headache

Question 1

what is a primary headache?

Answer 1

headache with no underlying medical cause

Question 2

what is a secondary headache?

Answer 2

headache with an identifiable structural or biochemical cause

Question 3

what are some types of primary headaches?

Answer 3

tension type headache
migraine
cluster headache

Question 4

what are some characteristics of tension type headaches?

Answer 4

mild, bilateral headache which is often pressing or tightening in quality, has no significant features and is not aggravated by routine physical activity

Question 5

what is the treatment for a tension headache?

Answer 5

aspirin or paracetamol

NSAIDS

Question 6

what are some features of a migraine attack?

Answer 6

headache
nausea
photophobia
phonophobia
functional disabilty

Question 7

what are some triggers for a migraine?

Answer 7

dehydration
sleep disturbance
diet
hunger
environmental stimuli
stress

Question 8

what are some premonitory features of a migraine?

Answer 8

mood changes
fatigue
muscle pain
food craving

Question 9

what are some post-attack features of a migraine?

Answer 9

fatigue
cognitive changes
muscle pain

Question 10

what is “aura” with regard to migraines?

Answer 10

transient neurological symptoms resulting from cortical or brainstem dysfunction

Question 11

what are some features of “aura”

Answer 11

loss of function
sudden onset
symptoms all start at the same time and can be localised to a specific vascular area

Question 12

what is the criteria for a chronic migraine?

Answer 12

headache on more than 15 days of the month of which 8 days have to be a migraine for more than 3 months

Question 13

what is a medication overuse headache?

Answer 13

headache present on more than 15 days of the month which has developed or worsened whilst taking regular symptomatic medication

Question 14

what types of medication may predispose someone to developing a MOH?

Answer 14

use of opioids for more than 10 days of the month
caffeine overuse
use of simple analgesics for more than 15 days of the month

Question 15

how is a migraine treated?

Answer 15

aspirin or NSAIDS
triptans
limit to 10 days per month to avoid development of MOH

Question 16

what are some prophylactic treatments for migraine?

Answer 16

propranolol
anti epileptics
tricyclic antidepressants

Question 17

how is the OCP affected with regards to migraine with aura?

Answer 17

contraindicated

Question 18

how are migraines treated in pregnant women?

Answer 18

paracetamol for attacks

propranolol or amitriptyline for prevention

Question 19

what does SUNCT stand for?

Answer 19

short lasting unilateral neuralgiform headache with conjunctival injection and tearing

Question 20

what does SUNA stand for?

Answer 20

short lasting unilateral neuralgiform headache with autonomic symptoms

Question 21

are cluster headaches unilateral or bilateral?

Answer 21

strictly unilateral

Question 22

where is the pain located in cluster headaches?

Answer 22

mainly orbital temporal

Question 23

what is the typical duration for a cluster headache?

Answer 23

45-90 mins

Question 24

what is the frequency of cluster headache attacks?

Answer 24

1 every other day to 8 per day

attacks occur at the same time each day

Question 25

what are 3 trigeminal autonomic cephalagias?

Answer 25

cluster headache paroxysmal hemicrania SUNCT

Question 26

where is the pain typically located in paroxysmal hemicrania?

Answer 26

mainly orbital and temporal

Question 27

how long do paroxysmal hemicrania attacks typically last?

Answer 27

2-30 mins

Question 28

what drug does paroxysmal hemicrania absolutely respond to?

Answer 28

indometacin

Question 29

what are some cutaneous triggers of SUNCT?

Answer 29

wind cold touch chewing

Question 30

what kind of pain is associated with SUNCT?

Answer 30

stabbing/pulsating

Question 31

what kind of pain is associated with cluster headaches/paroxysmal hemcrania?

Answer 31

sharp/throbbing

Question 32

what branches of the trigeminal nerve are more commonly affected in trigeminal neuralgia?

Answer 32

maxillary or mandibular division pain is more common than opthalmic

Question 33

what is abortive treatment for cluster headaches?

Answer 33

subcutaneous sumatripan | occipital depomedrone

Question 34

what is preventative treatment for cluster headaches?

Answer 34

verapamil lithium methysergide topiramate

Question 35

what is the preventative treatment for SUNCT/SUNA

Answer 35

lamotrigine topiramate gabapentin carbamAzepine

Question 36

what is the prophylactic treatment for trigeminal neuralgia?

Answer 36

carbamazepine | oxcarbamezipine

Question 37

what are some presentations of headache that are more likely to have a sinister cause?

Answer 37

``` associated head trauma first or worst sudden onset change in headache pattern or type returning patient ```

Question 38

what are red flags with regards to headaches?

Answer 38

``` new onset or change in headache focal or non focal neurological symptoms abnormal neurological exam neck stiffness/fever jaw claudication visual disturbance headache precipitated by sitting/standing up headache worse lying down ```

Question 39

what is a thunderclap headache?

Answer 39

high intensity headache that reaches maximum intensity in less than 1 minute

Question 40

what is the differential diagnosis for a thunderclap headache?

Answer 40

``` subarachnoid haemorrhage TIA/stroke carotid dissection meningitis intracerebral haemorrhage ```

Question 41

what are most subarachnoid haemorrhages caused by?

Answer 41

aneurysm rupture

Question 42

when should you suspect a SAH?

Answer 42

all patients presenting with a sudden severe headache that peaks within a few minutes and lasts for at least one hour

Question 43

what investigations are appropriate in a suspected SAH?

Answer 43

CT brain | LP

Question 44

when should you suspect a CNS infection?

Answer 44

any patient presenting with headache and fever

Question 45

what are some symptoms of meningism?

Answer 45

``` nausea with or without vomiting photophobia phonophobia stiff neck rash ```

Question 46

what are some symptoms of encephalitis?

Answer 46

altered mental state seizures focal symptoms/signs

Question 47

what are features suggestive of raised ICP?

Answer 47

``` progressive headache that is worse in the morning or wakes patient up seizures visual obscuration focal neuro symptoms non focal symptoms such as drowsiness ```

Question 48

what can cause intracranial hypotension?

Answer 48

dural CSF leak

Question 49

what are some symptoms of intracranial hypotension?

Answer 49

clear postural component to the headache | headache develops or worsens soon after assuming an upright posture and lessens or resolves shortly after lying down

Question 50

what investigations would be performed of intracranial hypotension was suspected?

Answer 50

MRI brain and spine

Question 51

what is the treatment for intracranial hypotension?

Answer 51

bed rest fluid analgesia caffeine

Question 52

what is giant cell arteritis?

Answer 52

arteritis of large arteries

Question 53

when should giant cell arteritis be considered?

Answer 53

any patient over 50 who presents with a new headache?

Question 54

what are the characteristics of giant cell arteritis?

Answer 54

``` usually diffuse, persistent and may be severe patient may be systemically unwell scalp tenderness jaw claudication visual disturbance prominent temporal arteries ```

Question 55

what investigations are useful in giant cell arteritis?

Answer 55

ESR CRP both of them being raised supports diagnosis

Question 56

how is giant cell arteritis treated?

Answer 56

high dose prednisolone | temporal artery biopsy should be arranged