Headache presentations

Question 1

Kernig sign (4)

Answer 1

• Person lies flat
• Flex thigh = right angle to trunk
• Completely extend leg at knee joint
• If can’t=positive for meningitis/SAH

Question 2

Bruzinski’s sign (2)

Answer 2

• Flex neck

- Positive= hips and knees flex = meningitus

Question 3

Migrane diagnostic criteria

Answer 3

• Episodes of headache: 4hrs - 3 days
• Onset= pre-40
  AT LEAST TWO
• At least unilateral pain
• Throbbing
• Motion sensitivity
• Moderate - severe intensity
  AT LEAST ONE:
• Nausea/vomiting
• Photophobia
• Normal exam

Question 4

What is often but not always associated with migrane?

Answer 4

Aura

Question 5

What are the symptoms of a migrane aura? (3)

Answer 5

• Shimmering
• Teichopepsia (zigzag lines)
• Image fragmentation

Question 6

Signs in GCA? (3)

Answer 6

• Reduced/absent superficial temporal artery pulse (below pterion skull)
• Pain
• Erythema/thickening

Question 7

Trigeminal neuralegia (6)

Answer 7

• Intense stabbing pain
• Lasts seconds
• Trigeminal distribution (esp. manible/maxillary)
• Unilateral
• Triggers: washing/shaving etc
• Recurring

Question 8

Typical trigeminal neuralegia (2)

Answer 8

• 50+

- Asians

Question 9

Cluster headache character (10)

Answer 9

• Rapid onset
• Excreciating pain around 1 eye
• Watery + bloodshot
• Lid swelling
• Lacrimination
• Facial flushing
• Rhinorrhoea
• Unilateral
• Nocturnal

Question 10

Time/onset of cluster headaches (3)

Answer 10

• 15-180 min
• OD/BD
• 4-12 week clusters then PAIN FREE many months

Question 11

Hemicrania continua symptoms

Answer 11

• Continuous
• Fluctuating
• Unilateral pain
• Eye watering + nasal blocking
• Nausea + vomiting + photophobia

Question 12

What confirms a diagnosis of hemicrania continua ?

Answer 12

Indomethacin