Pre PACES Podcast #134 Headache (part 1)
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Mar 1, 2026 Dr Yezen Samaraiee, neurology registrar and founder of QuesMed, brings specialist headache expertise and exam teaching. A quiz-show style romp covers pregnancy headaches and imaging choices, CVST management, cluster headache features and treatments, giant cell arteritis clues, meningitis red flags, and carotid dissection recognition and acute workup.
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Pregnancy Headache Demands Rule Out Of IIH And CVST
- Headache in pregnancy needs high suspicion for secondary causes rather than assuming migraine.
- Yezen highlights IIH and cerebral venous sinus thrombosis as top differentials in third trimester with progressive headache and new blurred vision.
Use MRI/MRV Then LP To Confirm Intracranial Hypertension
- Investigate suspected raised intracranial pressure with MRI head plus MR venogram where possible, and measure CSF opening pressure via lumbar puncture if imaging suggests IIH/CVST.
- Use CT head emergently if MRI unavailable; avoid delays in diagnosis during pregnancy.
Cluster Headache Presents With Clockwork Nocturnal Attacks
- Recurrent nocturnal unilateral severe headaches with ipsilateral lacrimation and rhinorrhoea point to trigeminal autonomic cephalalgias, commonly cluster headache.
- Cluster attacks are excruciating, often seasonal, pacing behaviour is typical and prevention uses high-dose verapamil.