Headaches

Question 1

Cluster Headache Sx

Answer 1

• Unilateral
• 10/10 pain intensity
• Peri-orbital pain
• Ipsilateral conjunctival injection
• Lacrimation
• Nasal congestion
• lasts up to 15 mins - 3 hours
• can occur multiple times daily up to 8x

Question 2

Cluster Headache Acute Tx

Answer 2

• High-flow 100% O2, flow rate 12-15L/mins, non-rebreather mask for 15-20mins
• Subcut / Intranasal Sumatriptan

Question 3

C for Cluster

Cluster headache Prophylaxis

Answer 3

• CCB: Verapamil (contraindicates in Bradycardia patients, needs regular ECG monitoring)
• Topirimate: teratogenic

Question 4

POON

Drugs NOT for acute cluster headache Tx

Answer 4

• Paracetamol
• Opioids
• Oral triptans
• NSAIDs

Question 5

Tension Headache Sx

Answer 5

• Bilateral
• Tightness around the head (like a band )
• Non-pulsatile
• Scalp muscle tenderness

Question 6

Episodic Tension Headache Mx

Answer 6

Common analgesia: Paracetamol and NSAIDS e.g. Ibuprofen as soon as possible after onset

Avoiding triggers: Stress, Sleep disorders, neck pain, diet etc.

Question 7

Tension headache prophylaxis

Answer 7

Amitriptyline 10mg nocte (Max. dose 150mg ‘off-label’ use)

Question 8

Migraine Sx

Answer 8

• Unilateral OR Bilateral
• Pulsating / Throbbing
• Photophobia
• Assoc. w/ nausea + vomiting
• Lasts 4 - 72 hours