Headache

Question 1

What are the signs and symptoms of meningitis?

Answer 1

• Severe
• Global headache
• Neck stiffness
• Fever
• Photophobia
• Purpuric rash
• Coma

Question 2

How should meningitis be investigated?

Answer 2

• CT head scan
• Lumbar puncture if no rasied intracranial pressure
  
  • Culture and specimen

Question 3

Outline the causes of a subarachnoid haemorrhage

Answer 3

• Rupture of the berry aneurysm
• Arteriovenous malformation

Question 4

Describe the pathophysiology of a subarachnoid haemorrhage

Answer 4

• Rupture of berry aneurysm common at the junction of posterior communicating with internal carotid

Question 5

What are the signs and symptoms of a subarachnoid haemorrhage?

Answer 5

• Thunderclap headache (worse headache ever)
• Sudden onset headache at occipital
• Stiff neck
• Decreased consciousness
  
  • Reduced GCS
• N+V
• Coma
• Focal neurology (pupil changes indicating 3rd nerve palsy with PCA)
• Confusion

Question 6

How should a suspected subarachnoid haemorrhage be investigated?

Answer 6

• CT head
• Lumbar puncture if no RICP (blood in CSF)

Question 7

How should a subarachnoid haemorrhage be managed?

Answer 7

• Refer to neurosurgery immediately
• Re-examine CNS often
• Aim BP <160

Question 8

What are the signs and symptoms of a head injury?

Answer 8

• Pain at site
• Pain may be global
• Pain can last for 2 weeks
• Pain is resistant to analgesia

Question 9

How should a head injury be investigated?

Answer 9

• CT head

Question 10

What are the sign and symptoms of sinusitis?

Answer 10

• Pain around the sinuses when leaning forward or bending forward
• Dull constant ache over frontal/maxillary sinuses
• Tenderness
• Postnasal drip

Question 11

What are the possible triggers of a migraine?

Answer 11

• CHOCOLATE
• Chocolate
• Hangover
• OCP
• Coffee/Cheese
• Orgasms
• Lie ins
• Alcohol
• Travel
• Exercise

Question 12

What are the signs and symptoms of a migraine?

Answer 12

• Photosensistivity
• Unilateral throbbing(focal)
• Aura
• Nausea and vomiting
• Slurred speech
• Weakness/numbness

Question 13

How should a migraine be managed with non-pharmacological therapies?

Answer 13

• Warm/cold packs to the head
• Breathing into a paper bag
• Lying in a dark room
• Acupuncture

Question 14

What is the prophylactic treatment for migraines?

Answer 14

• Propanolol
• 12 weekly botulinum toxin type A i injections and are the last resort

Question 15

What is the treatment of a migraine during an attack?

Answer 15

• Oral triptan with NSAID or paracetamol
  
  • Monotherapy with any of the above
• Anti-emetics

Question 16

What are the signs and symptoms of a cluter headache?

Answer 16

• Unilateral headache
• pain behind eye
• Bloodshot and watery eye
• Unilateral sweating and lacrimation
• Facial swelling
• Swollen eyelid
• Runny nose
• Pain usually comes on at night or at the same time during the day and lasts for the same amount of time (15-180 mins)

Question 17

How are cluster headaches treated?

Answer 17

• Acute attack
  
  • Oxygen
  • Sumatriptan

Question 18

How are cluster headaches prevented?

Answer 18

• Avoid triggers such as alcohol
• Medication
  
  • Corticosteroids
  • Verapamil
  • Lithium

Question 19

What is trigeminal neuralgia?

Answer 19

• Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain.
• If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain.

Question 20

What are the symptoms of trigeminal neuralgia?

Answer 20

• Intense, stabbing pain, lasting seconds in the trigeminal nerve distribution
• Unilateral pain
• Affects the mandicular and maxillary divisions

Question 21

What are the triggers of trigeminal neuralgia?

Answer 21

• Wasing affected area
• Shaving
• Eating
• Talking
• Dental prostheses

Question 22

How is trigeminal neura;gia inveastigated?

Answer 22

MRI to exclude other causes of the symptoms

Question 23

How is trigeminal neuralgia managed?

Answer 23

• Nerve pain management
  
  • Carbemazipine
  • LAmotrogine
  • Phenytoin
  • Gabapentin
• If drugs fail, surgery may be necessary
  
  • Gamma knife surgery

Question 24

What are the signs and symptoms of GCA?

Answer 24

• Tender thickened temporal head
• Pulseless temporal arteries
• Jaw claudication
• Vision loss/changes
• Combing hair causes pain

Question 25

What is the immediate managment for GCA?

Answer 25

• Steroids - high dose for 6 months to avoid blindness
• Urgent same day opthalmology review
• High ESR/CRP

Question 26

How is GCA management long term?

Answer 26

• Temporal biopsy within 1 week (skip lesions)
• Continue steroids 1-2 years
• Taper dose based on ESR and symptoms
• PPI and bisphosphonates to cover the effects of PPIs

Question 27

What are the signs and symptoms of tension headaches?

Answer 27

• Dull headache around he circumference of head
• Face/neck/head tenderness
• Pressure behind eyes
• Sensitivity to light

Question 28

How should tension headaches be managed?

Answer 28

• Cool packs
• Stress relief (massage, antidepressent)

Question 29

What are the signs and symptoms of raised intracranial pressure?

Answer 29

• Worse on waking, lying and leaning forward/coughing
• N+V
• Papilloedema
• Seizures
• False localising signs

Question 30

How should suspected RICP be investigated?

Answer 30

CT/MRI (exclude Space Occupying Lesion)