HEADACHES

Question 1

Primary vs Secondary Headache

Answer 1

Primary

• Due to the headache condition itself, not due to another cause
• E.g. migraine, tension, cluster

Secondary

• Headache that is present because of another condition
• E.g. headache in meningitis/sinusitis/SAH
• Medication overuse is in this category

Question 2

Differential Of Headaches :

Acute vs Chronic

which one must go to A+E/ for emergency assessment

Answer 2

Question 3

Red Flag symptoms of Headache

Answer 3

Question 4

what associated symptoms would u ask about in the patient? and what coniditions could these symptoms be related to

Answer 4

N+V – may suggest raised intracranial pressure (ICP)

Visual disturbance – aura related / intracranial lesion / bleeding / stroke

Photophobia – raised ICP / meningitis

Neck stiffness – meningitis (may be related to infection or subarachnoid haemorrhage)

Fever – suggestive of an infective process (e.g. bacterial meningitis/abscess)

Rash – non-blanching purpuric rash may indicate meningococcal sepsis

Weight loss – suggestive of malignancy – consider cerebral metastases

Sleep disturbance – headaches causing sleep disturbance are concerning (raised ICP)

Temporal region tenderness – consider temporal arteritis

Neurological deficits – weakness / sensory disturbance / impaired coordination / cognitive symptoms / altered level of consciousness – consider space-occupying lesions / intracranial bleeding / stroke

Question 5

what foods can be triggers for heaches?

which headche?

Answer 5

cheese, coffee, chocolate

cluster

Question 6

Most common headache?

Answer 6

Tension headache

Question 7

MOST PAINFUL HEADACHE EVER!!!

Answer 7

CLUSTER

Question 8

when can u say the tension headache is chronic? episodic?

Answer 8

if it occur more than 15X per month

if less>> episodic

Medication overuse also the same! occurs more than 15X per month

Question 9

MOH

Regular overuse greater than 3 months of one of the following:

Answer 9

• Triptans or opioids (codeine) on at least 10 days of the month
• Paracetamol, aspirin or NSAIDs on at least 15 days of the month

Question 10

which one gets symoathetic overdrive?

explain further symtoms

Answer 10

Cluster!

• red watery eye
• congested runny nose
• sweaty
• skin redness
• partial ptosis

Question 11

when does overuse medication settle down?

Answer 11

resolves completely after 2 months following discontinuation of medication

Question 12

made worse by stress and poor posture?

Answer 12

Tension headache

Question 13

pain behind eye, sharp and penetrating

Answer 13

cluster

Question 14

3rd most common type of headache!

Answer 14

medication overuse headache

Question 15

how does cluster headache differ from trigeminal neuralgia?

since the both occur around eye?

Answer 15

TIMING

TN> lasts a few secs to 2 mins

Cluster> last longer

Question 16

which one is mainly noctural?

Answer 16

Cluster

Question 17

mainly F r more than males,

which one do MEN mainly get it?

Answer 17

cluster

Question 18

squeezing headache?

Answer 18

tension

Question 19

what is triggered by alchohol? smoking? sudden heat?

Answer 19

cluster

Question 20

why can ppl with cluster headache get their cluster attack around summer time?

Answer 20

bc theyve got hay fever, HISTIMINE GOES UP, more prone to get attach

Question 21

throbbing pulsating

Answer 21

migraine

Question 22

in medication Overuse Headache, and patient has stopped medication.

what must u warn patient?

Answer 22

REBOUND HEADACHE

that the headache will get worse before it gets better!

but in 2 months it will go away!

Question 23

radiates to neck?

Answer 23

tension

Question 24

why can u get medication overuse headaches?

when do u mainly see this type of headche

Answer 24

increase in headache pain receptors

in patients who were taking medication to treat their headache in the first place!

Question 25

which headaches radiate? if so where?

Answer 25

TN\> radiates to eyes, lips, nose and scalp TEnsion\> To neck

Question 26

Site and quality * Migraine * Tension * Cluster * trigeminal neuralgia

Answer 26

1. Migraine\>\> Unilateral, often frontal, Sudden or gradual onset, Throbbing/**pulsating** 2. Tension\>\> Bilateral, frontol, squeezing, non-pulasatile 3. Cluster\>\> around/ behind one eye, sharp, pentrating 4. trigeminal neuralgia\>\> unilateral, over eye, stabbing, sharp, electric shock

Question 27

intensity and timing/onset/how long does attack last for? * Migraine * Tension * Cluster * trigeminal neuralgia

Answer 27

1. **Migraine**\>\> moderate, btw 4hrs-3days, may be cyclical 2. **Tension**\>\> less severe (mild-moderate), worse at end of day, less than 15 X permonth 3. **Cluster**\>\> VERY SEVERE, RAPID onset, Attacks last 15 min–3hrs, 1-2x/day, mostly **nocturnal**. * Clusters last 2 wks-3 mo, remission lasts 3mo-3yrs * Can be chronic vs. episodic 4. **TN**\>\> severe, SUDDEN onset, last few sec-2 mins

Question 28

aggrevating and releiving/radiation * Migraine * Tension * Cluster * trigeminal neuralgia

Answer 28

1. **Migraine\>\>** Photo/phonophobia, Sleep make better, medication, _X radiaiton_ 2. **Tension\>\>** stress, poor posture, lack of sleep _R to neck_ 3. **Cluster\>\>**head injury, alcohol, cigarette smoking, certain food, X radiation 4. **trigeminal neuralgia\>\>** light touch to face, eating, cold wind, vibrations _radiates to eyes, lips, nose and scalp_

Question 29

secondary symptoms * **Migraine** * **Tension** * **Cluster** * **trigeminal neuralgia**

Answer 29

1. **Migraine\>\>** +/- aura (mainly visual), mainly peripheral u see black dots or zig zaggy lines, N+V 2. **Tension\>\>** mild nausea 3. **Cluster\>\>** Red, watery eye, nasal congestion, sweating 4. **trigeminal neuralgia \>\>** proceeding symptoms\> tingling, numbness

Question 30

Treatment * **Migraine** * **Tension** * **Cluster** * **trigeminal neuralgia**

Answer 30

1. **Migraine \>\>** triptans, can give nasally 2. **Tension \>\>** 3. **Cluster \>\>** high flow oxygen! 4. **trigeminal neuralgia**

Question 31

Investigations?

Answer 31

Headache diary \>\> what where u doing when it happened? Imaging- CT/ MRI

Question 32

Referral Criteria

Answer 32