Headaches

Question 1

What are primary headaches?

Answer 1

Headaches without an underlying cause, including migraines, tension-type headaches, and cluster headaches.

Question 2

What are secondary headaches?

Answer 2

Headaches caused by an underlying condition, such as infections, trauma, or vascular disorders.

Question 3

What are red flag symptoms in headaches?

Answer 3

Sudden onset, “worst ever” headache, focal neurological signs, fever, altered consciousness, or signs of raised intracranial pressure.

Question 4

What is a migraine?

Answer 4

A primary headache characterised by unilateral, throbbing pain, often associated with nausea, photophobia, and phonophobia.

Question 5

What are the diagnostic criteria for migraines?

Answer 5

At least five attacks of headache lasting 4–72 hours with two of the following: unilateral location, pulsating quality, moderate or severe pain, and aggravation by physical activity, plus nausea or sensitivity to light/sound.

Question 6

What is an aura in migraine?

Answer 6

A reversible focal neurological symptom, such as visual disturbances or sensory changes, that precedes or accompanies the headache.

Question 7

What are tension-type headaches?

Answer 7

A primary headache characterised by bilateral, pressing, or tightening pain of mild-to-moderate intensity without nausea.

Question 8

What triggers tension-type headaches?

Answer 8

Stress, poor posture, lack of sleep, or eye strain.

Question 9

What are cluster headaches?

Answer 9

Severe, unilateral headaches around the eye, often associated with autonomic symptoms like lacrimation or nasal congestion.

Question 10

What is the typical duration of a cluster headache?

Answer 10

Cluster headaches last 15 minutes to 3 hours and often occur in cyclical patterns or “clusters.”

Question 11

What is a medication-overuse headache?

Answer 11

A chronic headache caused by the overuse of pain relief medications, particularly for more than 15 days a month.

Question 12

What are common secondary causes of headache?

Answer 12

Subarachnoid haemorrhage, meningitis, temporal arteritis, sinusitis, and brain tumours.

Question 13

What is the pathophysiology of migraines?

Answer 13

It involves activation of the trigeminovascular system, cortical spreading depression, and release of inflammatory neuropeptides.

Question 14

What investigations are required for headache with red flags?

Answer 14

Neuroimaging (CT/MRI), lumbar puncture, and blood tests.

Question 15

What is the initial treatment for acute migraine attacks?

Answer 15

Simple analgesics (paracetamol or NSAIDs) and triptans (e.g., sumatriptan).

Question 16

What prophylactic medications are used for migraines?

Answer 16

Beta-blockers (e.g., propranolol), tricyclic antidepressants (e.g., amitriptyline), and antiepileptics (e.g., topiramate).

Question 17

What is the treatment for tension-type headaches?

Answer 17

Simple analgesics like paracetamol or NSAIDs, and addressing lifestyle factors such as stress or poor posture.

Question 18

How are cluster headaches treated?

Answer 18

Acute treatment includes oxygen therapy and subcutaneous or intranasal triptans. Prophylaxis involves verapamil or corticosteroids.

Question 19

What is temporal arteritis, and how does it present?

Answer 19

Temporal arteritis is an inflammation of the temporal arteries causing headache, jaw claudication, and visual disturbances.

Question 20

What investigation is key for diagnosing temporal arteritis?

Answer 20

Raised erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), followed by temporal artery biopsy.

Question 21

What is the treatment for temporal arteritis?

Answer 21

High-dose corticosteroids to prevent complications like vision loss.

Question 22

What are the clinical features of subarachnoid haemorrhage?

Answer 22

Sudden, severe “thunderclap” headache, often associated with neck stiffness, photophobia, and altered consciousness.

Question 23

What investigation confirms subarachnoid haemorrhage?

Answer 23

CT head (within 6 hours of onset) and lumbar puncture (if CT is negative) to detect xanthochromia.

Question 24

What lifestyle modifications help reduce primary headache frequency?

Answer 24

Regular sleep, hydration, exercise, stress management, and avoiding known triggers like caffeine or alcohol.

Question 25

What is a “thunderclap headache”?

Answer 25

A sudden, severe headache that peaks within seconds to minutes, often associated with serious conditions like subarachnoid haemorrhage.

Question 26

What are the typical features of raised intracranial pressure (ICP) headaches?

Answer 26

Headaches worse in the morning, with nausea, vomiting, visual disturbances, and exacerbation by coughing or bending over.

Question 27

How is a sinusitis-related headache characterised?

Answer 27

Dull, aching pain over the affected sinus, often associated with nasal congestion, discharge, and tenderness over the sinus.

Question 28

What is a cervicogenic headache?

Answer 28

A secondary headache caused by disorders of the cervical spine or its components, often presenting with neck pain and restricted movement.

Question 29

What are the warning signs of a brain tumour-related headache?

Answer 29

Persistent headaches that worsen over time, morning headaches, nausea/vomiting, and associated neurological deficits like vision or motor changes.