EMQs in Clinical Medicine.pdf - Peshawar Medical College

Headache – answers 91
The clusters usually last between a few weeks and a few months.
B
A 24-year-old woman complains of a unilateral throbbing headache
lasting 6 hours associated with vomiting and photophobia. She has
had several episodes in the past.
The classic description of migraine includes a preceding aura before the
onset of the headache, but this feature does not occur in most patients.
30 Headache
Answers: L G J D E
L
G
J
D
A 56-year-old woman complains of unilateral stabbing pain on the
surface of her scalp and around her eye. The pain is precipitated by
washing or touching the specific area.
This woman gives a classic history of trigeminal neuralgia affecting the
ophthalmic division of the trigeminal nerve. This condition more commonly
presents in the mandibular and maxillary branches. It is principally
a complaint in older patients.
A 28-year-old woman complains of headache and double vision
which is worse when lying down. Examination reveals papilloedema
but no focal signs. There are no abnormal findings on CT.
Benign intracranial hypertension is a condition of unknown aetiology
which usually affects obese women. Steroids and tetracyclines are
recognized precipitants.
Diagnosis of raised CSF pressure is made by LP. Symptoms often
resolve after LP. Chronic treatment includes the use of repeated LPs and
diuretics.
A 30-year-old man complains of a dull headache that is worse when
lying down or when coughing. He has recently suffered a seizure.
A description of early morning headache that is exacerbated by lying
down/coughing/sneezing is a classic description of raised intracranial
pressure. The development of seizures is a sinister finding and urgent
imaging is warranted.
A 65-year-old woman complains of a constant aching pain around
the right eye radiating to the forehead. There is reduced vision in the
eye, which is red and congested with a dilated pupil.
Acute closed angle glaucoma mostly affects the long-sighted elderly
population. It is caused by blockage of drainage of aqueous humour from
the anterior chamber via the canal of Schlemm.
Stimuli that cause pupillary dilatation (e.g. sitting in the dark) increases
the tightness of contact between the iris and the lens and can precipitate
an attack.