Headaches

Question 1

Typical migraine features

Answer 1

Recurrent, severe headache, unilateral and throbbing. Associated with aura, nausea and photosensitivity. Interferes with daily living.
In women can be associated with menstruation.

Question 2

Tension headaches

Answer 2

Recurrent, non-disabling, bilateral headaches. Tight band sensation. Not aggravated by daily living. Related to stress.

Question 3

Cluster headache

Answer 3

Pain once/twice a day, lasting 15 minutes - 2 hours. Intense pain around one eye, restless during attack. Redness, lacrimation and lid swelling. Triggered by alcohol. More common in men and smokers.

Question 4

Temporal arteritis

Answer 4

Typically > 60 years, rapid onset unilateral headache, scalp tenderness, jaw claudication. Unilateral blindness. Raised ESR.

Question 5

Medication overuse headache

Answer 5

15 or more days per month, worse whist taking regular medications. Seen in opioid use.

Question 6

Acute causes for headache

Answer 6

Meningitis
Encephalitis
Subarachnoid haemorrhage
Head injury
Sinusitis
Acute closed angle glaucoma

Question 7

Chronic causes for headache

Answer 7

Psychological
Paget’s disease
Chronically raised ICP

Question 8

Cluster headache management

Answer 8

Acute- give 100% O2, then s/c triptan.

Prophylaxis with verapamil.

Question 9

Tension headache management

Answer 9

Aspirin, paracetamol, NSAID
Acupuncture
Low dose amitriptyline

Question 10

Post LP headache

Symptoms and management

Answer 10

Develops within 24-48 hours, may last several days, worse standing upright, improves with recumbent position.
Management: analgesia, rest. > 72 hours then consider blood patch, epidural saline, IV caffeine.

Question 11

Carbon monoxide poisoning

Answer 11

Headache in 90%, nausea and vomiting, vertigo, confusion, weakness.
Pulse oximetry falsely high, do VGB or ABD.
Normal carboxyhaemoglobin levels:
Non smokers < 3%
Smokers < 10%

Give high flow O2 via non rebreather. Minimum of 6 hours.