Everything you need to know about HEADACHES

Summary

In the comprehensive on-demand teaching session, medical professionals will learn all there is to know about headaches and taking a headache history. Facilitated by Rama Aubeeluck and Mohammed Binyameen, the session covers common causes of headaches, diagnostic techniques and protocols, management options, symptom differentials, and case study analyses. Participants not only gain insights into migraine, tension, cluster, and temporal headaches, but also frequent exam-related questions for further practice. This highly relevant issue cuts across both GP and acute medicine presentation, addressing every aspect from clinical relevance to practical applications. The session would also focus on enhancing one's ability to identify red flags promptly, ensuring patient management is effective. Unlock a higher level of understanding on what is, without a doubt, a frequent issue in day-to-day practice through this engaging session.

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Description

Welcome to Teaching Things!

We're excited to bring you this high-yield teaching series, designed to help you ace both your written and practical exams.

This tutorial will focus on Headaches, covering key differentials such as Migraines, intracranial bleeds and trigeminal neuralgia to ensure you're well-prepared.

The session will be led by Rama and Mohammed, both medical students in their clinical years at UCL, who are passionate about delivering practical, exam-focused content.

Don’t forget to fill out the feedback form after the tutorial—we value your input! And remember, you can access recordings of all past tutorials on our page

Learning objectives

To understand the different types of headaches, including tension, migraine, cluster headaches, and others, and their causes.
To learn how to take a detailed and structured headache history, including how to differentiate between the different types based on the patient's description.
To analyze the significance of associated symptoms such as nausea, vomiting, visual disturbances and others in diagnosing the type of headache.
To become familiar with the triggers for each type of headache, such as stress, alcohol, caffeine, hormonal changes, and others.
To comprehend the management strategies for each type of headache, including lifestyle recommendations, pharmacological interventions, and when to refer for further investigation or specialist input.

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ALL YOU NEED TO KNOW ABOUT HEADACHES AND TAKING A HEADACHE HISTORY Rama Aubeeluck Mohammed Binyameen Reminder to tutors: please change the description, summary and learning objectives on MedAll Keep this slide on here until you’ve done it (as a reminder) Here’s what we do: ■ Weekly tutorials open to all! ■ Focussed on core presentations and teaching diagnostic technique If you’re new here… ■ Bstudentsl students, for medical ■ Reviewed by doctors to ensure W elcome to accuracy T eaching ■ We’ll keep you updated about our Things! upcoming events via email and groupchats!Headaches Rama AubeeluckWhat do you know about headaches so far 1. Nothing… what is a headache? 2. A couple of things 3. I know a few pathologies 4. Well versed, just missing a few details 5. I know everythingWhat can come up in exams? ● CPSA: History taking and potential management ● CPSA: Counselling (unlikely) and management ● AKT: headache differentiation and management, understanding of red ﬂags Relevance to clinical practice ● Very common GP presentation ● Common acute medicine presentation ● May indicate a sinister cause!Quick ﬁre question - different types of headaches? Name as many as you canCauses of headaches ● Migraine ● Tension headaches ● Cluster headaches ● Temporal arteritis ● Trigeminal neuralgia ● Idiopathic intracranial hypertension (IIH) ● Medication overuse ● Subarachnoid hemorrhage ● Strokes ● Tumours ● Intracranial venous thrombosis ● Post-lumbar puncture headacheCase presentation 1 A 32-year-old woman presents to the GP with recurrent episodes of severe, throbbing headaches, primarily on one side of her head, lasting