question 18

What are the symptoms of migraine aura?

Answer 18

• cortical spreading depression (cause)
• visual aura
• sensory-motor aura
• dysphasic
• spreads, evolves then resolves by itself

Question 19

What is chronic migraine?

Answer 19

pain doesn’t fully go away will have episodes which are more severe but migraine is constant

Question 20

What will tension-type headaches present as?

Answer 20

• bland
• featureless
• tightness or weight in their head
• can last hours, days or weeks
• any location
• no provoking or exacerbating factors

Question 21

What are the risk factors of tension headaches?

Answer 21

• neck stiffness
• visual acuity
• TMJ pain

Question 22

How will ice-pick headache present?

Answer 22

• brief
• very localised to pin point
• disappears within seconds
• can linger
• may increase to migraine

Question 23

What headaches warrant visiting A&E?

Answer 23

• thunderclap

- fever cant rule out meningitis

Question 24

What are the types of new onset headache?

Answer 24

• thunderclap
• fever
• focal
• progressive
• persisting