| How is headache examined | Blood pressure
Palpation
- temporal arteries
- sinuses
Temperature
Neck examination
Fundoscopy |
| What is general approach for management of headache | Reassurance, hydration, optician review
Headache diary
- identify and avoid triggers |
| One feature of a tension headache that is different from a migraine | Nausea, Aura |
| What are red flags for a headache | Age above 50
Thunderclap headache
Progressive/persistent
Previous head injury |
| Difference between primary and secondary headache | Primary
- Non identifiable
- Common (90%)
- Generally not life threatening
Secondary
- Symptom of underlying disease
- Uncommon
- May be life threatening
- Sinusitis, SOL, Haemorrhage, Meningitis |
| What are red flags for a headache | Age above 50
Thunderclap headache
Progressive/persistent
Previous head injury |
| Where is tension headache likely to occur | Bilateral, frontal-temporal |
| Nausea comes with Tension headache
True or False | False |
| What is the cause of tension headache and how is it treated | Cause
- Stress/depression
Treatment
- Simple analgesia
- Does not reduce recurrence and may lead to secondary headache
- Stress management
- NSAIDS, aspirin, paracetamol |
| Where is migraine likely to occur | Unilateral, throbbing and disproportionally disabling |
| Difference between classical migraine and common migraine | Classical Migraine (10-30%)
- Migraine with aura (neurological change, usually visual symptom)
Common Migraine (70-90%)
- Migraine without aura |
| What are managements for migraine | Analgesia
Antiemetic
Triptans |
| One feature of a tension headache that is different from a migraine | Nausea, Aura |
| What are specific symptoms leading to diagnosis of cluster | Excruciating and restlessness
Increased tear production
Redness of eyes |
| Treatment for Cluster | DO NOT suggest simple analgesia
- does not work
Short burst of oxygen therapy
Injecting or intranasal triptan |
| How would patient present with Trigeminal neuralgia | Sudden severe facial pain
Shooting/Burning sensation
Triggered by light touch |
| Treatment for Trigeminal neuralgia | Carbamazepine
- If cannot use it, refer it to specialist |
| What drugs may lead to Medication overuse headache | Chronic use (over 10days) of these drugs
- Paracetamol
- NSAIDs
- Opioids
- Triptans |
| Treatments for medication overuse headaches | Rebound phenomenon
- Pain gets worst when they stop painkillers
However, resolves with discontinuation within 2 months |
| What differentiates from viral or bacterial infection of sinusitis | Bacterial infection (2%)
- blood/pus production
- Creamy discharge from nose or throat
Majority is viral infection |
| What are symptoms of Sinusitis | Tenderness
Fever
Rhinitis |
| What is space occupying lesion | Primary/Secondary brain tumour (from Lung, breast, Bowel, Kidney, Skin)
- primary way more common
Abscess or Haematoma |
| What are symptoms and signs or SOL | Symptoms
- Progressively worsening morning
- due to raised intercranial pressure
- Vomiting
- Seizure
Signs
- Altered GCS
- Cushing's triad (Low heart rate, respiratory rate, increased blood pressure)
- Papilloedema |
| What is subarachnoid haemorrhage | Bleed into subdural space
- following rupture of vein
Neurological emergency
It may be result of berry aneurysm, AV malformation, traumatic head injury |
| How would pateints present with subarachnoid haemorrahge | Thunderclap headache
- worst headache in their life
Meningism
- neck stiffness, photophobia
Nausea
Altered vision
Drowsiness |
| What are examinations for SAH | CT/MRI
Cerebral spinal fluid becomes xanthochromic
- Lysis of RBC resulting in haemoglobin breaking down to bilirubin |
| What is meningitis | Inflammation of meninges
- bacterial or viral infection
Life threatening which can mimic influenza |
| What are symptoms of meningitis | Headache
Fever
Stiff neck
Non-blanching purpuric rash
Opisthotonos
- Arched body with neck hyperextended
Kernig's sign
- Pain when knee extended with hip flexed |
| What bacteria causes meningococcal Septicaemia | Neisseria Meningitidis (meningococcus) |
| Why is Meningococcal Septiciaemia a paediatric emergency | Impacts clotting cascade
- Failure in coagulation
Leads to risk of sepsis |
| What is Temporal arthritis (Giant cell arthritis) | Auto-immune inflammatory vasculitis |
| What age group is prone to temporal arthritis and which gender is more vulnerable | Rare under 50
More common in women |
| Why is temporal region painful for patients with temporal arthritis | Temporal region supplied by temporal artery
Due to inflammation, pain
Pain may radiate to temples and jaws
May lead to Jaw claudication |
| What indicates medical emergency in case of temporal arthritis | Loss of vision |
