Headaches
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Question 1 of 12
1. Question
1 point(s)A 32 year old women presents to her GP with headaches.
She is a secretary and the headaches frequently come on while at work, and can be up to 6/10 in severity. They are usually focused across he forehead and around the sides of her head in a symmetrical fashion.
They usually resolve over 30 minutes or so.
She has no visual changes and rarely gets the headaches when not at work.
She is concerned about a brain tumour.
What is the most appropriate management?
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Question 2 of 12
2. Question
1 point(s)Match the typical presentation to the headache type.
Sort elements
- Tension headache
- Migraine
- Subarachnoid haemorrhage
- Cluster headache
- Analgesic Headache
- Sinusitis
- Giant Cell Arteritis
- Trigeminal neuralgia
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34 year old mother of three working part time and managing her household presenting with a band line achey headache around her forehead, temples and at the back of her head, without other symptoms.
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43 year old women who has suffered with headaches for many years. They can be triggered by eating her favourite food or strong emotions, and are preceded by sparks and blurring of her vision. They last several hours and are relieved by sleeping.
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A 67 year old man presents with a sudden onset severe headache that occurred whilst having sex. It felt like someone hit him over the back of his head with a hammer, and is the worst pain headache he has ever experienced. He is also struggling with bright lights.
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A 29 year old man who has suffered with on and off headaches for a few years. They are unilateral, and focused mainly over one eye. During he headache this eye goes red and waters. The pain is the most severe pain he can imagine, lasts about 30 minutes then eases off. He tends to get several attacks a day for a month, after which he doesn't have the headaches for a year or so. They are eased by 100% oxygen given at home.
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A 74 year old with severe osteoarthritis in her knees presents with headaches. They are generalised headaches and tend to come on a few hours after she wakes up and fluctuate throughout the day.
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A 23 year old man presenting with a headache over the upper portion of his face, behind his cheekbones, eyes and forehead. He had a runny nose and sore throat a week ago.
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A 68 year old woman presenting with a severe pain over the left side of her forehead. This is associated with slight blurring of the vision in her left eye and she noticed that it was very tender over the area when brushing her hair this morning.
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A 55 year old woman presents with episodes of pain across her the right side of her face. These episodes last no more than 30 seconds, and feel like somebody sends an painful electric shock from her right ear across to the middle of her face. Her left side is unaffected.
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Question 3 of 12
3. Question
1 point(s)Rearrange the stages of a migraine into the correct order.
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Prodromal stage
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Aura stage
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Headache stage
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Resolution stage
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Postdromal stage
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Question 4 of 12
4. Question
1 point(s)A 67 year old presents with unilateral headache focussed over her left temporal area. It started this morning and she noticed it was particularly painful and tender on brushing her hair on that side.
Give the most likely diagnosis, select the most helpful investigation from the list below for confirming the diagnosis.
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Question 5 of 12
5. Question
1 point(s)A 54 year old lady presents with a sudden onset occipital headache that started 4 hours ago whilst shopping. She said it felt like she had been hit suddenly over the back of her head. The severe pain has remained at the back of her head since, although she has developed other symptoms of neck stiffness and photophobia. She has had no fever, weakness or rash. She is otherwise fit and well, and has had no unwell contacts.
Examination is unremarkable except for observational pain and photophobia.
Blood tests and a CT head are normal.
What is the most appropriate next step in management?
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Question 6 of 12
6. Question
1 point(s)A middle aged man presents with a history suspicious of subarachnoid haemorrhage. You assist your registrar in performing a lumbar puncture. You are asked to label the bottles in the order that they are collected and to send them off. Other than normal cell microscopy, what else would it be important for you to send the samples for?
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Question 7 of 12
7. Question
1 point(s)A 32 year old man presents with headaches, which he has had for several years. They seem to be triggered by stressful situations and skipping meals. They after often proceeded by sparks across his vision, after which a generalised severe headache occurs associated mild photophobia. When he has these headaches he finds that resting in a dark room and having a short nap helps to relieve the symptoms. He has tried simple analgesia, which does not seem to help.
Neurological examination and fundoscopy is normal.
What is the next most appropriate step in management?
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Question 8 of 12
8. Question
1 point(s)A 45 year old man, who is known to have cluster headaches, presents to the A&E department with severe pain behind his left eye associated with left eye watering and erythema.
He has already self administered a sumatriptan 6mg subcutaneous injection, with little relief.
What would be an appropriate initial management?
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Question 9 of 12
9. Question
1 point(s)You review a 34 year old man in migraine clinic. He complains of severe headaches that affect him several times a day for 2 – 3 days every 3 months. They are characterised by severe pain behind his right eye, associated with watering of that eye. He has attended A&E several times with this headache where he had some relief from sumatriptan injections and high flow oxygen.
He is asking about something to prevent the headaches occurring.
What would be an appropriate medication to start?
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Question 10 of 12
10. Question
1 point(s)A 78 year old lady presents to her GP with left sided temporal headache associated with left sided jaw pain when chewing and left sided tenderness when brushing her hair. She rates the pain at 4/10.
She has had no visual changes.
Her GP refers her to the hospital for urgent blood tests and specialist review.
Given the likely diagnosis, select the medications to start whilst waiting for results from the blood tests?
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Question 11 of 12
11. Question
1 point(s)A 36 year old business man presents with left sided earache for the last week. He has also noted a clicking and crunching feeling underneath his left ear when chewing. He admits that work has been very stressful during this period.
ENT examination is normal.
Given the likely diagnosis, what is the most appropriate initial management?
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Question 12 of 12
12. Question
1 point(s)A 47 year old lady is referred to migraine clinic with shooting pains across the left side of her face.
The shooting pains occur randomly, and only last a few seconds. They occur across her left cheek and jaw, and do not affect her forehead or eye. They occur three or four times per day.
What would be the most appropriate first line medication to start to help prevent her symptoms?
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