Headache

Question 1

Classic presentation of Migraine?

Answer 1

Unilateral Throbbing Headache, 4-72hr duration. May also present with hallucination, photo/phonopbia + Aura.

Question 2

Diagnosis criteria for migraine?

Answer 2

At least 5 prior attacks

Question 3

Management of Migraine

Answer 3

1) NSAIDs (alternatively paracetamol)

2) Prevention = target underlying triggers

Question 4

Classic presentation of meningitis?

Answer 4

Triad: Headache, Neck Stiffness + Photophobia
Meningococcal: Purpuric Rash

Question 5

Examination signs of meningitis?

Answer 5

Kernig’s Sign - medial hamstring stiffness
Nuchal rigidity - neck hard to flex
Holt accentuation - pain on moving neck quickly

Question 6

Diagnosis of Meningitis

Answer 6

Lumbar Puncture/CSF: WCC > 5, Oncotic pressure > 25

CT/MRI: exclude other diagnoses

Question 7

Management of Meningitis

Answer 7

Viral: Supportive Therapy
Batcerial: 
1) IV Benzylpencillin
2) Transfer to Hospital 
3) IV Cephalosporin

Question 8

Red Flags of Space-Occupying Lesion?

Answer 8

Headache: Erratic, worse in mornings/bending over + neurological weakness/blackouts.

Question 9

Investigations for Space Occupying Lesion

Answer 9

1) FBC, U&E, LFT
2) CT/MRI of skull
3) CXR (metastases)

Question 10

Managing Space occupying Lesion

Answer 10

1) Treat malignancy

2) Diuretics, anti-emetics + painkillers (symptoms)

Question 11

Red Flags for Giant Cell Arteritis?

Answer 11

1) Temporal Headache w/scalp tenderness
2) Fever
3) Sudden loss of Vision

Question 12

Investigations for Giant Cell Arteritis?

Answer 12

1) History + Examination: Tender/prominent temporal artery
2) ESR >50
3) Artery Biopsy - High WCC (granulo/monocytes)

Question 13

Management for Giant Cell Arteritis?

Answer 13

Prednisolone 40mg (60mg - ischaemic)
Aspirin 75 mg