Headache and Migraine

Question 1

What investigation should you do if the headache is due to head trauma?

Answer 1

CT

Question 2

What can be triggers in trigeminal neuralgia?

Answer 2

Washing affected area, shaving, eating, talking

Question 3

What can cause trigeminal neuralgia?

Answer 3

Compression of trigeminal root

Question 4

What does CHOCOLATE stand for? (Migraine partial triggers)

Answer 4

Chocolate, Hangover, Orgasm, Cheese/caffeine, Oral contraceptives, Lie-ins, Alcohol, Travel, Exercise

Question 5

What presentations suggest sinusitis?

Answer 5

Dull, constant ache over frontal/maxillary sinuses, worse on bending over

Question 6

What presentation suggests intracranial hypotension?

Answer 6

Worse on standing

Question 7

Describe a tension headache

Answer 7

Bilateral, non-pulsatile +/- scalp muscle tenderness

Question 8

What are some types of headache that tend to recur?

Answer 8

Migraine, cluster headache, trigeminal neuralgia

Question 9

What features can suggest raised ICP?

Answer 9

Chronic, progressive headaches that are typically worse on waking, lying, bending forward, coughing

Question 10

What features can suggest acute glaucoma?

Answer 10

Eye pain +/- reduced vision

Question 11

What feature can suggest giant cell arteritis?

Answer 11

Jaw claudication, tender with thickened, pulseless temporal arteries

Question 12

Describe a cluster headache

Answer 12

Rapid onset excruciating unilateral pain around one eye that may become watery and bloodshot

Question 13

Describe the timing pattern of cluster headaches?

Answer 13

Pain lasts 15-180 mins once or twice a day for 4-12 weeks and then months-years pain free

Question 14

Describe pain from trigeminal neuralgia

Answer 14

Intense unilateral stabbing pain lasting seconds in trigeminal nerve distribution

Question 15

What other symptoms can accompany a migraine?

Answer 15

Nausea and vomiting, all stimuli can produce pain

Question 16

What can type of auras are there?

Answer 16

Visual, somatosensory, motor, speech

Question 17

What can cause an medication overuse headache?

Answer 17

Mixed analgesics

Question 18

What should you ask about their life?

Answer 18

Stress and recent life events

Question 19

What investigation should you do in trigeminal neuralgia?

Answer 19

MRI to exclude secondary causes

Question 20

How can you help manage cluster headaches?

Answer 20

100% oxygen for 15 minutes, sumatriptan at onset

Question 21

How can you manage trigeminal neuralgia?

Answer 21

Some AEDs

Question 22

What migraine prophylaxis can you start?

Answer 22

Propranolol, amitryptyline

Question 23

How can you help migraines during an attack?

Answer 23

Triptan, NSAIDs, anti-emetic

Question 24

What non-pharmacological management can help migraines?

Answer 24

Acupunture

Question 25

What contraception should people with migraines use?

Answer 25

Progesterone-only or non-hormonal contraception

Question 26

What red flags can indicate SAH?

Answer 26

First and worst headache, thunderclap

Question 27

What red flag can indicate acute glaucoma?

Answer 27

Unilateral eye pain

Question 28

What red flag can indicate a tumour or vascular cause?

Answer 28

Unilateral pain and ipsilateral symptoms

Question 29

What red flags can indicated increased ICP or venous thrombosis?

Answer 29

Cough-initiated headache, worse in the morning or bending forward

Question 30

What red flag can indicate giant cell arteritis?

Answer 30

Persisting headache +/- scalp tenderness in over 50s

Question 31

What red flag can indicate meningitis?

Answer 31

Headache with fever or stiff neck

Question 32

What other red flags could be present?

Answer 32

Change in pattern of a usual headache, decreased level of consciousness

Question 33

What's are migraines?

Answer 33

Recurrent throbbing headache often preceded by an aura and associated with nausea, vomiting, visual changes

Question 34

Describe a migraine

Answer 34

Unilateral pain, throbbing-type pain, moderate to severe intensity, motion sensitivity

Question 35

Give an example of a triptan

Answer 35

Sumatriptan

Question 36

Give an example of an anti-emetic

Answer 36

Prochlorperazine

Question 37

What prevention for cluster headaches is there?

Answer 37

Verapamil is first line, then prednisolone, reduce alcohol and stop smoking

Question 38

What is the first line prophylactic treatment of migraines?

Answer 38

Topiramate

Question 39

What can cause tension headaches?

Answer 39

Depression, lack of sleep, missed meals, stress