Persistent headaches

Question 1

What are the features of migraines?

Answer 1

-Unilateral location
-Pulsating
-Moderate or severe pain intensity
-Aggravation by or causing avoidance of routine physical activity
-During the headache nausea/ vomiting, photophobia, phonophobia
-May be preceded by an aura

Question 2

What is the difference between a migraine and a tension headache?

Answer 2

A migraine is a full feature headache associated with lots of symptoms and pain

A tension headache is a feature-less headache, only pain

Question 3

What are the features of a tension headache?

Answer 3

-Lasting from 30 minutes to 7 days -Bilateral location
-Pressing or tightening, non-pulsating Mild or moderate pain intensity
-Not aggravated by routine physical activity such as walking

Question 4

What is a medication over-use headache?

Answer 4

The person has headache occurring on at least 15 days per month and a pre-existing headache disorder.

Overuse of acute headache medication more than 10 or 15 days per month (depends on the medication) for 3 months

Question 5

What is the management for a medication over-use headache?

Answer 5

Stopping the medication for at least 1 month; support while this take place

Question 6

What is a cluster headache?

Answer 6

Prevalence 0.05%

Very severe unilateral orbital, supraorbital and/or temporal pain lasting 15–180 minutes

Symptoms:
Ipsilateral conjunctival lacrimation
Nasal congestion / rhinorrhoea
Eyelid oedema
Forehead and facial sweating
Facial flushing
Sensation of fullness in the ear

May have a sense of restlessness or agitation

Attacks occur between one every 1-8 days

Question 7

What are some red flags for headaches?

Answer 7

-New severe or unexpected headache
-Head trauma
-Immunosuppression/ malignancy
-Progressive or persistent headache that has changed dramatically
-Onset over 50 years
-Current or recent pregnancy
-Neurological symptoms like dizziness, personality change, new cognitive dysfunction
-Fever, neck pain/ stiffness, impaired consciousness, photophobia, seizure
-Worse on Valsalva manoeuvre
-Worse on lying or standing
-Visual disturbance
-Vomiting

Question 8

What is the SNOOP mnemonic for?

Answer 8

A red flag tool for secondary headaches

-Systemic symptoms/signs and disease
-Neurologic symptoms or signs
-Onset sudden or
-Onset after the age of 40 years
-Change of headache pattern