Headaches

Question 1

Tension-type headache presentation

Answer 1

Mild, bilateral headache often pressing or tightening in quality, no significant associated features.

Question 2

Treatment for tension-type headache

Answer 2

Abortive - aspirin, paracetamol, NSAIDS.

Limit to 10 days per month.

Question 3

Migrane 1. presentation

and 2. Triggers.

Answer 3

1. Episodic attacks = Headache, nausea, photophobia, functional disability.
   In-between attacks = Enduring predisposition to future attacks, anxiety.
2. Triggers = Dehydration, diet, sleep disturbance, stress, hunger, changes in oestrogen levels, environmental stimuli.

Question 4

What is Aura?

Answer 4

Fully reversible, neurological changes, visual somatosensory - can be confused with TIA - loss of function, sudden onset.

Question 5

Treatment for migrane

Answer 5

Abortive - aspirin, NSAIDs, triptans.
Prophylactic treatment - Propranolol, anti epileptics (avoid in child bearing age)
gabapentin. Tricyclic antidepressants.

Question 6

What is chronic migrane?

Answer 6

Headache on more than 15 days per month of which 8 days are migrane for more than 3 months.

Question 7

Cluster headache presentation

Answer 7

Mainly orbital and temporal pain.
Attacks strictly unilateral, rapid onset, duration about 15mins. Excruciatingly severe (suicide headache).
Patients restless and agitated during attacks.
Migrainous symptoms too..

Question 8

Treatment for cluster headache

Answer 8

Subcutaneous sumatriptan 
100% oxygen 
Occipital depomedrone injection 
Oral prednisone. 
Preventative treatment = Lithium, verapamil.

Question 9

Trigeminal neuralgia presentation

Answer 9

Unilateral or mandibular division > ophthalmic stabbing pain.

Question 10

Treatment for trigeminal neuralgia

Answer 10

Prophylaxis - carbamazepine.

Question 11

What are the red flags for secondary headaches?

Answer 11

New onset
Change in headache 
Change in frequency, associated symptoms
Focal neurological symptoms 
Abnormal neurological examination
Neck stiffness
High pressure - worse lying down, waking up patient. 
Low pressure - standing up.
Giant cell arteritis - jaw claudication, visual disturbance, prominent temporal artery.

Question 12

What is a thunderclap headache?

Answer 12

High intensity headache reaching maximum intensity in less than 1 minute.
Major peak instantaneously
May be primary or secondary.

Question 13

What is a subarachnoid haemorrhage

Answer 13

1 in 10 patients with thunderclap headache will have this.
Decreased consciousness, fainting, seizures.
85% aneurysmal.
50% mortality.
Re bleed 40% chance
LP must be done > 12 hrs after onset.
CT brain

Question 14

Features of raised intracranial pressure

Answer 14

Headache 
Worse in morning 
Lying flat is worse 
Focal symptoms
Seizures 
Visual obscurations 
Cognitive or personality change, drowsiness.