Headache

Question 1

What headache symptoms would be regarded as ‘red flags’?

Answer 1

Abrupt or 'spilt second' headache
Diurnal/postural variation
Progressively worsening, insidious onset
Neurological signs/symptoms
Systemic signs/symtpoms
Secondary risk factors eg sinusitis, cancer, head injury

Question 2

What signs would be regarded as red flags?

Answer 2

pyrexia
neck stiffness
papilloedema
Focal neurological signs
Tender temporal arteries

Question 3

What is papilloedma

Answer 3

Blurring of the optic disc due to raised intracranial pressure
There is absence of venous pulsation

Question 4

What is pseudopapilloedema

Answer 4

Calcification of the optic disc due to globules of mucoproteins and mucopolysacrarides build up- knows as an optic disc drusen
Can look like papilloedema

Question 5

What is a migraine

Answer 5

a neurological disease characterized by recurrent moderate to severe headaches often in association with a number of autonomic nervous system symptoms with or without aura

Question 6

What is associated with migraines?

Answer 6

Nausea and vomiting
Photophobia
phonophobia

Question 7

How is a migraine headache described

Answer 7

pulsating
often unilateral but can be bilateral
aggravated by movement

Question 8

What can be the ‘trigger’ factors for a migraine be

Answer 8

premenstrual
stress
lack of sleep
missing meals

Question 9

what is a migraine ‘aura’?

Answer 9

focal cerebral cortical and/brain dysfunction
gradually progressing
resolves over about one hour
visual/percetual disturbances common

Question 10

How are migraines treated

Answer 10

avoid preceipitating factors
simple analgesia +/- anti emetic
Specific anti migraine agent - triptan

Question 11

What can result due to overuse of triptans

Answer 11

rebound headache

Question 12

what migraines may benefiti from preventative measures

Answer 12

frequent sever migraines with more than three per month

Question 13

what can be used to prevent migraines

Answer 13

beta blockers -1/2 Inderal LA
antidepressants- dothiepin or amytriptilyn
gabapentin up to 600mg PO BD
topiramate up to 100mg PO OD 
acupuncture

take for 10-12 weeks then review

Question 14

what is a tension headache

Answer 14

most common primary headache
what most of us think of as a 'standard' head ache
usually bilateral and mild to moderate
Has a pressing tingling quality
no N and V
Absence of photophobia or phonophobia

Question 15

What is used to prevent tension headaches

Answer 15

dothiepin
amitriptyline
3 months then review

Question 16

what is a cluster headache?

Answer 16

unilateral head ache severe
often around the eye or supra orbital
lasts 30-180 minutes and is recurrent
associated autonomic features

Question 17

what are the autonomic features assocatied with a cluster headache

Answer 17

Typically eye watering, nasal congestion and swelling around the eye, typically confined to the side of the head with the pain.

Question 18

What drugs can be given to help treat cluster headaches

Answer 18

triptan 
prednisolone
oxygen
verapamil
lithium

Question 19

name some other types of primary heachache

Answer 19

hypnic
hemicranias continua
trigeminal autonomi cephalgia

Question 20

Name a type of vasculitis which often presents with a headache

Answer 20

giant cell arteritis

Question 21

What condition Is giant cell arteritis associated with

Answer 21

polymyalgia rheumatica

Question 22

What is elevevated in the blood in GCA

Answer 22

ESR

plasma viscosity

Question 23

What is the main risk of GCA

Answer 23

vision loss