QuestionSBA
QuestionChoice
Cluster headaches tend to appear intermittently in irregular 'clusters', and are often described as unilateral pain around the orbit of the eye. The auras this patient experiences alongside the pulsatile, long-lasting nature of the headaches, make it more likely these are migraines.
10025687
c
Cluster
QuestionChoice
Tension headaches tend to be bilateral and non-pulsatile, feeling like a 'tight band'. They do not tend to present with auras beforehand. Migraines are therefore a more likely underlying diagnosis in this case.
10025686
b
Tension
QuestionChoice
This type of headache typically presents as bilateral and non-pulsatile. In addition, they are often found to be worse in the morning. Cushing's reflex may be seen in cases of raised ICP; this is characterised by a triad of increased blood pressure, decreased heart rate and irregular breathing. The absence of these features and the presence of an aura makes migraines the more likely underlying diagnosis.
10025688
d
Raised Intra-cranial-pressure (ICP)
QuestionChoice
The presence of a visual aura preceding a severe headache that is unilateral and pulsatile in nature is characteristic of a migraine. The nausea and vomiting also support this diagnosis. Stress is a common trigger for migraines, as alluded to by this patient changing jobs at a similar time to when the headaches first appeared.
10025685
a
Migraine
QuestionChoice
Trigeminal neuralgia is more prevalent in those over 50. It presents with sharp, stabbing pain that follows the distribution of the trigeminal nerve across one side of the face. The absence of these features and the presence of an aura makes migraines the more likely underlying diagnosis.
10025689
e
Trigeminal neuralgia
Concept
Chapter
2693
5857
Headache
Topic
162
General practice
17535
A 30 year old woman presents to her GP with recurrent headaches that have been present intermittently for the past 2 months. She describes seeing spots and zig zags in her vision before developing a pulsating, unilateral headache that can last for several hours. Alongside the, she reports bouts of nausea & vomiting. She takes paracetamol as needed, with little benefit.

She has no past medical history, but notes feeling particularly stressed since starting a new job 2 months ago. She does not smoke or drink alcohol, but notes her diet is 'not the best'.

Which of the following is the most likely underlying diagnosis?
a