Headaches

Question 1

What are the 3 types of primary headaches and where do they affect?

Answer 1

1) Tension (Bilateral and forehead)
2) Migraine: Unilateral and above eye
3) Cluster (Around the eye -> Infra, Supra and Retro orbital)

Question 2

What are the 4 triggers of secondary headaches?

Answer 2

1) Meningitis (Pyrexia and Neck stiffness)
2) GCA (Over 50, temporal artery and woman)
3) Medication Overdose (Analgesic)
4) Sub-Arachnoid Haemorrhage

Question 3

What are the important questions to include in a headache history?

Answer 3

1) Time: Onset, Duration, pattern and frequency
2) Pain: Quality, severity, site and spread
3) Associated symptoms e.g. Photo/Phonophobia
4) Triggers
5) Response e.g. Medication
6) Symptoms between attacks

Question 4

What are the main red flags presenting for suspect brain tumour?

Answer 4

1) Cluster headache
2) Seizure
3) Significantly altered memory
4) New onset headache with cancer history
5) Papilloedema

Question 5

What are the main features of a migraine attack?

Answer 5

1) 4-72 hours in duration
2) Unilateral distribution
3) Can present with or without aura
4) Severe pain, Increased by physical activity and throbbing symptom
5) Photo or Phonophobia

Question 6

What are the 2 classifications of a migraine?

Answer 6

1) Chronic: Recurrent for over a year without remission (Less than month)
2) Episodic: 20%w/, 80%w/o aura

Question 7

What are the main features found in with aura?

Answer 7

• Language and motor disturbances
• Visual: Flashing lights and zig-zag lines
• Sensory: Tingling in hands and feet

Question 8

What is the main treatment for migraines?

Answer 8

1) Accurate diagnosis
2) Lifestyle modification
3) Psychological/Behavioural Treatment
4) Abortive Treatment: Paracetamol/NSAIDs and Triptan
5) Anti-Emetics: Topiramate and AEDs
6) Surgical Intervention

Question 9

What is the most common type of primary headache and what are the main features?

Answer 9

Tension Headache

• Bilateral found across the forehead
• Ranges from 30 mins to 7 days
• Found in > 10 attacks
• Not affected by physical movement
• Tightening of Vasculature (No pulsating feeling)
• Mild/moderate pain

Question 10

What is the 3rd type of primary headache and where is it most commonly found?

Answer 10

• Cluster headache
• Surrounding the eye: Supra, Infra and Retro-orbital
• 15 mins to 180 mins (3 H)
• Unilateral distribution
• 1 x every other day –> 8x a day
• Worst ever headache
• Cranial Autonomic features

Question 11

What is Trigeminal Neuralgia?

Answer 11

• Affects distribution of 1/more branches of TN

- 1/60 to 2 mins, Electric shock feeling, Unilateral. Severe pain

Question 12

What is the most common secondary headache and common features?

Answer 12

• Medication Overdose

- Present >15 days, Regular use for 3 months of symptomatic drugs and worse exacerbations when using analgesics etc

Question 13

What are the 2 other types of secondary headache and main features?

Answer 13

1) S-A: Sub-Arachnoid Haemorrhage with Thunderclap bleed, CT and Cerebral Angiography (Resus and Nimodipine)
2) Meningitis: Neck stiffness and pyrexia