Is studying for headaches giving you a headac—- … no I won’t do it. Sorry. Stop reading this and try some questions. I’m tired haha.
Reviewed by Jonathan Loomes-Vrdoljak
Approach to the Patient with Headache - Part One
Stem 1 of 4
A 27 year-old woman comes to her GP fed up. She’s had one-sided, aching head pain for about 2 years now. It lasts the “whole damned day” when she gets a flare of it, and she has to wear sunglasses. She can’t eat much more than dry toast during the “attacks” as she puts it, and is also worried because now she’s started seeing “flashing stars before the headache comes on - like its warning me!”.
What is the best matched differential?
Stem 2 of 4Which of the following is a true statement about this diagnosis?
An aura succeeds the headache usually
Migraine affects about 1 in 70 people worldwide
Migraine is more common in males
Pregnancy often improves symptoms
Prognosis is worsened with age
Stem 3 of 4When taking the history, which red flags are most appropriate to ascertain?
Focal neurological signs
Pulsatile tinnitus associated sign
Stem 4 of 4How would you initially manage this patient’s acute episode?
Stem 1 of 4
A 19 year-old university student is brought to his GP. He is drowsy and poorly responsive with a fever. His friend accompanying him says that he’s been rubbing his neck constantly for a few days and complaining of a worsening headache. Whilst in the waiting room the patient has a generalised seizure.
Given the most likely diagnosis, what is the most common aetiology?
Stem 2 of 4The patient is positive of Kernig’s sign. Which of the following best describes this test?
Erythematous rash on flanks and anterior torso
Flexion of the neck causes a flexion of hip
Hip flex, knee extend causes back pain
Knee flex, hip extend causes back pain
Non-blanching purpuric rash on flanks
Stem 3 of 4The patient has a non-blanching purpuric rash. What would be the first line step in PRIMARY care?
Administer parenteral antibiotics and monitor 20 minutes
Call 999 and administer parental antibiotics
Call 999 but without antibiotics
Send home with antipyretics
Send home with antipyretics and emollient cream
Stem 4 of 4Which of the following is an expected result for the CSF of this patient?
Elevated CSF lactate suggests bacterial infection
Elevated CSF protein should be expected
Glucose concentration will be elevated relative to plasma
Polymorphonuclear leukopenia is common in CSF
There is no need for a LP
Stem 1 of 4
A 52 year old female presents to her primary care practitioner complaining of a year’s worth of “headaches at the end of her busy work day”. She is a lawyer, denying any occupational health exposures, but is getting frustrated. She denies photophobia, nausea or pain sufficient to disable.
During the differential process, the clinician considers “medication overuse headache”. Which are the top two drug classes responsible for this diagnosis?
Stem 2 of 4The patient is diagnosed with a tension-type headache. Which muscle group(s) are LEAST tender in this patient demographic?
Stem 3 of 4Which risk factor is LEAST associated with tension-type headache?
Stem 4 of 4Which medication below would you NOT consider as a first-line option in acute tension-type headache?
- BMJ Best Practice – https://bestpractice.bmj.com/topics/en-gb/10?q=Migraine%20headache%20in%20adults&c=suggested
- BMJ Best Practice – https://bestpractice.bmj.com/topics/en-gb/12?q=Tension-type%20headache&c=suggested
- BMJ Best Practice – https://bestpractice.bmj.com/topics/en-gb/3000104/investigations
- NICE CKS – https://cks.nice.org.uk/topics/meningitis-bacterial-meningitis-meningococcal-disease/
- NICE CKS – https://cks.nice.org.uk/topics/migraine/