Headaches

Question 1

Tension: triggers, syx, mx

Answer 1

Headache due to muscle-tension. Triggers: stress, squinting, poor posture, dehydration, tired, missed meal, screen

Syx:

• tight band around head
• gradual onset
• 30mins-several hrs
• neck pain
• episodic

Mx

• avoid triggers, reassure
• analgesia
• relaxation, sleep hygiene, diet, water intake etc
• physio
• acupuncture (NICE recommends) if chronic

Question 2

Migraine: triggers + dx for migraine, migraine with aura, chronic migraine

Answer 2

Triggers: stress, dehydration, tired, missed meal, COCP, Chocolate/ Cheese/caffeine, alcohol

Dx:
5 attacks lasts 4-72hrs + at least 2 of following:
- Unilateral
- Pulsating 
- Moderate-severe intensity 
- Aggravation or avoidance of activities
& at least 1 of:
- N+/-V
- Photophobia + phonophobia

Dx: migraine with Aura: at least 2 of:

• Visual syx (flashing lights/unusual lights/zig zag)
• Sensory syx (paraesthesia)
• Speech or language syx

Dx: chronic migraine
Occurs >15d/month for 3m.

Question 3

Migraine mx + prophylaxis

Answer 3

(1. ) Diary, identify triggers + monitor Rx
(2. ) Lifestyle: hydration, stress mx, sleep hygiene
(3. ) Avoid medical overuse headache

Medical

(1. ) Simple analgesics: ibuprofen, aspirin, pcm. NOT opioids.
(2. ) PO Triptan (1st line)
(3. ) Antiemetics
(4. ) FU 2-8w

Prophylaxis
(1.) Propranolol (2.) Topiramate (CI: pregnancy) (3.) Amitriptyline

Non-pharm prophylaxis

(1. ) Relaxation technique/mindfulness/ meditation
(2. ) Acupuncture

Question 4

Cluster headaches: triggers, presentation, dx

Answer 4

Triggers: alcohol, histamine, sleep disruption, solvents

Presentation

• sudden severe u/l pain around eye/temporal
• ipsilateral ANS syx: lacrimation, eyelid oedema, nasal congestion, sweating, ptosis
• Syx are predictable occurs at same time for weeks.
• Pt agitated during headache

Dx: >5 attacks with:

• severe u/l pain lasts 15-180mins
• > 1 ANS syx
• attacks occur every other day to 8x/day
• not due to other causes

Question 5

cluster headache mx

Answer 5

(1. ) SC or Nasal triptan
(2. ) Short burst oxygen therapy
(3. ) Avoid pcm, NSAIDs, opioids, PO triptans
(4. ) Prophylaxis: verapamil, sodium valproate, steroids, lithium