Week 8: Headache

Question 1

What is a secondary headache?

Answer 1

something else is causing the headache

Question 2

Explain the different types of onset of a headache and give examples of each?

Answer 2

• acute (seconds to minutes): SAH/haemorrhage/thunderclap
• evolving (hours to days): infection/inflammatory/increased ICP
• chronic - chronic daily headache/increased ICP

Question 3

what is an episodic headache? give examples

Answer 3

at least a few days free between attacks e.g migraine/trigeminal neuralgia

Question 4

What might be some causes of chronic headache?

Answer 4

medication overuse/chronic migraine

Question 5

What are some associated features of headaches?

Answer 5

• diurnal variation/postural element
• nausea and vomiting
• photophobia/phonophobia
• autonomic features (lacrimation, horners, red eye)
• premonitory/prodromal

Question 6

What are the red flag associated features of a headache?

Answer 6

• cognitive effects
• seizures
• fever
• visual disturbance
• vomiting
• weight loss
• sudden onset or older onset

Question 7

What behaviours can be noticed in a patient with chronic headaches?

Answer 7

• lies down in dark room (migraine)

- agitation/pacing (cluster)

Question 8

What top disabiling condition is often familial?

Answer 8

migraine

Question 9

What signs should you look for in a patient with headache?

Answer 9

fever
rash
neck stiffness
increased BP
organomegaly 
fundal changes (papilloedema - swelling of the optic nerve)
cranial nerve signs/horners syndrome
focal abnormalities e.g right arm being weak

Question 10

Give 7 primary head ache syndromes

Answer 10

1. migraine
2. tension headache
3. cluster headache
4. paroxysmal hemicrania
5. exertional headache
6. ice-pick headache
7. coital headache
8. hypnic headache

Question 11

Give 7 secondary head ache syndromes

Answer 11

1. SAH
2. intra cerebral haemorrhage/stroke
3. meningoencephalitis
4. intracranial venous thrombosis
5. giant cell arteritis
6. tumour with raised ICP
7. cervicogenic headache
8. benign intracranial hypertension

Question 12

What does exotropic mean and what is it a sign of?

Answer 12

means eyes are looking outward (unable to look medially)

sign of 3rd nerve palsy

Question 13

When examining a patient, if you can’t see the optic nerve, what might that mean?

Answer 13

• caused by papillary oedema

- suggesting increased ICP

Question 14

What are the potential causes of raised intracranial pressure?

Answer 14

• mass effect (brain tumour, abscess)
• brain swelling (hypertensive encephalopathy)
• increased venous pressure
• CSF outflow obstruction (hydrocephalus)
• increased CSF production (meningitis/SAH)

Question 15

What are the symptoms of raised ICP?

Answer 15

Headache
vomiting
seizures

Question 16

What are the symptoms of temporal arteritis?

Answer 16

weight loss
myalgia
transient loss of vision
jaw claudication
tender non-pulsatile temporal artery

Question 17

Who might get temporal arteritis?

Answer 17

patients above 50

F>M

Question 18

What are the signs of a migraine?

Answer 18

UNILATERAL
nausea
photophobia
dizziness

Question 19

What are thought to be triggers of migraines?

Answer 19

sleep deprivation
hunger
stress
oestrogens

Question 20

What are the 3 methods of managing migraines?

Answer 20

1. Brain imaging
2. Conservative measures
   - avoid caffiene
   - increase water intake
   - avoid tyramine foods (cheese/chocolate/red wine)
   - sleep hygiene and regular meals
3. Analgesia
   - triptans/naproxen/NSAIDs

Question 21

What substance is released during a migraine?

Answer 21

CGRP

Question 22

What is erenumab?

Answer 22

first licensed CGRP receptor antagonist specifially designed to prevent migraines

Question 23

How long and often might cluster headaches occur?

Answer 23

30-180 mins

1-8 per 24hrs

Question 24

How long and often might paroxysmal hemicrania headaches occur?

Answer 24

2-30 minutes

Question 25

What is SUNCT/SUNHA?

Answer 25

-short unilateral neuralgiform headache with conjuctival infections and tears (rare, seconds, up to 200 attacks per 24 hrs)

Question 26

How do we manage cluster headaches?

Answer 26

• sumatriptan (class A), high flow 100% oxygen, neurostimulation
• prevention is predinosolone

Question 27

What is a tension headache?

Answer 27

• non specific description of ‘constricting’ / ‘tight band’

- paracetamol doesn’t resolve

Question 28

What can be some causes of new daily persistent headaches?

Answer 28

• raised ICP / (IIH - idiopathic intracranial hypertension)
• low ICP
• chronic meningitis
• post head injury

Question 29

What is the main treatment for idiopathic intracranial hypertension?

Answer 29

loosing weight

Question 30

If headaches change from episodic to chronic, what should you consider?

Answer 30

analgesia overuse