Headaches

Question 1

Tabulate differences between Migranes, tension type and cluster headaches

Question 2

Diagnostic criteria for migraines

Question 3

Diagnostic criteria for tension types

Question 4

Red flags of headache

Answer 4

Systemic sx eg fever
Hx of cancer
Sudden onset of
Oder age (>50)
Pattern change
Progressive headache
Pregnancy or puerperiupainful eye with autonomic features
Posttraumatic
Painkiller overuse
Pathology of immune system or immunosuppressive therapy

Question 5

What types of headaches need emergency evaluation

Answer 5

Sudden onset thunderclap headache
Acute or subacute headache or neck pain with Horner syndrome or neurological deficit- cervical artery dissection
Headache with suspected meningitis or encephalitis -fever
Headache with focal or global neurological deficit or papillodema- raised ICP
Headache with orbital or periorbital symptoms- visual impairmen, periorbital pain or opthalmoplegia -acute angle glaucoma
Headache with possible carbon monoxide poisoning

Question 7

Management of migraines

Answer 7

If not vomiting
NSAIDs
If not effective add tryptan (naproxen sodium)

Prophylaxis with a beta blocker

If severe in the emergency department : SC Sumatriptan 6mg, adjunctive IV Metochlopromide and IV or IM Dexamethasone