Managing Headaches (8)

Question 1

Epidemiology

Answer 1

95% people affected, 1 in 10 migraines, 1 in 10 neurology clinic benign headaches, 0.1% sinister causes of headaches are rare

Question 2

Acute onset (vascular)

Answer 2

(Seconds-minutes), SAH, intra-cerebral haemorrhage, coital (presents like SAH), thunderclap

Question 3

Evolving onset

Answer 3

(Hours-days), infection, inflammatory, raised ICP

Question 4

Chronic onset

Answer 4

(Weeks-months), chronic daily headache, raised ICP

Question 5

Episodic

Answer 5

(Few days between) migraine, cluster headache

Question 6

Chronic

Answer 6

(Most days) chronic migraine, medication overuse, hemicrania continua (persistent unilateral headache)

Question 7

Associated features

Answer 7

Diurna variation/postural, nausea and vomiting, photophobic/phonophobia, autonomic features (lacrimation, Horners, red eye)

Question 8

Red flags

Answer 8

Cognitive effects, seizures, fever, visual disturbance, vomiting, weight loss

Question 9

Behavioural changes

Answer 9

Lies down in a dark room (migraine), agitation/pacing (cluster)

Question 10

Look for

Answer 10

• Fever/rash/neck stiffness/high bp/organomegaly (malignancy)
• Fundal changes (papilloedema)
• Horners syndrome/cranial nerve signs
• Focal abnormalities
• Long tract signs (UMN)

Question 11

Primary headache syndromes

Answer 11

Migraine, tension headache, cluster headache, paroxysmal hemicrania, exertional headache, ice-pick headache, coital headache, hypnic headache

Question 12

Secondary headache syndromes

Answer 12

SAH, intra-cerebral haemorrhage/stroke, meningoencephalitis, intracranial venous thrombosis, giant cell arteritis, tumour with raised ICP, cervicogenic headache, benign intracranial hypertension