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3 NERVOUS SYSTEM > HEADACHE & TRIGEMINAL Neuralgia > Flashcards

HEADACHE & TRIGEMINAL Neuralgia Flashcards

1
Q

Pain SENSITIVE STRUCTURE of BRAIN

🧠⚡Pain Sensitive Means Dura Feels Chilling² Pain ⚡

A
  1. Periosteum
  2. Scalp
  3. Middle Meningeal ARTERY
  4. Duramater
  5. Falx cerebri
  6. Circle of WILLIS
  7. CN 5, 9, 10
  8. Pial Arteries (PROXIMAL part)
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2
Q

Pain INSENSITIVE STRUCTURE IN BRAIN

🧠⚡ ABCDE⚡

A
  1. Arachnoidmater & Piamater
  2. Brain Parenchyma
  3. Choroid Plexus
  4. Dura over convexity of skull
  5. Ependyma
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3
Q

🌸 TYPES of HEADACHE

A

⭐ 1° HEADACHE
⭐ 2° HEADACHE

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4
Q

Benign ➕ Recurrent ➕ No Organic Disease

A

1° headache

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5
Q

Causes of 1° HEADACHE

🧠⚡T²IME⚡

A
  1. Tension type
  2. Trigeminal Autonomic Cephalgias
  3. Idiopathic STABBING
  4. Migraine
  5. Exertional
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6
Q

Dangerous vs NON-DANGEROUS HEADACHE

A

Dangerous headache: ICP ⬆️ ⬆️

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7
Q

Mechanism of PRODUCTION OF HEADACHE

A
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8
Q

⚡⚡ MOST COMMON TYPE OF 1° HEADACHE

A

Tension Type Headache

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9
Q

Middle aged Female
➕
Headache: Fullness, Tightness Band like or Pressure
➕
Steady Pain
➕
Stress ± Depression (33%)
➕
Chronicity (> 15 days/month)

A

Tension Type Headache

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10
Q

Patient is NEVER DISTURBED FROM SLEEP in which type of HEADACHE

A

Tension Type Headache

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11
Q

Duration of HEADACHE in TENSION TYPE HEADACHE

A

> 30 mins (4-6 hrs)

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12
Q

Headache symptoms that suggest SERIOUS Underlying DISORDER

A
  1. Sudden onset
  2. 1st EVER HEADACHE
  3. WORST HEADACHE EVER
  4. VOMITING F/b Headache
  5. Subacute worsening
  6. Disturbs sleep
  7. Pain induced by BENDING, LIFTING or COUGHING
  8. SYSTEMIC ILLNESS ➕
  9. Age > 55 yrs
  10. Abnormal Neurological Examination
  11. Fever (OR) Unexplained Systemic symptoms
  12. Pain ASSOCIATED with LOCAL tenderness (TEMPORAL Artery)
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13
Q

Raised ICT
⚡⚡ MOST COMMON DIAGNOSTIC FEATURE

A

Papilledema
➕
Bradycardia
Hypertension

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14
Q

💊💉 MANAGEMENT of TENSION TYPE HEADACHE

⭐ ACUTE ATTACK
⭐ CHRONIC TTH

A

⭐ ACUTE ATTACK
🎯 NSAID

⭐ CHRONIC TTH
🎯 Prophylaxis with AMITRIPTYLINE (TCA)

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15
Q

🌸 TYPES of MIGRAINE

A
  1. Migraine without AURA (COMMON MIGRAINE)
  2. Migraine with AURA ( Classical MIGRAINE)
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16
Q

RARE TYPES OF MIGRAINE
🧠⚡BOHR Family ⚡

A
  1. Basilar Migraine
  2. Opthalmoplegic Migraine
  3. Hemiplegic Migraine
  4. Retinal Migraine
  5. Familial HEMIPLEGIC Migraine (Calcium Channelopathy)
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17
Q

Familial HEMIPLEGIC Migraine: 🌸 TYPES

A
  1. FHM1: Calcium Channelopathy (CACNAIA)
  2. FHM2: Na-K ATPase (ATP1A2)
  3. FHM3: Na channel (SCN1A)
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18
Q

SCN1A gene mutation is seen in

A
  1. Familial HEMIPLEGIC Migraine 3
  2. DRAVET SYNDROME
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19
Q

Stages of MIGRAINE headache

A
  1. Prodrome
  2. Aura
  3. Headache
  4. Postdrome
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20
Q

