Headaches

Question 1

Describe features of a tension headache

Answer 1

Recurrent, non disabiling bilateral headache whcih can be described as a tight band. Not aggrevated by daily activities
Treat with analgesia and emilimate the cause

Question 2

What are the symptoms of a migraine?

Answer 2

Unilateral throbbing headache preceeded by an aura (visual, sensory, motor). Lasts for 4-72 hours

Question 3

Explain the diagnosis of a migraine

Answer 3

Precence of aura confirms diagnosis. Otherwise followign criteria is required:
- 5 headaches lasting at least 4-72 hours
- nausua/vomiting or photo/phono-phobia
- At least 2 of following: unilateral, pulsating or worsened by daily activities

Question 4

Whats the management of a migraine?

Answer 4

• Oral triptan eg, sumatriptain with paracetamol/NSAID
• Avoid triggers
• Prophylaxis with proanolol, amytriptiline or topiramate

Question 5

What is the diagnositic criteria for cluster headaches?

Answer 5

A. At least 5 attacks
B. Severe or very severe orbital/supraorbital pain lasting 15-180mins
C. One or both of following: autonomic features ipsilateral to headache or a sense of agitation/restless ness
D. Frequency of one every other day to 8 per day.

Question 6

What are the autonomic symptoms associated with cluster headaches?

Answer 6

• Lacrimation,
• Rhinorrhoea,
• Eyelid oedema,
• Facial sweating,
• Facial flushing,
• Fullness in ear,
• Miosis/ptosis

Question 7

What is the management of cluster headaches?

Answer 7

• 100% O2 cua non-rebreather and subcut/oral triptan.
• Prophylaxis is with verapamil

Question 8

What are the symptoms and diagnosis of trigmeinal neuralgia?

Answer 8

Recurrent episodes of severe stabbing pain affecting one side of the face in trigeminal nerve distribution.
Pain can be triggered by touching face, eating or talking.
Diagnosis is clinical but need MRi to exclude secondary causes

Question 9

What is the treatment for trigeminal neuralgia?

Answer 9

Carbamazepine or decompression surgery

Question 10

What are the symptoms of a raised ICP headache?

Answer 10

Headaches worse in the morning and worse upon bending down. Improve when laying down and after vomiting.
May be associated with neurological deficits due to comrpession of cranial structures

Question 11

What is the diagnosis and treatment of a raised ICP headache?

Answer 11

CT head
Treat underlaying cause

Question 12

What are some other differentials for headaches?

Answer 12

• Giant cell arteritis (associated with monocular blindness, temporal tenderness and treat with high dose steroids)
• Medication overuse headaches
• Meningitis