Migraines, Headaches and Pain Tutorial

Question 1

15M - attends clinic with mum. 2-month history of headaches that he describes as “banging” and that make his head “very very sore”. 6 headaches in last 2 months, last 2-4hrs. Light hurts his eyes, but not nauseous or vomiting during headache

Unable to go to school. Mum gives him paracetamol and if that doesn’t work she also gives him ibuprofen. He says that these seem to work but that it still hurts a lot until the headache eventually goes completely.

What are the most common primary headaches?

Answer 1

Tension headaches - tight muscles around head and neck

Cluster headaches

Migraines

Question 2

What important questions/information should you ask/obtain to help you diagnose the type of headache?

Answer 2

What is the onset of your headaches, did they come on suddenly or gradually?

Do you have a stiff neck? (to rule out meningitis)

Where is the headache?

Do sounds make your headache worse?

Have you had a fever?

Any rashes?

Any changes in your vision generally?
Any changes in vision during the headache e.g. blind spots, double vision etc.?

[To mum] have you noticed confusion in your son during the headaches?

Have you noticed any triggers for the headaches?

Does lying down make it better?

Do you have any family history about chronic headaches?

Head trauma / injuries?

Do you get warning signs (aura) before a headache e.g. visual signs, pins and needles, etc.?

Question 3

What type of headaches does he have?

Answer 3

Migraine

Question 4

What treatments might you suggest?

Answer 4

Analgesia
Rest
Avoidance of triggers

Question 5

32M - history of severe headaches, he says the most pain he has ever felt. Pain is around his eye and along the side of his face, on one side. Drooping or swelling of the eyelid, watery eye and nasal congestion, on the same side as the headache.

First one = 2 weeks ago, he went to A&E and had a CT scan; the results were normal.

Suffered 6 more since the first one two weeks ago, each last around 30 to 90 mins.

What are the most common primary headaches?

Answer 5

Tension headaches - tight muscles around head and neck

Migraines

Question 6

What important questions/information should you ask/obtain to help you diagnose the type of headache?

Answer 6

What is the onset of your headaches, did they come on suddenly or gradually?

Do sounds or lights make your headache worse?

Do you have a stiff neck? (to rule out meningitis)

Do you feel nauseous or vomit during the headaches?

Have you had a fever?

Any rashes?

Any changes in your vision generally?
Any changes in vision during the headache e.g. blind spots, double vision etc.?

Have you noticed confusion during your headaches?

Have you noticed any triggers for the headaches?

Does lying down in the dark make it better?

What do you do when you have a headache? How do you try and relieve it?

Do you have any family history about chronic headaches?

Head trauma / injuries?

Question 7

What type of headaches does he have?

Answer 7

Cluster headache

Question 8

What treatments might you suggest?

Answer 8

O2 therapy
Sumatriptan
Transcutaneous vagus nerve stimulation