several hours. She experiences associated nausea, vomiting, and sensitivity to light and sound, with occasional visual disturbances before the headache begins. The headaches have worsened recently, and she has been traveling frequently. She eats excessive amounts of cheese and has been struggling with sleep lately so has been drinking more alcohol as an aid Most likely diagnosis?Migraines Any triggers?Migraine triggers: think CHOCOLA TE ● Chocolate ● Hangovers ● Cheese/caffeine ● Oral contraceptives ● Lie-ins ● Alcohol ● Travel ● ExerciseMigraine: main facts ● Pathophysiology: most likely due to cerebral artery dilatation Timeline of a migraine ● Prodrome (hours - days): precedes headache - yawning, cravings, mood/sleep change ● Aura (5-60 mins): ⅓ patients, visual isseus (hemianopias, partial visual loss, zig zags) ● Headache (up to 72 hours): unilateral, throbbing, associated with N/V, photo/phonophobia ● Postdrome (24-48 hours): fatigue, depressed / euphoric, inability to concentrateMigraines: diagnostic criteriaMigraines: managementMigraines: extra management ● Pregnant: paracetamol 1g, NSAIDs 2nd line ● COCP: absolute CI if migraine with aura present due to stroke risk ● Menstruation: migraines can be worse w/ menstruation, consider mefenamic acid and triptans ● HRT: safe for people with migraines to have HRTCase presentation 2 A 32-year-old woman presents to the GP with frequent, dull, pressing headaches that feel like a tight band around her forehead and temples. The pain is mild to moderate (3-4/10), bilateral, and not associated with nausea, vomiting, or visual disturbances She has been under a lot of work stress and has been on her computer screen for up to 12 hours a day Most likely diagnosis?T ension headaches ● Associated with stress, depression, alcohol, dehydration ● Tight band around head, gradual onset, no visual changes ● Usually bilateral ● No aura, N/V ● Can co-exist with migraine / develop into a migraine over time ● Management: basic analgesia, reassure, relaxation and trigger reduction (key part of management - do not skip this!). Consider acupuncture for prophylaxisCase presentation 3 A 38-year-old man presents with a severe headache that began 30 minutes ago. Early this week, he had two similar headaches, lasting about 2 hours and mainly focused around his right temple and eyebrow region. He reports they are the worst headaches he's ever experienced. What is the most appropriate ﬁrst-line treatment? a. Carbamazepine b. Prednisolone c. Metoclopramide d. High-ﬂow oxygen e. VerapamilCase presentation 3 A 38-year-old man presents with a severe headache that began 30 minutes ago. Early this week, he had two similar headaches, lasting about 2 hours and mainly focused around his right temple and eyebrow region. He reports they are the worst headaches he's ever experienced. What is the most appropriate ﬁrst-line treatment? a. Carbamazepine b. Prednisolone c. Metoclopramide d. High-ﬂow oxygen e. VerapamilCluster headaches (suicide headaches) ● One of the most painful headaches one can experience ● Risk factors: male (3:1), smoking, alcohol (common trigger) ● Come in clusters of attacks and then disappear for a while ● Typically occurs 1-4 times a day, each episode lasting 15 mins -3 hours ● Clusters typically last 4-12 weeks, followed by a pain free period of 1-2 yearsCluster headaches (suicide headaches) ● Excruciating stabbing pain around one eye that may be accompanied by redness, lacrimation, lid swelling in the eye ● Attacks always on the same side ● The patient is restless and agitated during an attack ● Nasal stuffiness and discharge ● Miosis and ptosis in a minorityCluster headaches (suicide headaches) Management ● Acute: 100% oxygen (15L RM), SC triptan 6mg ● Prophylaxis: Verapamil main drug to know, also lithium, corticosteroids ● Prevention: avoid triggersCase presentation 4 A 70-year-old woman presents to the ED with a three-day history of persistent headache at her right temple and jaw pain on chewing food. She reported experiencing a dark curtain transiently descending over her right ﬁeld of vision upon waking this morning. ESR is 110 mm/hr (<20 mm/hr) Which of