Headache & Intracranial Bleeds Supplementary

Question 1

What should you consider in terms of onset of headache when taking a history?

Answer 1

• acute - subarachnoid haemorrhage
• sub-acute - migraine
• gradual - tumour

Question 2

What should you consider in terms of relieving features of headache when taking a history?

Answer 2

• posture

- headache behavirous

Question 3

What should you consider in terms of exacerbating features of headache when taking a history?

Answer 3

• posture
• valsalva (sneezing, coughing, straining)
• diurnal variation

Question 4

What should you consider in terms of associated features of headache when taking a history?

Answer 4

autonomic features,
photophobia,
phonophobia,
positive visual symptoms,
ptosis,
miosis,
nasal stuffiness

Question 5

What do triptans do?

Answer 5

5HT agonists

Question 6

What are 3 side effects of amitriptyline?

Answer 6

• dry mouth
• postural hypotension
• sedation

Question 7

For how long is each drug trialled in migraine prophylaxis?

Answer 7

3 months

Question 8

What are 5 atypical types of migraine and describe them.

Answer 8

• acephalgic: get the symptoms without headache
• basilar: nauseating, vertigo
• retinal, opthalmic
• hemiplegic: weakness or sensory loss for days/weeks
• abdominal

Question 9

What is advice/treatment for tension headache?

Answer 9

• relaxation physio

- antidepressant (dothiepin/amitriptyline) for 3 months

Question 10

What are the features of paroxysmal hemicrania?

Answer 10

• severe unilateral headache

- unilateral autonomic features

Question 11

What is difference between hemicrania continua and paroxysmal hemicrania?

Answer 11

hemicrania continua is ongoing where paroxysmal is recurrent

Question 12

How long do SUNCT headaches last and what are 2 drug treatments?

Answer 12

15-120 seconds

lamotrigine or gabapentin

Question 13

What are the features of headache caused by idiopathic intracranial hypertension and what is classic patient?

Answer 13

headache shows diurnal variation,
morning N&V,
visual blurring/double vision,
papilloedema (25% patients get visual loss),
tinnitus,
classic patient: obese, F>M of child-bearing age

Question 14

What are investigations for IIH?

Answer 14

• CT/MRI normal
• LP: CSF elevated pressure but normal constituents
• CTV (venogram): look at cerebral venous sinuses
• visual fields
• fundoscopy

Question 15

What is treatment for IIH?

Answer 15

• weight loss
• acetazolamide, topiramate (carboanhydrase inhibitors)
• diuretics (furosemide)
• ventricular atrial/lumbar peritoneal shunt (rarely)
• intervention radiology e.g. intracranial venous sinus plasty/stenting

Question 16

What are primary headache syndromes?

Answer 16

headaches plus autonomic features e.g. TAC