Headaches

Question 1

What are some of the red flags in a headache history?

Answer 1

Constant headaches in elderly
Immunosuppresed with constant headache (intracranial infection)
Headache worse when cough (raised ICP)

Question 2

Women 42yrs gets bad headaches around her period time. Say they are on her right side of head and get worse with over 30mins during which she sees a spinning flash and feels very nauseated and sensitive to light. Clears over a few hours. Likely diagnosis?

Answer 2

Migraine

Question 3

What is the acute management for migraine?

Answer 3

NSAIDs (aspirin, naproxen, ibuprofen)

Anti-emetics (triptans like riaztriptan)

Question 4

What is the prophylactic management for migraines?

Answer 4

Propranolol 80-240mg (good in females as non-tetatrogenic)

Topiramate 25-100mg (tetragenic, wegith loss, tingling hands, depression)

Question 5

What is the criteria for starting migraine prophylaxis?

Answer 5

More than 3 attacks a month
Very severe attacks

Must trial for a minimum of 3 months

Question 6

What must you warn females with migraine with aura?

Answer 6

Cant take the combined oral contraceptive pill as there is an increased risk of stroke (take progesterone only)

Topiramate (for prophylaxis is tetragenic causing cleft lip and palate)

Question 7

Male presents with sudden onset headaches on one side of his head that last seconds. He has watering of his eye during this time and says he eye looks red. Likely diagnosis?

Answer 7

SUNCT

Question 8

Male smoker with sudden onset headaches that last hours and occur a few times a day. These are unilateral and also get nasal congestion during this time. What is the likely diagnosis?

Answer 8

Cluster headache

Question 9

What is the prophylactic treatment for SUNCT?

Answer 9

Lamotrigine

Question 10

Waht is the prophylactic treatment for a cluster headahceh?

Answer 10

Verapamil

Question 11

Which of the trigeminal cephalgia’s headaches last only minutes?

Answer 11

Paroxysmal hemicrania

Question 12

Male diabetic presents with seeing double vision. On examination he has ptosis in his right eye with the eye’s primary position down and out. His pupil is fixed dilated and cannot accomodate. What is the likely diagnosis

Answer 12

Third nerve palsy

Question 13

What is the treatment for trigeminal neuralgia?

Answer 13

Carbamazepine

Question 14

Sudden onset headache with with slurring of speech and sensory deficit in right leg. seizes infront of you. Known hypertension. likely diagnosis?

Answer 14

Intracerebral haemorrhage

Sudden onset, not stroke as dont get headaches- pressure effect

Question 15

Severe sudden onset headache, vomited due to pain, patient also has photophobia. You do a CT angio which shows a dense white ring around the circle of willis. Likely diagnosis?

Answer 15

Subarachnoid haemorrhage due to puture of berry aneurysm