Headache

Question 1

What are acute causes of headaches?

Answer 1

Haemorrhage

• SAH
• Subdural

Meningitis

Encephalitis

Acute glaucoma

Increased ICP

Question 2

What are chronic causes of headaches?

Answer 2

Migraine
Cluster headaches
Drugs 
Tension headache 
Trigeminal neuralgia
Increased ICP
Giant cell arteritis

Question 3

What is a primary headache?

Answer 3

Headache due to the headache condition itself

Question 4

What are examples of a primary headache?

Answer 4

Migraine
Tension
Cluster

Question 5

What is a secondary headache?

Answer 5

Headache that is present due to another condition

Question 6

What are examples of a secondary headache?

Answer 6

Meningitis
Sinusitis
SAH
Medication overuse

Question 7

What is a pneumonic for red flag symptoms of headaches?

Answer 7

SNOOP

Question 8

What are red flag symptoms of headaches?

Answer 8

Systemic signs 
Neurological symptoms
Onset - new or changed in patient >50 
Onset - thunderclap
Papilledema

Question 9

What are clinical features of a space occupying lesion?

Answer 9

Pain on one side
Gradual onset
Progessive symptoms
Change in vision

Features of raised ICP

• early morning headache
• N+V
• worse on coughing

Question 10

What is the epidemiology of migraines?

Answer 10

F>M

Younger patients

Question 11

What is the site of a migraine?

Answer 11

Unilateral

Often frontal

Question 12

What is the quality of a migraine?

Answer 12

Throbbing/pulsating

Question 13

What is the intensity of a migraine?

Answer 13

Moderate

Question 14

What is the timing of a migraine?

Answer 14

Sudden or progressive onset

Last between 4-72 hours

Question 15

What makes migraines worse?

Answer 15

Light - photophobia

Question 16

What makes migraines better?

Answer 16

Sleep

Pain relief

Question 17

What are associated symptoms with a migraine?

Answer 17

+/- aura
N+V
Photophobia

Question 18

What can trigger a migraine?

Answer 18

Lack of sleep
Stress
Types of food

Question 19

What is the epidemiology of tension headaches?

Answer 19

Most common type of headache
F>M
Young>old

Question 20

What is the site of a tension headache?

Answer 20

Bilateral

Frontal

Question 21

What is the quality of a tension headache?

Answer 21

Squeezing, non-pulsatile

Question 22

What is the intensity of a tension headache?

Answer 22

Mild-moderate

Question 23

What is the timing of a tension headache?

Answer 23

Worse at the end of the day

Question 24

What can make a tension headache worse?

Answer 24

Stress
Poor posture
Lack of sleep

Question 25

What can make a tension headache better?

Answer 25

OTC pain relief

Question 26

What are associated symptoms with a tension headache?

Answer 26

Mild nausea

Question 27

What is the epidemiology of medication overuse headache?

Answer 27

30-40 years old | F>M

Question 28

How is a medication overuse headache defined?

Answer 28

Headache on at least 15 days per month - not improved by OTC medication

Question 29

What medications can bring on a medication overuse headache?

Answer 29

> 3 months - triptans - opioids - paracetamol - aspirin - NSAIDs

Question 30

How are medication overuse headaches managed?

Answer 30

Discontination of medication

Question 31

How long does it take to resolve a medication overuse headache?

Answer 31

2 months

Question 32

What advice do you give to patients with a medication overuse headache?

Answer 32

Gets worse before it gets better

Question 33

What is the epidemiology of cluster headaches?

Answer 33

M>F | 20-40 years old

Question 34

What the site of a cluster headache?

Answer 34

Around/behind one eye

Question 35

What is the quality of a cluster headache?

Answer 35

Sharp | Penetrating

Question 36

What is the intensity of a cluster headache?

Answer 36

Very severe

Question 37

What is the timing of a cluster headache?

Answer 37

Rapid onset Attacks = 15 mins - 3hours (1-2x day) Clusters last 2-12 weeks

Question 38

What are associated symptoms of a cluster headache?

Answer 38

Red watery eye | Nasal congestion

Question 39

What can trigger a cluster headache?

Answer 39

``` Alcohol Histamine GTN Heat Exercise Lack of sleep ```

Question 40

What is the epidemiology of trigeminal neuralgia?

Answer 40

50-60 years old | F>M

Question 41

What is the main cause of trigeminal neuralgia?

Answer 41

Compression of CNV by loop of artery or vein

Question 42

What is the site of trigeminal neuralgia?

Answer 42

Unilateral | Often over the eye

Question 43

What is the quality of trigeminal neuralgia?

Answer 43

Stabbing Sharp 'Electric shock'

Question 44

What is the intensity of trigeminal neuralgia?

Answer 44

Severe

Question 45

What is the timing of trigeminal neuralgia?

Answer 45

Sudden onset | Lasts few seconds - 2 mins

Question 46

What can make trigeminal neuralgia worse?

Answer 46

Light touch to face Eating Cold wind Vibrations

Question 47

Where can trigeminal neuralgia radiate?

Answer 47

Eyes Lips Nose Scalp

Question 48

What symptoms can precede the pain in trigeminal neuralgia?

Answer 48

Numbness | Tingling