the following is the most appropriate initial treatment? a. Aspirin 300mg STAT b. Aspirin 75mg c. Intravenous methylprednisolone 500mg d. Oral prednisolone 30mg e. Oral prednisolone 40mgCase presentation 4 A 70-year-old woman presents to the Emergency Department with a three-day history of persistent headache at her right temple and jaw pain on chewing food. She reported experiencing a dark curtain transiently descending over her right ﬁeld of vision upon waking this morning. The erythrocyte sedimentation rate (ESR) is 110 mm/hr (<20 mm/hr). Which of the following is the most appropriate initial treatment? a. Aspirin 300mg STAT b. Aspirin 75mg c. Intravenous methylprednisolone 500mg d. Oral prednisolone 30mg e. Oral prednisolone 40mgGiant cell arteritis - background ● Associated with polymyalgia rheumatica (PMR) ● Systemic vasculitis of the medium and large arteries. It typically presents with symptoms affecting the temporal arteries and is also known as temporal arteritis ● Histology shows changes that characteristically 'skips' certain sections of the affected artery whilst damaging others. ● Typically patient > 60 years oldGiant cell arteritis - clinical features ● Usually rapid onset (e.g. < 1 month) ● Constant throbbing unilateral headache ● Tender scalp (e.g when combing hair) ● Blurred or double vision ● Pain on chewing ● Jaw claudication (65%) ● PMR symptoms: aching, morning stiffness in proximal limb muscles (not weakness)GCA What investigations would you order on a patient presenting with suspected GCA?GCA - investigations Bedside ● Neurological exam ● Opthal assessment (fundoscopy, cranial nerve testing) Bloods ● ESR > usually 50 mm/hr (note ESR < 30 in 10% of patients) for diagnosis ● FBC: normocytic anaemia, thrombocytosis Speciﬁc ● Temporal artery biopsy → Skip lesions may be present ● Duplex ultrasound of temporal artery: hypoechoic halo signGCA and visual loss ● Medical emergency - must be treated ASAP! ● Anterior ischemic optic neuropathy accounts for the majority of ocular complications. Due to occlusion of the posterior ciliary artery (a branch of the ophthalmic artery) → ischaemia of the optic nerve head ● Fundoscopy: swollen pale disc and blurred margins ● May result in temporary visual loss - amaurosis fugxax ● Permanent visual loss is the most feared complication of temporal arteritis and may develop suddenly ● Diplopia may also result from the involvement of any part of the oculomotor system (e.g. cranial nerves)GCAGCA - management principles ● Expect rapid response to steroids (48 hours) ● Ophtal referral if visual impairment, rheumatology referral if suspectedPMR, vascular referral for biopsy ● Early complication: visual loss, stroke ● Late complications: relapse, steroid side effects, stroke ● Main cause of death and morbidity in GCA?Case presentation 5 A 40-year-old female presents to the GP complaining of daily headaches that feel similar to her usual migraines but have become more persistent and less responsive to treatment. She has been taking sumatriptan and ibuprofen almost daily for the past few months, and the headaches often start in the morning, feeling dull and diffuse before worsening throughout the day. She is worried about why her headaches are getting worse despite taking medication regularly. Most likely diagnosis?Medication overuse headache ● Present >15 days / month ● Worsened when taking regular symptomatic medication ● Speciﬁcally opioid and triptan use increase risk Management ● Simple analgesics and triptans should be withdrawn abruptly (may initially worsen headaches) ● Opioid analgesics should be gradually withdrawn (taper) ● Withdrawal sx: vomiting, hypotension, tachycardia, restlessness, sleep disturbances and anxiety may occur when medication is stoppedCase presentation 6 A 67-year-old woman presents to her GP with headaches. She describes short but recurrent episodes of severe stabbing pain in her right temple. Some episodes are precipitated by chewing or touching her face, and others occur spontaneously. Which of the following is the ﬁrst-line treatment for this condition? a. Verapamil b. Ibuprofen c. Sumatriptan d. Prednisolone