Headaches

Question 1

red flag symptoms of headache

Answer 1

• Short history
• severe recurrent headaches
• symptoms of raised ICP
• personality/behaviour change
• focal neurology
• seizures
• Hx of neurocutaneous syndrome
• systemic illness
• <3yo

Question 2

red flag signs of headaches

Answer 2

• papilloedema
• 6th N palsy
• decreased conciousness
• associated neurological signs

Question 3

symptoms of raised ICP

Answer 3

early morning headache
morning vomiting
headache worse with cough/valsalva

Question 4

What should you consider in a child presenting with occipital headaches

Answer 4

likely tension headaches but need to consider posterior fossa tumour

Question 5

What is paroxysmal hemicrania

Answer 5

rare, unilateral all over headache

ipsilateral autonomic features (ptosis, miosis, eye watering, eye redness, nose watering, eyelid oedema)

Question 6

Management of paroxysma hemicrania

Answer 6

indomethacin

Question 7

What is idiopathic intracranial HTN

Answer 7

elevated ICP >25cm (>28cm in obese)

no clinical, radiological or laboratory cause

Question 8

Symptoms of idiopathic intracranial HTN

Answer 8

headache
neck/shoulder/arm pain
N&V
tinnitus
diplopia/blurred vision/visual abnormalaties

Question 9

What is the investigation of choice if suspecting idiopathic intracranial HTN

Answer 9

MRI with venography - need to rule out intracranial masses or venous thrombosis’

Question 10

What is the management of Idiopathic intracranial HTN

Answer 10

topiramate or axetazolamide

Question 11

What features of idiopathic intracranial htn would spur you to get emergency neurosurigcal advise

Answer 11

associated with visual loss - may require CSF diversion