Headaches

Question 1

Causes of acute headaches

Answer 1

VICIOUS

Vascular - ICH, infarction
Infection - Meningitis, Encephalitis
Compression - hydrocephalus
ICP
Ophthalmic - acute glaucoma
Unknown
Systemic

Question 2

Systemic causes of acute headaches

Answer 2

HTN: Phaeochromocytoma
Infection: sinusitis
Toxins: CO

Question 3

Causes of chronic headaches

Answer 3

MCT DINGS

Migraine
Cluster headaches
Tension headaches

Drugs - analgesics, caffeine, vasodilators
ICP
Neuralgia (trigeminal)
Giant cell arteritis
Systemic - HTN, organ failure (uraemia)

Question 4

Investigations for headaches

Answer 4

Bloods + Cultures
Urine
LP
Non contrast CT

Question 5

Subarachnoid haemorrhage

Answer 5

Thunderclap headache
Sudden onset
Occipital

Question 6

Tension headache

Answer 6

Bilateral
Band like
Non pulsatile

Question 7

Cluster headache

Answer 7

Rapid onset
Unilateral
Severe pain around one eye
Red, watery eye
Nasal congestion
Miosis +/- ptosis
Attacks 15 mins - 3 hrs
Clusters 4 - 12 wks
Remission 3 months - 3 yrs

Question 8

Acute treatment of cluster headache attacks

Answer 8

100% O2

Triptans (Sumitriptan)

Question 9

Prevention of cluster headache attacks

Answer 9

Verapamil
Topiramate
Lithium

Question 10

Trigeminal neuralgia

Answer 10

Unilateral stabbing pain
Trigeminal division distribution (usually V2/3)
Male > 50 yrs

Question 11

Secondary causes of trigeminal neuralgia

Answer 11

Compression (aneurysm)
MS
Zoster

Question 12

Triggers of trigeminal neuralgia

Answer 12

Washing area
Shaving
Eating
Talking

Question 13

Management of trigeminal neuralgia

Answer 13

Med:
Carbamazepine
Lamotrigine
Gabapentin

Surg:
Microvascular decompression

Question 14

Giant cell arteritis
Age
ESR
Treatment

Answer 14

Age > 60 yrs
ESR > 60
Prednisolone 60 mg

Question 15

Giant cell arteritis presentation

Answer 15

Unilateral scalp pain / tenderness
Thickened pulseless temporal artery
Jaw claudication
Amaurosis fugax
Sudden blindness
Associated with PMR

Question 16

Giant cell arteritis investigations

Answer 16

ESR > 60
Raised PLT
Raised ALP
Decreased Hb
Temporal artery biopsy

Question 17

Treatment of giant cell arteritis

Answer 17

Prednisolone 60 mg PO OD 5-7d

PPI + Bisphosphonate

Question 18

Migraine risk factors

Answer 18

F
Obesity
Patent foramen ovale

Question 19

Types of migraine

Answer 19

Aura + Headache (classic)
Isolated aura
Headache w/o aura (common)

Question 20

Migraine triggers

Answer 20

CHOCOLATE

CHeese
OCP
Caffeine
alcohOL
Anxiety
Travel
Exercise

Question 21

Migraine symptoms

Answer 21

Aura 15-30 mins
Then unilateral throbbing headache
Phono/photophobia
Nausea / vomiting
Allodynia
Often premenstrual

Question 22

Migraine prodrome

Answer 22

Preceed migraine by hrs - days
Yawning
Cravings
Changes in sleep, appetite or mood

Question 23

Migraine aura

Answer 23

Preceed migraine by mins
Visual - distortion, zig zags, hemianopia
Paraesthesia
Speech
Motor

Question 24

Migraine w/o aura diagnostic criteria

Answer 24

5+ headaches lasting 4-72 hrs
\+  Nausea/vomiting or phono/photophobia
\+ 2+ out of :
- Unilateral
- Pulsating
- Interference with normal life
- Worsened by routine activity

Question 25

Treatment of an acute migraine episode

Answer 25

1) Paracetamol + metoclopramide
2) NSAID + metoclopramide
3) Rizatriptan (triptans)
4) Ergotamine

Question 26

Prophylaxis of migraines

Answer 26

Avoid triggers

1) Propanolol, topiramate
2) Valproate, pizotifen, gabapentin