For DIAGNOSIS of

⭐ COMMON MIGRAINE
⭐ CLASSICAL MIGRAINE

A

⭐ COMMON MIGRAINE
Minimum: 5 ATTACKS, each lasting 4-72 hours

⭐ CLASSICAL MIGRAINE
Minimum: 2 ATTACKS, each lasting 4-72 hours
✨ Features of CLASSICAL AURA MUST be ➕

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21
Q

Features of MIGRAINE AURA

A
  1. Gradual onset > 40min
  2. Lasting < 60min
  3. Fully Reversible
  4. Headache after 60 mins or simultaneously without AURA
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22
Q

U/L HEADACHE

A

✨ MIGRAINE
✨ TRIGEMINAL AUTONOMIC CEPHALGIA

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23
Q

⚡⚡ MOST COMMON MIGRAINE AURA

🧠⚡ VASE⚡

A

Visual
⬇️
Auditory
⬇️
Sensory

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24
Q

⚡⚡ MOST COMMON VISUAL AURA IN MIGRAINE

A

Zig Zag lines
⬇️
Fortification spectra
Scintillating SCOTOMA
Tunnel Vision
transient Visual loss

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25
Q

2 Days Prior to Migraine Headache

A

Mood changes
Irritability
Depression

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26
Q

Sensory Aura in MIGRAINE

A

Tingling sensation in Hand, spreading to ARMS ➡️ Lips & Tongue

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27
Q

Features of MIGRAINE HEADACHE

🧠⚡SULTANS ⚡

A
  1. Severe or Moderate INTENSITY
  2. U/L
  3. Throbbing
  4. Activity Worsens Headache
  5. Nausea & Vomiting
  6. Sensitivity to Light & Sound
    (Photophobia, Phonophobia, Osmophobia)

⭐ AFTER HEADACHE, PATIENT FEELS LETHARGIC & DEPRESSED for 2 Days

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28
Q

Precipitating FACTOR for MIGRAINE

A
  1. Glare
  2. Bright Light
  3. Sound
  4. Hunger
  5. Stress Excess
  6. Physical Exertion
  7. Hormonal Fluctuations during MENSES
  8. Lack (OR) Excess of Sleep
  9. Alcohol
  10. Chemical stimulation
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29
Q

Vascular theory of MIGRAINE

A
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30
Q

Serotonin theory of MIGRAINE

A

⬇️ Serotonin levels in Brain

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31
Q

⚡⚡ MOST IMPORTANT CYTOKINE IN MIGRAINE

A

CGRP
(Calcitonin Gene Related Peptide)

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32
Q

Central Pathogenicity of MIGRAINE

A

Trigeminovascular complex

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33
Q

Ophthalmoplegic MIGRAINE

A

Headache ➕ TRANSIENT & Reversible U/L 3rd CN PALSY

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34
Q

MIGRAINE Headache
➕
Ataxia
➕
Vertigo
➕
Tinnitus

A

Basilar Migraine

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35
Q

Hemiplagia
➕
MIGRAINE headache

A

Familial HEMIPLEGIC Migraine

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36
Q

MIGRAINE
➕
Transient MONOCULAR VISION LOSS

A

Retinal MIGRAINE

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37
Q

Episodic Disabling Headache > 6months duration with NORMAL Neurological Examination is MIGRAINE, unless proven otherwise

A
38
Q

💊💉 MANAGEMENT of MILD Acute MIGRAINE

🧠⚡ ⚡

A
  1. Paracetamol (OR) NSAID
    ✨ Naproxen 550mg BD
    ✨ Ibuprofen 400mg Q4H
    ➕
  2. Anti-ematics
    ✨ Metoclopramide 5-10 mg OD
39
Q

💊💉 MANAGEMENT of MODERATE MIGRAINE

A
  1. ORAL TRIPTANS
    Eletriptan 40-80mg
    (OR)
    Rizatriptan 5-10mg
    (OR)
    Almotriptan 12.5-25mg
    ➕
  2. Anti-ematics
    ✨ Metoclopramide 5-10 mg OD
40
Q

💊💉 MANAGEMENT of SEVERE to VERY SEVERE Acute MIGRAINE

A

⭐ Sumatriptan 6mg SC inj
(Repeat after 1 hour, if not RESOLVED)

(OR)

