Headaches

Question 1

Features of trigeminal neuralgia

Answer 1

Recurrent short episodes of severe stabbing pain affecting one side of the face in the trigeminal nerve distribution

Question 2

Typical age presentation of trigeminal neuralgia

Answer 2

> 50 years old

Question 3

Triggers of pain in trigeminal neuralgia

Answer 3

Touching face, eating or talking

Question 4

Diagnosis of trigeminal neuralgia

Answer 4

MRI needed to exclude tumours and aneurysms

Question 5

Treatment of trigeminal neuralgia

Answer 5

Carbamazepine first line, microvascular decompression surgery

Question 6

Symptoms of headache from raised ICP

Answer 6

Worse in morning, when bending over, improve after vomiting and lying down. May be associated with neurological deficits

Question 7

Differentials of headache

Answer 7

Migraine, cluster headache, tension headache, trigeminal neuralgia, raised ICP, giant cell arteritis, medication-overuse, meningitis

Question 8

Symptoms of cluster headaches

Answer 8

Recurrent attacks of sudden-onset unilateral periorbital pain

Question 9

Associations with cluster headaches

Answer 9

Watery and bloodshot eye, lacrimation, miosis, rhinorrhoea, ptosis, lid swelling, facial flushing

Question 10

Time course of cluster headache

Answer 10

15 minutes - 3 hours. Once or twice a day over 4-12 weeks. Pain free months before next cluster

Question 11

Treatment of cluster headache

Answer 11

Avoid triggeres, prophylaxis with verapamil

Question 12

Treatment of acute attack of cluster headache

Answer 12

100% oxygen via non-rebreather mask, with SC or nasal triptan

Question 13

Symptoms of tension headache

Answer 13

Bilateral non-pulsatile headache, tight around head

Question 14

Associations with tension headaches

Answer 14

Scalp muscle tenderness

Question 15

Treatment of tension headaches

Answer 15

Paracetemol or NSAID and addressing cause of stress

Question 16

Symptoms of migraine

Answer 16

Unilateral throbbing headache often preceded by aura such as visual or sensory symptoms

Question 17

Time courses of migraines

Answer 17

4-72 hours

Question 18

Associations of migraine

Answer 18

Photophobia or phonophobia

Question 19

Management of migraine

Answer 19

Avoid triggers, propanolol prophylaxis or topiramate or amitriptyline. Females to stop taking COCP

Question 20

Diagnosis of migraine

Answer 20

5 headaches lasting 4-72 hours with nausea/vomiting and photo/phonophobia and 2 of : unilateral headache, pulsating character, impaired or worsened by daily activities

Question 21

Acute management of migraine

Answer 21

Oral triptan such as sumatriptan with paracetemol or NSAID