e. CarbamazepineCase presentation 6 A 67-year-old woman presents to her GP with headaches. She describes short but recurrent episodes of severe stabbing pain in her right temple. Some episodes are precipitated by chewing or touching her face, and others occur spontaneously. Which of the following is the ﬁrst-line treatment for this condition? a. Verapamil b. Ibuprofen c. Sumatriptan d. Prednisolone e. CarbamazepineT rigeminal neuralgia - background ● Typical patient: male >50 ● Affects 1 speciﬁc branch of the CNV (V1, V2, V3) ● Causes: idiopathic, compression of the nerve (tumour), MS, VZV infectionTrigeminal neuralgia - triggers? T rigeminal neuralgia - triggers? ● Cold weather ● Spicy food ● Caffeine ● Citrus fruits ● Around 5-10% of people with multiple sclerosis have trigeminal neuralgia.T rigeminal neuralgia - clinical features ● Intense facial pain, spontaneous and lasts anywhere between a few seconds to hours ● Electricity-like shooting pain ● Limited to 1 division of CNV ● 90% unilateral ● Pain evoked by light touch, including washing, shaving, smoking, talking, and brushing the teeth (trigger factors), and frequently occurs spontaneously Red ﬂags suggesting serious underlying cause ● Sensory changes, deafness, pain in optic neuritis, FH of MST rigeminal neuralgia - investigation and management ● Investigation: MRI ● Medical: carbamazepine as ﬁrst-line. Start at 100mg/12h PO, consider lamotrigine, phenytoin or gabapentin ● If drugs fail, surgery to decompress or intentionally damage the trigeminal nerve is an option ● Mechanism of action of carbamazepine: blocking voltage-gated sodium channels on neuronal membranes, stabilizing hyperexcitable nerve ﬁbers and reducing the repetitive ﬁring of action potentials. This prevents the abnormal pain signals responsible for the sudden, severe facial pain seen in trigeminal neuralgiaCase presentation 7 A 25-year-old woman presents with a headache. She describes 'blackness' and 'ﬂashes of light' in her vision when bending forwards. These symptoms are reported as lasting a few seconds. She reports intermittent ringing sounds. PMH: diabetes and acne rosacea and is taking tetracycline and metformin. On examination: BMI 30. Her visual acuity is 6/60 bilaterally. Her CSF result is as follows: Which of the following is the most likely underlying cause? a. Metformin b. Bacterial encephalitis c. Tetracycline d. Stroke e. Autoimmune encephalitisCase presentation 7 A 25-year-old woman presents with a headache. She describes 'blackness' and 'ﬂashes of light' in her vision when blending forwards. These symptoms are reported as lasting a few seconds. She reports intermittent ringing sounds. She has a past medical history of diabetes and acne rosacea and is taking tetracycline and metformin. On examination, her BMI is 25. Her visual acuity is 6/60 bilaterally. Her CSF result is as follows: Which of the following is the most likely underlying cause? ● Metformin ● Bacterial encephalitis ● Tetracycline ● Stroke ● Autoimmune encephalitisIdiopathic intracranial hypertension Risk factors?Idiopathic intracranial hypertension - risk factors? Think of a moon-faced obese woman trying to treat her acne: 1. Moon-faced - steroids 2. Female, obese 3. Trying to treat acne - isotretinoin, tetracyclines, and COCP are used to manage acneIIH - clinical features ● Non-pulsatile, bilateral headaches, typically worse in the morning or after bending forwards ● Vomiting ● Visual disturbances: blurred vision, transient visual darkening or loss, likely due to optic nerve ischaemia ● May have CNVI palsy. ● Bilateral papilloedema seen on fundoscopy, indicating increased ICPIIH - management Conservative ● Weight loss (ﬁrst lone) Medical ● Diuretics e.g. acetazolamide (carbonic anhydrase inhibitor) and/or topiramate (causing weight loss in most patients) ● Consider steroids Surgical ● Repeated LP, consider optic nerve sheath decompression and VP shunt tro reduce ICPOther headaches to consider Subarachnoid haemorrhage ● Neurological emergency ● Thunderclap headache // hit at the back of the head with a baseball bat ● Have a look at our CT head tutorial for more information! Meningitis ● Neurological