Headaches

Question 1

Red flag features in a history

Answer 1

Immunosuppresed
Previous cancer 
Age >50 
Headache that wakes you up 
Exacerbation by valsalva

Question 2

To diagnose a migraine, how many attacks are needed within what time frame?

Answer 2

5 attacks within 4-72 hrs

Question 3

Triggers of migraine

Answer 3

Stress
skipping meals
menstruation
COP

Question 4

Symptoms of a migraine?

Answer 4

Unilateral throbbing 
Photophobia 
Worse on movement 
N&V
Aura - visual/auditory disturbances before the headache begins

Question 5

How to treat migraines?

Answer 5

NSAID +/- antiemetic –> MILD

Oral triptan +/- NSAID +/- antiemetic –> SEVERE

Question 6

2 symptoms of tension headache

Answer 6

pressure and tingling sensation around the head

Question 7

Treatment of tension headache

Answer 7

Relaxation therapy

Amitriptyline

Question 8

Name some TACs (Trigeminal autonomic cephalgias)

Answer 8

Cluster headaches
Paroxysmal hemicrania
Short lived unilateral neuralgia headache with conjunctival injection and tearing (SUNCT)
Trigeminal Neuralgia

Question 9

Headache lasting 50 secs happening 50 times a day, unilateral in the supraorbital region.
Feels like constant stabbing

What is it and what is the treatment?

Answer 9

SUNCT

Lamotrigene or Gabapentin

Question 10

Pt presents with electric shock pain in nose lasting up to 90s and has been happening for 2 months now.
Gets worse when outside in the winter and when they talk.
What investigation to order?

Answer 10

MRI brain

This may be trigeminal neuralgia

Question 11

What is the most likely cause of trigeminal neuralgia?

Answer 11

Compression of the trigeminal nerve

Question 12

Treatment for trigeminal neuralgia

Answer 12

Carbamazepine

If this fails - neurosurgical debulking

Question 13

30 y/o male presents with 30 min headachce attacks 5 times a day during the month of April every year
Occurs in the temporal region.
Assoc. symptoms include droopy eyelid and a leaky eye
He finds that it happens just before he goes to sleep

What is this type of headache and what is the treatment?

Answer 13

Cluster headache

Ix - MRI and MRI angiogram

Mx:
ACUTE - High flow O2 and sumitriptan
CHRONIC (PROPHYLAXIS) - Verampamil

Question 14

How does a cluster headache and paroxysmal headache compare?

Answer 14

Paroxysmal headaches last slightly shorter (10-30mins)
P occur more frequently in the day than C
P headaches in females, C headaches in males

Question 15

What do you treat with Indomethicin?

Answer 15

Paroxysmal headaches

Question 16

What is the most common cause of secondary headaches?

Answer 16

Medication overdose

Question 17

Give 3 vascular causes of headaches

Answer 17

SAH
Carotid dissection
Giant cell arteritis

Question 18

What people group are most liley to suffer headaches from idiopathic intracranial hypertension?

Answer 18

Obese young women

Question 19

Clinical features of idiopathic intracranial hypertension (IIH)

Answer 19

Throbbing 
Worse in morning, relieved on standing 
N&V 
Papilloedema 
6th nerve palsy

Question 20

Ix of IIH

Answer 20

MRI or CT
‘slit like ventricles’ will be the finding

Visual field testing - Enlarged blind spot (papilloedema)

LP - high opening pressure

Question 21

Mx of IIH

Answer 21

Weight loss

Acetazolamide (decreases CSF production)