Headaches

Question 1

What mediates head pain?

Answer 1

CN 5 and 9 and upper cervical sensory roots

Question 2

Red flag headache symptoms

Answer 2

Neurological deficits
Old (>65 years old)
Onset of headache is extremely abrupt <1 min
Papilloedema
Positional (worse when lying down, better when sitting up)
Precipitated by Valsalva manoeuvre

Question 3

Difference between secondary and primary headache symptoms

Answer 3

Secondary headache is an underlying pathology causing a headache
Primary headache is not caused by an underlying condition

Question 4

Subtypes of secondary headaches

Answer 4

Mass occupying lesions
CNS pathology
External causes of CNS pathology

Question 5

Mass occupying lesions cause…

Answer 5

An increase in blood, brain or CSF

Question 6

Mass occupying lesions causing increase in blood

Answer 6

Intraparenchymal haemorrhage
Subdural haematoma
Epidural haematoma
Subarachnoid haemorrhage

Question 7

Mass occupying lesions causing increase in brain

Answer 7

Pituitary adenoma
Brain abscess
Brain tumour

Question 8

Mass occupying lesions causing increase in CSF

Answer 8

Hydrocephalus

Question 9

CNS pathology causing secondary headaches

Answer 9

Meningitis/ encephalitis
Cerebral venous sinus thrombosis
Carotid or Vertebral artery dissection
idiopathic intracranial hypertension

Question 10

External causes of CNS pathology causing a headache

Answer 10

Sinusitis
Giant cell arteritis
Trigeminal neuralgia
Acute Angle closure glaucoma

Question 11

Clinical presentation of a migraine

Answer 11

Pulsatile, phonophobia, photophobia
One day duration (can last up to 72 hours)
Unilateral
Nausea and vomiting
Disabiling

With/without aura

Question 12

Types of migraine aura

Answer 12

Visual (scotoma, zig-zag lines)
Sensory (Paraesthesia)
Motor (weakness)
brainstem abnormalities (vertigo, diplopia, decreased hearing)

Question 13

What is a tension-type headache

Answer 13

Described as band-like vice around the temporal-frontal region of the head
Bilateral and non-pulsating
No nausea/vomiting/phonophobia/photophobia
Relieve through analgesics
NOT WORSE OF EXERTION

Question 14

What are the subtypes of Trigeminal autonomic cephalgias

Answer 14

Cluster headache
Paroxysmal Hemicrania

Question 15

Clinical presentation of cluster headaches

Answer 15

Unilateral orbital, supraorbital headache
Sharp/ burning pain
1-8 headaches in a cluster and then none for months
Associated autonomic symptoms (rinorrhoea, conjunctival hyperaemia, lacrimation, miosis and Ptosis)
Restlessness

Question 16

Clinical presentation of paroxysmal Hemicrania

Answer 16

Same a cluster headaches
BUT
More common in women and don’t occur in clusters

Question 17

Risk factors for Idiopathic intracranial hypertension

Answer 17

OBESITY
Female sex
Pregnancy
Drugs (COCP, steroids, tetracyclines, lithium, retinoids)

Question 18

Clinical features of idiopathic intracranial hypertension

Answer 18

Blurred vision
Headache
Papilloedema
Enlarged blind spot
6th CN palsy

Question 19

Most appropriate management first line for IIH

Answer 19

Weight loss