Headache & Migraine

Question 1

Outline the presentation of meningism

Answer 1

• Acute single episode, severe, all head

- Neck stiffness

Question 2

Outline the presentation of SAH

Answer 2

• Sudden-onset WORST EVER
• Often occipital
• Meningism
• Focal onset
• Reduced consciousness

Question 3

Outline the presentation of Head injury

Answer 3

• Site of trauma to generalised

- Resistant to analgesia

Question 4

Outline the presentation of Venous Sinus Thrombosis

Answer 4

• Subacute/ sudden headache

Papilloedema

Question 5

Outline the presentation of Sinusitis

Answer 5

• Dull, constant ache over frontal/ maxillary sinuses
• • Tenderness +/- postnasal drip
• Pain worse bending over

Question 6

Outline the presentation of Acute Glaucoma

Answer 6

• Elderly, longsighted ppl
• Constant, aching pain around 1 eye
• Radiating to forehead
• Reduced vision, visual haloes, n&v
• Red, congested eye
• Cloudy cornea
• Dilated, non-responsive pupil (/oval)
• Low acuity

Question 7

Outline the presentation of Migraine

Answer 7

Typical: Prodrome - Aura - Headache
- (visual) Aura 15-30min and then 1hr unilateral throbbing headache
- isolated aura (no headache)
- Episodic severe headache without aura (+ n&V, photophobia)
- Allodynia (pain from stimulus)
Diagnosis: Typical Hx/ >5 headaches >4hr & n&v & photophia (& 2 of unilateral/ pulsating/ impairs

Question 8

Outline potential triggers for Migraine

Answer 8

CHOCOLATE
Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptives
Lie-ins
Alcohol
Tumult (loud confused noise)
Exercise

Question 9

Outline the treatment of (active) Migraine

Answer 9

NSAIDs
Triptans: Rizatriptan
Ergotamine

Question 10

What is the class & mechanism of action of Rizatriptan

Answer 10

Triptan

Agonist to 5-HT receptors in cranial blood vessels causing constriction

Question 11

How do you prevent a Migraine

Answer 11

Find & remove triggers
1st line: Propanolol, amitriptyline & topiramate
2nd line: Valproate, pizotifen, gabapentin, pregabalin

Question 12

Outline the mechanism of action of Propanolol

What line is it in Migraine treatment

Answer 12

Block action of noradrenaline at B-adrenoceptors
Located in;
- Myocardium
- Throughout circulatory system
1st line

Question 13

Outline the mechanism of action of Amitriptyline

What line is it in Migraine treatment

Answer 13

Tricyclic Antidepressant
Serotonin-norepinephrine reuptake inhibitor
1st line

Question 14

Outline the mechanism of action of Topiramate

What line is it in Migraine treatment

Answer 14

Anticonvulsant

1st line

Question 15

What is the mechanism of action of Valproate

What line is it in Migraine treatment

Answer 15

Unknown. Na+ block & inc. GABA.

2nd line

Question 16

What is the mech of action of Pizotifen

What line is it in Migraine treatment

Answer 16

Serotonin antagonist

2nd line

Question 17

What is the mech of action of Gabapentin

What line is it in Migraine treatment

Answer 17

Anticonvulsant

2nd line

Question 18

What is the mech of action of Pregabalin

What line is it in Migraine treatment

Answer 18

Anticonvulsant

2nd line

Question 19

What is the pathophysiology of Migraine

Answer 19

Primary brain disorder resulting from altered modulation of normal sensory stimuli and trigeminal nerve dysfunction
Old: Constriction during aura, dilatation of intracerebral vessels, reduced water diffusion

Question 20

Outline the presentation of Tension headaches

Outline treatment

Answer 20

Usual cause of
- Bilateral, non-pulsatile heache
- +/- scalp muscle tenderness
- NO vomiting/ sensitivity to movement
STRESS RELIEF

Question 21

Outline the pathophysiology & presentation of Cluster Headaches

Answer 21

Unknown cause.
?-Superficial Temporal Artery smooth muscle hyper-reactivity to 5HT
?-Hypothalamic grey matter abnormalities also
?-Autosomal dominant gene

Presentation;

• Rapid unilateral (pain around 1 eye + eye symptoms)
• x2d/ nocturnal then long absent periods

Question 22

Outline the management of Cluster Headaches

Answer 22

Acute attack:
- 100 O2 for 15mins via non-rebreathable
- Sumatriptan/ Zolmitriptan
Preventatives:
- God knows

Question 23

Outline the mechanism of action of Sumatriptan/ Zolmitriptan

Answer 23

Triptan

Agonist to 5-HT receptors in cranial blood vessels causing constriction