Headaches

Question 1

Mx of tension headache

Answer 1

aspirin, paracetamol or an NSAID are first-line
Prophylaxis - acupuncture

Question 2

Recurrent, severe headache which is usually unilateral and throbbing in nature
May be be associated with aura, nausea and photosensitivity
Aggravated by, or causes avoidance of, routine activities of daily living. Patients often describe ‘going to bed’.
In women may be associated with menstruation

Answer 2

Migraine

Question 3

Recurrent, non-disabling, bilateral headache, often described as a ‘tight-band’
Not aggravated by routine activities of daily living

Answer 3

Tension headache

Question 4

Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks
Intense pain around one eye (recurrent attacks ‘always’ affect same side)
Patient is restless during an attack
Accompanied by redness, lacrimation, lid swelling
More common in men and smokers

Answer 4

Cluster headache

Question 5

Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks
Intense pain around one eye (recurrent attacks ‘always’ affect same side)
Patient is restless during an attack
Accompanied by redness, lacrimation, lid swelling
More common in men and smokers

Answer 5

Cluster headache

Question 6

Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks
Intense pain around one eye (recurrent attacks ‘always’ affect same side)
Patient is restless during an attack
Accompanied by redness, lacrimation, lid swelling
More common in men and smokers

Answer 6

Cluster headache

Question 7

Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks
Intense pain around one eye (recurrent attacks ‘always’ affect same side)
Patient is restless during an attack
Accompanied by redness, lacrimation, lid swelling
More common in men and smokers

Answer 7

Cluster headache

Question 8

Typically patient > 60 years old
Usually rapid onset (e.g. < 1 month) of unilateral headache
Jaw claudication (65%)
Tender, palpable temporal artery
Raised ESR

Answer 8

Temporal arteritis

Question 9

Present for 15 days or more per month
Developed or worsened whilst taking regular symptomatic medication
Patients using opioids and triptans are at most risk
May be psychiatric co-morbidity

Answer 9

Medication overuse

Question 10

attacks of severe, unilateral headache, usually in the orbital, supraorbital or temporal region. These attacks are often associated with autonomic features, usually last less than 30 minutes and can occur multiple times a day.

Answer 10

Paroxysmal hemicrania

Question 11

Management of paroxysmal hemicrania

Answer 11

Indomethacin

Question 12

Management of paroxysmal hemicrania

Answer 12

Indomethacin

Question 13

Mx of migraine

Answer 13

oral triptan and an NSAID, or an oral triptan and paracetamol
Prophylaxis - propranolol or topiramate

Question 14

Mx of cluster headache

Answer 14

100% oxygen (80% response rate within 15 minutes)

subcutaneous triptan (75% response rate within 15 minutes)

Prophylaxis
Verapamil

Question 15

Mx of MO headache

Answer 15

simple analgesics and triptans should be withdrawn abruptly (may initially worsen headaches)
opioid analgesics should be gradually withdrawn