⭐ I/N SUMATRIPTAN (OR) ZOLMITRIPTAN

➕
2. Anti-ematics
✨ Metoclopramide 5-10 mg OD

41
Q

Triptans
🧠⚡FRiENdS⚡

A
  1. Frovatriptan
  2. Rizatriptan
  3. Eletriptan
  4. Naritriptan
  5. Sumatriptan
  6. Zolmitriptan
42
Q

⭐ Triptan with MAXIMUM EFFICACY

⭐ Triptan with MINIMUM EFFICACY

A

⭐ Triptan with MAXIMUM EFFICACY
🎯 RIZATRIPTAN

⭐ Triptan with MINIMUM EFFICACY
🎯 SUMATRIPTAN

43
Q

LONGEST ACTING TRIPTAN
🧠⚡Forever lasting ⚡

A

Frovatriptan

44
Q

SAFEST TRIPTAN IN PREGNANCY

A

Sumatriptan

45
Q

FASTEST ACTING TRIPTAN

A

Rizatriptan

46
Q

Triptan with LEAST ORAL BIOAVAILABILITY

A

Sumatriptan

47
Q

DITANS

A

5HT1F AGONISTS
⬇️
LASMIDITAN
⬇️
USE: MIGRAINE

48
Q

🤢😳SIDE EFFECTS🥴😵 of TRIPTANS

A
49
Q

🚫 CONTRAINDICATION of TRIPTAN

A
  1. CVA
  2. CAD
  3. Peripheral Vascular Diseases
50
Q

Monoclonal antibodies against CGRP Receptor

A

ERENUMAB
RIMEGEPANT
UBROGEPANT

51
Q

Anti-CGRP
🧠⚡cdEFG… ⚡

A

EPTINEZUMAB
FREMANEZUMAB
GALCANEZUMAB

52
Q

Prophylaxis of MIGRAINE
🧠⚡Flunarezine Can P-RE-VE-NT Migraine⚡

A
  1. Flunarezine
  2. Cyproheptadine
  3. Propranolol
  4. Pizotifen
  5. Release GABA ➡️ Gabapentin
  6. Valproate
  7. Venlafaxine
  8. Nortriptyline & Amitriptyline
  9. Topiramate
  10. Methysergide
53
Q

Class I DRUGS FOR MIGRAINE Prophylaxis
🧠⚡PVT ⚡

A
  1. Propranolol
  2. Valproate
  3. Topiramate
54
Q

Class II DRUGS FOR MIGRAINE Prophylaxis

A

Venlafaxine
TCA

55
Q

Class III DRUGS FOR MIGRAINE Prophylaxis

A
  1. Pizotifen
  2. Flunarizine
  3. Clonidine
  4. Candesartan
56
Q

Newer TREATMENT modalities for MIGRAINE
🧠⚡GOES ⚡

A
  1. Greater Occipital Nerve Block
  2. Onabotulinum Toxin A
  3. ERENUMAB
  4. Supraorbital Transcutaneous Stimulation
57
Q

MIGRAINE is commonly misdiagnosed as SINUS Headache
Why?

A
  1. Pain is often located over Sinus
  2. Migraine is TRIGGERED by Weather changes
  3. Tearing & Nasal Congestion is COMMON: DUE TO: Autonomic symptoms in MIGRAINE
  4. Sinus medications may help to abort Migraine episode
58
Q

🌸 TYPES of TRIGEMINAL AUTONOMIC CEPHALGIA
🧠⚡PCS² H ⚡

A
  1. Paroxysmal Hemicrania
  2. Cluster Headache
  3. SUNCT: Short lasting U/L Neuralgic Headache with Conjunctival Congestion & Tearing
  4. SUNA: Short lasting U/L Neuralgiform Headache with Cranial Autonomic features
  5. Hemicrania Continua
59
Q

⚡⚡ MOST COMMON TYPE OF TRIGEMINAL AUTONOMIC CEPHALGIA

A

Cluster Headache

60
Q

SUNA

A

Short lasting U/L Neuralgiform Headache with Cranial Autonomic features

61
Q

SUNCT

A

SUNCT: Short lasting U/L Neuralgic Headache with Conjunctival Congestion & Tearing

62
Q

Diagnostic feature of TAC

A

I/L headache
➕
Any 1:
1. Conjunctival injection
2. Nasal congestion
3. Rhinorrhea
4. Eyelid edema
5. Forehead & Facial Sweating
6. Flushing of Face & forehead
7. Fullness in Ear
8. Miosis or Ptosis