emergency ● Severe and sudden pain surrounding entire head, also with features of meningism (stiff neck, photophobia, drowsiness) Taking a headache history Mohammed BinyameenHistory proforma PC HPC ICE Red Flags Systems review PM/S/PH (if relevant) DH Allergies FH SHHistory proforma PC - Presenting complaint (‘what brings you in today?’) HPC ICE Red Flags Systems review PM/S/PH (if relevant) DH Allergies FH SHHistory proforma PC - Presenting complaint (‘what brings you in today’) HPC - History of presenting complaint - When did it start? - How has it progressed? - Has it ever happened before? (SAH vs migraine) - SOCRATES (for pain) - Triggers ICE Red Flags Systems review PM/S/PH (if relevant) DH Allergies FH SHSOCRA TES Site - Where exactly is the headache? Onset - Did it come on gradually or suddenly? Character - How would you describe the pain? (Dull? Ache? Sharp?) Radiation - Does the pain radiate? Associated symptoms - This will be covered in your systems review and redﬂag Time course - When did it start? Exacerbating/Alleviating factors - Anything made it any better or worse? (Pain relief? Posture? Lights?) Severity - Can you rate the pain on a scale from 1 to 10?SOCRA TES Site - Where exactly is the headache? Onset - Did it come on gradually or suddenly? Character - How would you describe the pain? (Dull? Ache? Sharp?) Radiation - Does the pain radiate? Associated symptoms - This will be covered in your systems review and redﬂag Time course - When did it start? Exacerbating/Alleviating factors - Anything made it any better or worse? (Pain relief? Posture? Lights?) Severity - Can you rate the pain on a scale from 1 to 10?SOCRA TES Site - Where exactly is the headache? Onset - Did it come on gradually or suddenly? Character - How would you describe the pain? (Dull? Ache? Sharp?) Radiation - Does the pain radiate? Associated symptoms - This will be covered in your systems review and redﬂag Time course - When did it start? Exacerbating/Alleviating factors - Anything made it any better or worse? (Pain relief? Posture? Lights?) Severity - Can you rate the pain on a scale from 1 to 10?SOCRA TES Site - Where exactly is the headache? Onset - Did it come on gradually or suddenly? Character - How would you describe the pain? (Dull? Ache? Sharp?) Radiation - Does the pain radiate? Associated symptoms - This will be covered in your systems review and redﬂag Time course - When did it start? Exacerbating/Alleviating factors - Anything made it any better or worse? (Pain relief? Posture? Lights?) Severity - Can you rate the pain on a scale from 1 to 10?SOCRA TES Site - Where exactly is the headache? Onset - Did it come on gradually or suddenly? Character - How would you describe the pain? (Dull? Ache? Sharp?) Radiation - Does the pain radiate? Associated symptoms - This will be covered in your systems review and redﬂag Time course - When did it start? Exacerbating/Alleviating factors - Anything made it any better or worse? (Pain relief? Posture? Lights?) Severity - Can you rate the pain on a scale from 1 to 10?SOCRA TES Site - Where exactly is the headache? Onset - Did it come on gradually or suddenly? Character - How would you describe the pain? (Dull? Ache? Sharp?) Radiation - Does the pain radiate? Associated symptoms - This will be covered in your systems review and red Time course - When did it start? Exacerbating/Alleviating factors - Anything made it any better or worse? (Pain relief? Posture? Lights?) Severity - Can you rate the pain on a scale from 1 to 10?SOCRA TES Site - Where exactly is the headache? Onset - Did it come on gradually or suddenly? Character - How would you describe the pain? (Dull? Ache? Sharp?) Radiation - Does the pain radiate? Associated symptoms - This will be covered in your systems review and redﬂag Time course - When did it start? Exacerbating/Alleviating factors - Anything made it any better or worse? (Pain relief? Posture? Lights?) Severity - Can you rate the pain on a scale from 1 to 10?SOCRA TES Site - Where exactly is the headache? Onset - Did it come on gradually or suddenly? Character - How would you describe the pain? (Dull? Ache? Sharp?) Radiation - Does the