Managing headaches

Question 1

what questions are important to ask when taking a headache history

Answer 1

can you classify the headache- benign or malignant.
Do i need to investigate e.g. scan
How do I explain diagnosis
what are the patients expectations
Is treatment appropriate.

Question 2

what questions should be asked about the onset of a headache?
acute/ evolving/ chronic.

Answer 2

Acute (seconds to minutes)- SAH/intra-cerebral haemorrhage/ thunderclap/ coital/ vascular.

Evolving (hours to days)- Infection/inflammatory/↑ICP

Chronic (weeks to months)- Chronic daily headache/ ↑ICP

Question 3

what questions should be asked about the frequency of the headache?
episodic or chronic

Answer 3

Episodic- few days free in between attacks- migraine or cluster headache

Chronic (headache most days)
Medication overuse/ chronic migraine/ hemicrania continua.

Question 4

what are common associated factors with headaches

Answer 4

diurnal variation/ postural element
Nausea and vomitting- found to increase pressure and meningitis.
Photophobia and/phonophobia- hypersensitivity to sound and light.
autonomy features (horner’s and lacrimation)

Question 5

what are the red flag symptoms of headaches

Answer 5

cognitive effects, seizures, fever, visual disturbance (increased ICP), vomitting (Increased pressure and meningitis), weight loss

Question 6

if on onset of headache patient lies down it is like to be

Answer 6

migraine

Question 7

if on onset of headache patient becomes agitated

Answer 7

cluster headache

Question 8

are migraines familial

Answer 8

Yes

Question 9

what signs are typically found upon examination of a patient with a headache

Answer 9

fever, rash, neck stiffness, high BP, organomegaly.
Fundal changes (papilloedema due to raised ICP)
Cranial nerve signs (horner’s syndrome)
Focal abnormalities (increase BP).
Long tract signs e.g spasticity, hyperreflexia, and abnormal reflexes - intracerebral space lesion.

Question 10

what are primary headache syndromes

Answer 10

migraine, tension headache, cluster headache, paroxysmal headache, exertional headache, coital headache, hypnic headache.

Question 11

what are the secondary headache syndromes

Answer 11

SAH, intracerebral
haemorrhage /stroke.
meningoencephalitis, intracranial venous thrombosis, giant arteritis, tumour with raised ICP, cervicogenic headache, benign intracranial hypertension.

Question 12

define primary headache

Answer 12

headache not caused by a underlying disease

Question 13

define secondary headache

Answer 13

headache caused by an underlying disease