63
Q

Difference BETWEEN CLUSTER HEADACHE, PAROXYSMAL HEMICRANIA & SUNCT (OR) SUNA

A
64
Q

⭐ Alcohol is the TRIGGER for which TAC

⭐ CUTANEOUS TRIGGER for which TAC

A

⭐ Alcohol is the TRIGGER for which TAC
🎯 Cluster Headache

⭐ CUTANEOUS TRIGGER for which TAC
🎯 SUNCT (OR) SUNA

65
Q

Indomethacin is useful for treatment of which TAC

A

🎯 PAROXYSMAL HEMICRANIA
🎯 HEMICRANIA CONTINUA

66
Q

Shortest LASTING HEADACHE in which TAC

A

SUNA (OR) SUNCT

67
Q

IV LIGNOCAINE is used for treatment of which HEADACHE

A

SUNCT

68
Q

No effective Treatment is available for which TAC

A

Paroxysmal HEMICRANIA

69
Q

SUICIDE HEADACHE

A

Cluster HEADACHE

70
Q

⚡⚡ MOST SEVERE HEADACHE

A

Cluster Headache

71
Q

U/L PHOTOPHOBIA seen in

A

Cluster Headache

72
Q

Young MALE
➕
H/O alcohol intake
➕
SEVERE HEADACHE
➕
RESTLESS & AGGRESSIVE
➕
NOCTURNAL HEADACHE
➕
PHOTOPHOBIA & AUTONOMIC FEATURES

A

Cluster Headache

73
Q

Headache features of CLUSTER HEADACHE

A

Site: Orbit & Temple
Type: Stabbing & Boring
Severity: Very Severe EXCRUCIATING
Attack frequency: 1-8 times per day
Duration: 15 min to 3 hrs
Migraine like features ➕

74
Q

TAC predominant in MALES

TAC predominant in FEMALES

A

TAC predominant in MALES
🎯 Cluster Headache

TAC predominant in FEMALES
🎯 SUNCT
🎯 HEMICRANIA CONTINUA

75
Q

TAC more common in NIGHT

A

Cluster HEADACHE

76
Q

Migrane-like features is seen in which TAC

A
  1. Cluster Headache
  2. Paroxysmal HEMICRANIA
77
Q

🩺 IOC for HEMICRANIA CONTINUA

A

MRI

78
Q

TRIGEMINAL Neuralgia

A

Paroxysms of INTENSE BRIEF SHOCK LIKE SUPERFICIAL PAIN along the distribution of TRIGEMINAL NERVE

79
Q

⚡⚡ MOST COMMON BRANCH OF TRIGEMINAL involved in TRIGEMINAL Neuralgia

A

V2: MAXILLARY

80
Q

Cutaneous Trigger ➕
➕
Refractory Period
➕
U/L Intense Pain
➕
Patient Winces & Sit Silently

A

TRIGEMINAL Neuralgia

81
Q

⭐ U/L TRIGEMINAL NEURALGIA cause

⭐ B/L TRIGEMINAL NEURALGIA cause

A

⭐ U/L TRIGEMINAL NEURALGIA cause
🎯 Compressive etiology: Superior Cerebellar Artery

⭐ B/L TRIGEMINAL NEURALGIA cause
🎯 Demyelination etiology: MULTIPLE SCLEROSIS

82
Q

TIC DOULOUREUX
(OR)
Prosopalgia
(OR)
Fothergill’s Disease

A

Trigeminal Neuralgia

83
Q

🔬DIAGNOSIS of TRIGEMINAL NEURALGIA

A

3D MRI

84
Q

DOC: TRIGEMINAL NEURALGIA

A

Carbamazepine > > Lamotrigene
Carbamezepine 100-200mg OD, increase im 2-3wks to 200-400mg

Others: SC BOTOX

85
Q

Surgical 💊💉 MANAGEMENT of TRIGEMINAL NEURALGIA

A

Microvascular Decompression

86
Q

HLA B-1502 ➕ Carbamazepine

A

SJS

87
Q

Glossopharyngeal NEURALGIA
Synonyms

A

Eagle’s SYNDROME

88
Q

SUDDEN Pain in TONSIL BED, THROAT & ANGLE OF JAW
➕
CARDIAC CONDUCTION ANOMALIES
➕
⬆️ ⬆️ by Swallowing Coughing Yawning

A

Eagle SYNDROME

89
Q

Small Circumscribed areas of CONTINUOUS PAIN on the HEAD

A

Nummular Headache

90
Q

Causes of 2° HEADACHE

A

3 NERVOUS SYSTEM (40 decks)

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