pain radiate? Associated symptoms - This will be covered in your systems review and redﬂag Time course - When did it start? Exacerbating/Alleviating factors - Anything made it any better or worse? (Pain relief? Posture? Lights?) Severity - Can you rate the pain on a scale from 1 to 10?SOCRA TES Site - Where exactly is the headache? Onset - Did it come on gradually or suddenly? Character - How would you describe the pain? (Dull? Ache? Sharp?) Radiation - Does the pain radiate? Associated symptoms - This will be covered in your systems review and redﬂag Time course - When did it start? Exacerbating/Alleviating factors - Anything made it any better or worse? (Pain relief? Posture? Lights?) Severity - Can you rate the pain on a scale from 1 to 10?T riggers Migraines Tension headaches: Cluster headaches: (CHOCOLATE) - Stress and anxiety - Alcohol - Chocolate/caffeine - Poor posture - Strong smells - Hangovers - Eye strain (prolonged - Bright lights screen use) - Heat - Orgasms - Sleep disturbances - High altitudes - Cheese - Oral contraceptives - Caffeine withdrawal - Sleep disturbances - Lie ins - Dehydration - Alcohol - Travel - ExerciseHistory proforma PC - Presenting complaint (‘what brings you in today’) HPC - History of presenting complaint ICE - Ideas, Concerns and Expectations Red Flags Systems review PM/S/PH (if relevant) DH Allergies FH SHHistory proforma PC - Presenting complaint (‘what brings you in today’) HPC - History of presenting complaint ICE - Ideas, Concerns and Expectations Red Flags - Is this an urgent or life threatening condition? Systems review PM/S/PH (if relevant) DH Allergies FH SHRed ﬂags to ask about Think ‘does this person need urgent referral to the hospital?’ (if GP scenario) Condition -> Symptoms GCA SAH Meningitis Raised ICP SOL (tumour) Pre-eclampsia TraumaRed ﬂags to ask about Think ‘does this person need urgent referral to the hospital?’ (if GP scenario) Condition -> Symptoms GCA - Scalp tenderness? Pain when chewing? Visual issues? Age over 50? SAH Meningitis Raised ICP SOL (tumour) Pre-eclampsia TraumaRed ﬂags to ask about Think ‘does this person need urgent referral to the hospital?’ (if GP scenario) Condition -> Symptoms GCA - Scalp tenderness? Pain when chewing? Visual issues? Age over 50? SAH - Neck stiffness? Confusion? Photophobia? Meningitis Raised ICP SOL (tumour) Pre-eclampsia TraumaRed ﬂags to ask about Think ‘does this person need urgent referral to the hospital?’ (if GP scenario) Condition -> Symptoms GCA - Scalp tenderness? Pain when chewing? Visual issues? Age over 50? SAH - Neck stiffness? Confusion? Photophobia? Meningitis - Fever? Rash? Photophobia? Neck stiffness? Raised ICP SOL (tumour) Pre-eclampsia TraumaRed ﬂags to ask about Think ‘does this person need urgent referral to the hospital?’ (if GP scenario) Condition -> Symptoms GCA - Scalp tenderness? Pain when chewing? Visual issues? Age over 50? SAH - Neck stiffness? Confusion? Photophobia? Meningitis - Fever? Rash? Photophobia? Neck stiffness? Raised ICP - Worse on coughing or straining? Visual issues? SOL (tumour) Pre-eclampsia TraumaRed ﬂags to ask about Think ‘does this person need urgent referral to the hospital?’ (if GP scenario) Condition -> Symptoms GCA - Scalp tenderness? Pain when chewing? Visual issues? Age over 50? SAH - Neck stiffness? Confusion? Photophobia? Meningitis - Fever? Rash? Photophobia? Neck stiffness? Raised ICP - Worse on coughing or straining? Visual issues? SOL (tumour) - Seizures? Focal neuro deﬁcits? Fevers? Weight loss? Night sweats? Pre-eclampsia TraumaRed ﬂags to ask about Think ‘does this person need urgent referral to the hospital?’ (if GP scenario) Condition -> Symptoms GCA - Scalp tenderness? Pain when chewing? Visual issues? Age over 50? SAH - Neck stiffness? Confusion? Photophobia? Meningitis - Fever? Rash? Photophobia? Neck stiffness? Raised ICP - Worse on coughing or straining? Visual issues? SOL (tumour) - Seizures? Focal neuro deﬁcits? Fevers? Weight loss? Night sweats? Pre-eclampsia - Pregnant? Oedema? Visual issues? Epigastric pain? TraumaRed ﬂags to ask about Think ‘does this person need urgent referral to the hospital?’ (if GP scenario) Condition -> Symptoms GCA - Scalp tenderness? Pain when chewing? Visual issues? Age over 50? SAH - Neck stiffness? Confusion? Photophobia? Meningitis - Fever? Rash? Photophobia? Neck stiffness? Raised ICP - Worse on coughing or straining? Visual issues? SOL (tumour) - Seizures? Focal neuro deﬁcits? Fevers? Weight loss? Night sweats? Pre-eclampsia - Pregnant? Oedema? Visual issues? Epigastric pain? TraumaHistory proforma PC - Presenting complaint (‘what brings you in today’) HPC - History of presenting complaint ICE - Ideas, Concerns and Expectations Red Flags - Is this an urgent or life threatening condition? Systems review - General vs focused (+ constitutional) PM/S/PH (if relevant) DH Allergies FH SHHistory proforma PC - Presenting complaint (‘what brings you in today’) HPC - History of presenting complaint ICE - Ideas, Concerns and Expectations Red Flags - Is this an urgent or life threatening condition? Systems review - General vs focused PM/S/PH (if relevant) - Past medical, surgical and psychiatric history DH Allergies FH SHHistory proforma PC - Presenting complaint (‘what brings you in today’) HPC - History of presenting complaint ICE - Ideas, Concerns and Expectations Red Flags - Is this an urgent or life threatening condition? Systems review - General vs focused PM/S/PH (if relevant) - Past medical, surgical and psychiatric history DH - Drug history (MOH) Allergies FH - Family history SH - Social historyScenario 1 Site - Typically unilateral Onset - Gradual onset over minutes to hours. Character - Throbbing Radiation - Can spread to the other side Association - N+V, photophobia, phonophobia, usually preceded by visual changes or tingling in arms Timing - Lasts 4–72 hours, episodic attacks. Exacerbating/Relieving factors - Worse with physical activity, light, noise. Improves with rest, dark room, NSAIDs. Severity - 8/10Answer - Migraine with aura Site - Typically unilateral Onset - Gradual onset over minutes to hours. Character - Throbbing Radiation - Can spread to the other side Association - N+V, photophobia, phonophobia, usually preceded by visual changes or tingling in arms Timing - Lasts 4–72 hours, episodic attacks. Exacerbating/Relieving factors - Worse with physical activity, light, noise. Improves with rest, dark room, NSAIDs. Severity - 8/10Scenario 2 Site - Generalized Onset - Gradual, progressively worsening over time Character - Dull, deep, pressure-like pain Radiation - None Associations - N+V, visual disturbances Timing - Worse in the morning. Been going on for more than a week Exacerbating/Relieving factors - Worse with coughing, bending forward, or sneezing. Some relief when upright Severity - Started as a 3/10, progressively worsening (now a 6/10)Answer - Raised ICP headache Site - Generalized Onset - Gradual, progressively worsening over time Character - Dull, deep, pressure-like pain Radiation - Can spread diffusely across the head Associations - N+V, visual disturbances Timing - Worse in the morning. Been going on for more than a week Exacerbating/Relieving factors - Worse with coughing, bending forward, or sneezing. Some relief when upright Severity - Started as a 3/10, progressively worsening (now a 6/10)Scenario 3 Site - Bilateral, across the forehead, temples, or back of the head Onset - Gradual, builds up over time Character - Band-like, tight, or pressure sensation Radiation - Can radiate to the neck and shoulders Associations - No associated symptoms Timing - Can last hours to days. Exacerbating/Relieving factors - Worse with stress, fatigue, long screen time. Improves with relaxation, NSAIDs or paracetamol Severity - 4-5/10Answer - T ension headache Site - Bilateral, across the forehead, temples, or back of the head Onset - Gradual, builds up over time Character - Band-like, tight, or pressure sensation Radiation - Can radiate to the neck and shoulders Associations - No associated symptoms Timing - Can last hours to days. Exacerbating/Relieving factors - Worse with stress, fatigue, long screen time. Improves with relaxation, massage, NSAIDs, or paracetamol Severity - 4-5/10 THANKS FOR WATCHING! Please ﬁll out the feedback form on Medall and see you next week!