Headach

Question 1

Types of headache

Answer 1

1) intracranial
(1ry +2ry)
2ry
-irritatve (meningitis +subarachnoid hge)
-ICP(tumour, hydrocephalus, subdural hge)
2) extracranial
(Local +systemic)
Local (eyes ears and nose)
Systemic (Anemia, hypoglycaemia,depression)

Question 2

Normal ICP

Answer 2

Term infants: 1.5-6
Young children: 3-7
Older children: 10-15

Question 3

Red Flags:

Answer 3

Abnormal neurological exam 
New/ unusual headache 
Worst headache 
Immunocompromised
Stiff neck and fever
Early morning headache 
Seizure

Question 4

Triptans

Answer 4

Rizatriptan (6-17)

Almotriptan (adolescent)

Question 5

Preventive meds indication

Answer 5

has four days or more of disabling headaches per month 
Beta blocker
Calcium channel blocker
TCA 
Valporic acid (sodium channel blocker)

Question 6

Which headache is related to psychiatric illnesses?

Answer 6

Tension headache

Question 7

What are complex aura with migraines

Answer 7

hemiparesis, monocular blindness, ophthalmoplegia, vertigo, confusion)

Question 8

if the headache and associated vomiting are worse when lying down or on first awakening; awaken the child from sleep; remit on arising; or are exacerbated by coughing, Valsalva maneuver, or bending over. Papilledema or focal neurological deficits

Answer 8

Icp

caused by a mass (tumor, vascular malformation) or intrinsic increase in pressure (pseudotumor cerebri).

Question 9

Contraindications of triptans

Answer 9

patients with focal neurological deficits associated with their migraines or signs consistent with basilar migraine (syncope) because of the risk of stroke.

Question 10

Types of visual aura

Answer 10

1) negative phenomena, such as hemianopia (loss of half the visual field) or scotoma
2) positive phenomena such as fortification spectra (seeing zigzag lines).

Question 11

What is the most affected nerve in ICP

Answer 11

The VIth (abducens) cranial nerve has a long intracranial course and is often affected when there is raised pressure, resulting in a squint with diplopia and inability to abduct the eye beyond the midline. It is a false localising sign

Question 12

Red flags for space occupying lesion

Answer 12

Squint ,torticollis, papilloedema , bradycardia

Question 13

Forms of migraine

Answer 13

Familial hemiplegic migraine (Ca channel defect)
Sporadic hemiplegic migraine 
Basilar type (vomiting with nystagmus +/ cerebellar signs
Periodic syndrome (cyclic vomiting, Abdominal migraine, benign vertigo of childhood)