headache

Question 1

cluster headaches risk factors

Answer 1

more common in men
smokers
triggered by alcohol
relation to nocturnal sleep

Question 2

presentation of cluster headaches

Answer 2

intense sharp, stabbing pain around one eye
- occurs once or twice a day lasting 15mins-2 hours
4-12 weeks
accompanied by redness, lacrimation, lid swelling
nasal stuffiness
miosis and ptosis

Question 3

investigations in cluster headaches

Answer 3

MRI with gadolinium contract

Question 4

management of cluster headaches

Answer 4

acute: oxygen, subcutaneous triptan
prophylaxis: verapamil (some evidence for prednisolone)

Question 5

red flag headaches symptoms

Answer 5

fever, photophobia or neck stiffness
visual disturbance
sudden onset occipital headache
worse on coughing or straining
postural, worse of standing, lying or bending over
vomiting

Question 6

what is trigeminal neuralgia

Answer 6

unilateral disorder characterised by brief electric shock like pains, abrupt in onset and termination, limited to one or more divisions of trigeminal nerve

Question 7

features of trigeminal neuralgia

Answer 7

sharp shooting pain
commonly evoked by light touch, washing, shaving, smoking, talking
small areas nasolabial fold or chin my be particularly susceptible

Question 8

management of trigeminal neuralgia

Answer 8

carbamazepine first line
refer to neuro

Question 9

presentation of medication overuse headache

Answer 9

present for 15 days or more
developed or worsened whilst taking regular symptomatic medication
patients using opioids and triptans highest risk
may be psych co-morbidity

Question 10

management of medication overuse headache

Answer 10

simple analgesics and triptans should be withdrawn abruptly
opioid analgesics withdrawn gradually

Question 11

withdrawal symptoms in medication overuse headaches

Answer 11

vomiting
hypotension
tachycardia
restlessness
sleep disturbances
anxiety

Question 12

typical patients who get post-lumbar puncture headaches

Answer 12

young females with low BMI

Question 13

typical features of post-LP headache

Answer 13

usually develops within 24-48hours
last several days
worsens with upright position
improves with recumbent position

Question 14

management of post-LP headache

Answer 14

supportive initially (analgesia and rest)
pain continues -> blood patch, epidural saline and IV caffeine

Question 15

red flag symptoms in trigeminal neuralgia

Answer 15

aged < 40
sensorineural hearing loss
history of skin or oral lesions
pain only in the ophthalmic division of trigeminal nerve
optic neruitis