Headache Diagnosis Quiz

A 28-year-old man presents with a severe, intermittent, piercing left-sided frontotemporal headache over the past few days. It seems to occur early in the morning, around the same time each day and lasts between 15 minutes to 2 hours. He feels sick at the time and is unable to lie still. He had a similar episode last year. A full neurological examination whilst headache-free is entirely normal. What is the most likely underlying diagnosis?

A 32 year old female has been suffering with unilateral, throbbing headaches for the past 24 hours. She is currently 36 weeks pregnant. Her pregnancy has thus far been uncomplicated. On examination, there is no papilledema, reflexes are normal and her blood pressure is 130/90mmHg. Prior to pregnancy, the patient would usually take ibuprofen or aspirin for her headaches, with good effect.

A 20-year-old man presents with recent episodes of severe, stabbing pain in the right eye. These episodes typically occur once a day and last around 30 minutes. His wife reports him pacing around and shouting with the pain. She also reports that his right eye appears red and that he has clear nasal discharge during the episodes. Given the likely diagnosis, which one of the following should you advise the patient to avoid to help prevent further episodes?

A 23-year-old presents for review. For the past 3 months or so he has been having problems with frequent headaches. These are now occuring on an almost daily basis and can be severe at times. In this patient, which one of the following features should prompt investigation for a secondary cause of headaches?

A 45-year-old female presented to her GP with a headache persisting for the past 4 weeks. The headache was mainly frontal, with no additional symptoms of visual disturbance, nausea or vomiting. She complained of waking up in the mornings with the headache present, and it persisting throughout the day. The patient is on lansoprazole for a gastric ulcer, inhalers for asthma, regular painkillers for fibromyalgia, and has a Mirena coil in situ for contraception. Which of the following medications is most likely to be contributing to this patient's headaches?

A 30-year-old woman who suffers from menstrual migraine comes for review. Every month she gets a severe headache just before her period is due to start. Which one of the following do NICE recommend to try and stop the headaches developing?

You review a 31-year-old woman who is suffering from frequent tension-type headaches. Her headaches partially respond to paracetamol and ibuprofen but she asks if there is any treatment to stop the headaches coming in the first place. What is the most appropriate action?

A 34-year-old man presents with episodes of severe pain around his right eye. These occur once or twice a day and typically last 30 minutes. The episodes started around 1 week ago and whilst severe have not been getting worse. During an attack his girlfriend reports that his eye goes red and starts to water. Examination of his eye now including visual acuity is normal. His last episode was around 3 hours ago and he is now pain free. What is the most appropriate next step?