Headache

Question 1

Headache
Common Types Migraine s/sx

Answer 1

P: Pulsatile
O: Onset 4-72hrs
U: Unilateral
N: N/V
D:Disabling Intensity

Photophobia/phonophobia
Chronic, recurrent, +/- aura

Question 2

Headache
Common Types Cluster s/sx

Answer 2

Unilateral
Sudden sharp
Retro-orbital pain
<3 hours usually at night
Pseudo-Horner’s symptoms Precipitated by alcohol/smoking

Question 3

Headache
Common Types Tension s/sx

Answer 3

Tight band-like pain
Tense neck/scalp muscle
Precipitated by stress or lack of sleep

Question 4

Headache
Differential Diagnosis Intra-cranial Bleed

Answer 4

Epidural
Subdural
Subarachnoid
Intracerebral

Question 5

Headache
Differential Diagnosis Intra-cranial
Infection

Answer 5

Meningitis
Encephalitis
Brain abscess

Question 6

Headache
Differential Diagnosis Intra-cranial
Increased ICP

Answer 6

Mass
Cerebral venous
Sinus thrombosis

Question 7

Headache
Differential Diagnosis Extra-canial

Answer 7

Acute angle closure glaucoma
Temporal arteritis
Carotid artery dissection
CO Poisoning
Pregnancy-related headaches

Question 8

Headache
History

Answer 8

Red flags (sudden onset, thunderclap, exertional onset,meningismus, fever, neurological deficit, AMS)
Symptoms of increased ICP
(persistent vomiting, headache worse lying down and in AM)

Question 9

Headache
Physical Exam

Answer 9

Vitals
detailed neuro exam (cranial nerves, gait,coordination, motor/sensory, reflexes)
Neck for meningeal irritation
eye
Exam (slit lamp, IOP)
Temporal artery tenderness

Question 10

Headache
Investigations Imaging

Answer 10

Neuroimaging to rule out deadly causes. Most benign headaches do NOT need further investigation. Refer to Ottawa SAH Rule.

Question 11

Headache
Investigations Procedures

Answer 11

LP: if CT head negative (>6h from onset) but strong suspicion of SAH

Question 12

Headache
Investigations Labs

Answer 12

ESR/CRP: if suspect temporal arteritis

Question 13

Headache
Management Common Benign Headache Regimen

Answer 13

Fluids: No clear evidence but consider in dehydrated patient
Antidopaminergic: Metoclopramide 10mg IV
Antihistamine: Diphenhydramine 25mg IV
Analgesic: Acetaminophen 1g PO
NSAIDs: Ketorolac 10-30mg IV or Ibuprofen 600mg PO
Steroids: Dexamethasone 10mg PO/IV (rebound migraine prophylaxis)

Question 14

Headache
Management Non-Traditional Uses
Cluster

Answer 14

Oxygen
Sumatriptan
Verapamil

Question 15

Headache
Management Non-Traditional Uses
Refractory Headaches

Answer 15

Magnesium
Lidocaine
Propofol
Ketamine
Valproate

Question 16

Headache
Management Non-Traditional Uses
Nerve Blocks

Answer 16

Greater occipital nerve
Sphenopalatine block
Trigger points