Headaches

Question 1

What are some of the possible causes of headaches?

Answer 1

Tumour 
Meningitis 
Vascular disorders 
Systemic infection 
Head injury 
Drug induced

Question 2

What are the different types of primary headaches?

Answer 2

Tension type headache
Migraine
Cluster headaches

Question 3

What are the clinical features of a tension type headache?

Answer 3

Mild pain 
Bilateral 
Pressing or tightening 
No significant associated features 
Not aggravated by routine physical activity

Question 4

What abortive treatment is used for tension type headaches?

Answer 4

Aspirin
Paracetamol
NSAIDs

Question 5

What preventative treatments are used for tension type headaches?

Answer 5

Tricyclic antidepressants

Question 6

What is a migraine?

Answer 6

Chronic disorder with episodic attacks due to complex changes in the brain

Question 7

What are the clinical features of a migraine?

Answer 7

Headache 
Nausea 
Photophobia 
Phonophobia 
Functional disability

Question 8

What are some of the triggers of a migraine?

Answer 8

Stress
Diet 
Dehydration 
Environmental stimuli 
Changes in oestrogen level in women 
Sleep disturbance 
Hunger

Question 9

What are the different stages of a migraine?

Answer 9

Premonitory 
Aura 
Early headache 
Advanced headache 
Postdrome

Question 10

What is an aura?

Answer 10

Neurological symptoms resulting from cortical brainstem dysfunction, may involve visual, sensory, motor or speech systems

Question 11

What can make headaches worse?

Answer 11

Medication overuse

Caffeine overuse

Question 12

What is the abortive treatment for migraines?

Answer 12

Aspirin or NSAIDs

Triptans

Question 13

What is the prophylactic treatment for migraines?

Answer 13

Propanolol or candesartan
Anti- epileptics
Tricyclic antidepressants
Venlafaxine

Question 14

What effect can pregnancy have on migraines?

Answer 14

Migraines with aura get better

Migraines without aura usually don’t change

Question 15

What is the effect of OCP on migraines?

Answer 15

Contraindicated in migraine with aura

Question 16

What are the different types of trigeminal autonomic cephalagias?

Answer 16

Cluster headaches
Paroxsymal hemicrania
SUNCT
SUNA

Question 17

What are the clinical features of a cluster headache?

Answer 17

Mainly orbital and temporal 
Strictly unilateral 
Rapid onset 
Excruciatingly severe 
Restless and agitated

Question 18

What are the clinical features of paroxysmal hemicrania?

Answer 18

Mainly orbital and temporal 
Strictly unilateral 
Rapid onset 
Restless and agitated 
Absolute response to indometacin 
CHRONIC

Question 19

What are the clinical features of SUNCT?

Answer 19

Unilateral orbital, supraorbital or temporal pain 
Stabbing or pulsating pain 
Short lived 
No refractory period
Conjunctival injection and tearing

Question 20

What are the clinical features of trigeminal neuralgia?

Answer 20

Unilateral maxillary, mandibular or ophthalmic pain
Stabbing
Short lived
Has a refractory period

Question 21

What are the triggers of trigeminal autonomic cephalagias?

Answer 21

Wind, cold
Touch
Chewing

Question 22

What is the abortive treatment for cluster headaches?

Answer 22

Subcutaneous sumatriptan
Nasal zolmatripan
Occipital depomedrone injection

Question 23

What is the preventative treatment for cluster headaches?

Answer 23

Verapamil

Lithium

Question 24

What is the treatment for paroxysmal hemicrania?

Answer 24

No abortive treatment
Indometacin
Topiramate

Question 25

What is the treatment for SUNCT/SUNA?

Answer 25

No abortive treatment Topiramide Lamotrigine

Question 26

What is the treatment for trigeminal neuralgia?

Answer 26

``` No abortive treatment Carbamazepine Oxcarbazepine Glycerol ganglion injection Steriotactic radiosurgery ```

Question 27

What presentations of headache are more likely to have a sinister cause?

Answer 27

``` Associated head trauma First or worst Sudden (thunderclap) headache New daily persistent headache Change in headache pattern or type ```

Question 28

What are the red flag symptoms associated with headache?

Answer 28

``` Neck stiffness Fever High or low pressure New onset or change in headache Abnormal neurological examination ```

Question 29

What is a thunderclap headache?

Answer 29

High intensity headache reaching maximum intensity in less than 1 minute

Question 30

What is the differential diagnosis of a thunderclap headache?

Answer 30

``` Subarachnoid haemorrhage Intracerebral haemorrhage TIA/stroke Carotid/vertebral dissection Meningitis/encephalitis Cerebral venous sinus thrombosis ```

Question 31

What investigations are used for a subarachnoid haemorrhage?

Answer 31

CT scan | Lumbar puncture 12 hours after onset

Question 32

What are the signs of meningitis?

Answer 32

Nausea, vomiting Photo/phonophobia Neck stiffness

Question 33

What are the signs of encephalitis?

Answer 33

Altered mental state/ consciousness Focal symptoms or signs Seizures

Question 34

What are the features suggestive of a space occupying lesion or raised intracranial pressure?

Answer 34

``` Progressive headache with associated symptoms and signs Visual obscurations Pulsatile tinnitis Seizures Personality change ```

Question 35

What investigations are used for intracranial hypotension?

Answer 35

MRI brain and spine

Question 36

What is the treatment for intracranial hypotension?

Answer 36

Bed rest, fluids, analgesia, caffeine Epidural blood patch IV caffeine

Question 37

What are the symptoms of giant cell arteritis?

Answer 37

``` Diffuse, persistant headache Systemically unwell Scalp tenderness Jaw claudication Visual disturbance Prominent, beaded or enlarged temporal arteries ```

Question 38

What is the treatment for giant cell arteritis?

Answer 38

High dose prednisolone | Temporal artery biopsy