Headaches and migraine

Question 1

What is the most common cause of headache?

Answer 1

Tension headache

Question 2

What causes tension type headache?

Answer 2

Muscular pain from scalp and neck

Question 3

How long do tension headaches last?

Answer 3

Hours-days

Question 4

What are the characteristics of tension headache?

Answer 4

Dull, aching, diffuse

Question 5

How is tension headache managed?

Answer 5

Analgesia

Stress reduction

Question 6

What causes migraine?

Answer 6

Vascular spasm associated with altered sertonergic activity

Question 7

When do migraines tend to occur in life?

Answer 7

Onset in early adulthood

Question 8

What are the three types of migraine?

Answer 8

Simple (migraine without aura)
Classic (migraine with aura)
Acephalic (aura without migraine)

Question 9

What are the characteristics of a classic migraine?

Answer 9

Aura onset before headache
Unilateral
Throbbing
Associated nausea/vomiting
Photophobia

Question 10

What dietary factors can precipitate migraine?

Answer 10

Caffeine, cheese, alcohol, chocolate

Question 11

What medication can precipitate migraine?

Answer 11

Oral contraceptive pill

Question 12

What medication is used for prophylaxis of migraine?

Answer 12

Propranolol or topiramate first line

Amytriptilline second line

Question 13

What medication can be taken during a migraine?

Answer 13

Triptans e.g. sumatripan + NSAID/paracetamol

Anti-emetic e.g. prochlorperazine

Question 14

What are triptans?

Answer 14

Selective 5HT1 agonists

Question 15

What are the three main causes of subarachnoid haemorrhage?

Answer 15

Trauma
Ruptured anuerysm
Ateriorvenous malformation

Question 16

What are the characteristics of a subarachnoid haemorrhage?

Answer 16

Sudden, severe headache, ‘thunderclap’

Question 17

What are the clinical features of subarachnoid haemorrhage?

Answer 17

Meningism
Raised ICP
Photophobia
Nausea/vomiting

Question 18

How should suspected subarachnoid haemorrhage be investigated?

Answer 18

FBC
U&Es
Clotting screen
CT
Lumbar puncture

Question 19

What can be seen on lumbar puncture that is diagnostic of subarachnoid haemorrhage?

Answer 19

Positive xanthochromia after 12 hours

Question 20

What medication can be given to reduce vasospasm in subarachnoid haemorrhage?

Answer 20

Calcium channel blockers

Question 21

What surgical options are available for subarachnoid haemorrhage?

Answer 21

Cerebral angiography and coiling

Surgical clipping

Question 22

How is acute cluster headache managed?

Answer 22

100% oxygen and nasal/sub-cut sumatripan

Question 23

What is the prophylactic treatment for cluster headache?

Answer 23

Verapamil

Question 24

What is topiramate?

Answer 24

Anticonvulsant

Question 25

What drug can be used in glaucoma or idiopathic intracranial hypertension?

Answer 25

Acetazolamide

Question 26

What is the surgical treatment of idiopathic intracranial hypertension?

Answer 26

Peritoneal shunt

Question 27

What is idiopathic intracranial hypertension?

Answer 27

Elevated intracranial pressure in the absence of tumour or other disease

Question 28

Who gets idiopathic intracranial hypertension?

Answer 28

Obese women

Question 29

What are the side effects of triptans?

Answer 29

Rebound headache

Dependence

Question 30

What other treatments can be used for cluster headache?

Answer 30

Prednisolone

Lithium

Question 31

What are the associated autonomic features of cluster headache?

Answer 31

Eye watering and nasal conjestion

Question 32

What is a cluster headache?

Answer 32

Headaches occurring close together

A trigeminal neuralgia affecting the opthalmic division

Question 33

How long does a cluster headache last?

Answer 33

Roughly 60 mins