6 (Headache)

Question 1

Headache Redflags?

Answer 1

Sudden severe (thunderclap), Progressive, change in pattern
After 50, Cancer, immunosuppression, systemic weight loss night sweats
Fever, Vomiting, Papiledema, Positional, valsalva, head trauma, Jaw claudication, scalp tenderness
Weakness, numbness, vision changes, confusion, seizure

Question 2

Tension headache

Answer 2

band like, usually bilateral, not affected by physical activity

Question 3

Migraine criteria

Answer 3

5 attacks 4-72h +
2+/4: unilateral, pulsating/throbbing, Moderate/severe, aggravated by/causing avoidance of physical activity
1+: N/V, photophobia, phonophobia

Question 4

Migraine Aura features

Answer 4

25% aura, flashes of light, scintillating scotoma, zig zag fortification spectra, jagged crescent, tunneled vision, sensory motor speech brainstem (stroke mimicker), must be relieved within 1h

Question 5

Migraine Management steps

Answer 5

Lifestyle
Acute Attack
Prophylaxis

Question 6

Migraine Lifestyle

Answer 6

sleep hygiene, Regular meals and hydration, stress management, exercise aerobic, Avoid alchohol
Migraine diary
caffeine, chocolate, cheese, alcohol, citrus fruits,

Question 7

Migraine Acute attack?

Answer 7

paracetamol/ NSAID, Triptan (Below 17 nasal, cause coronary spasm)+ Antiemetic (Metoclopramide, Domperidone)

Question 8

Migraine Prophylaxis indication?

Answer 8

4 days per month
disabling
overused acute med

Question 9

Migraine Prophylaxis medications?

Answer 9

Propranolol (asthma), amitriptyline, topiramate (causes weight loss, teratogenic, reduces OCP effect),
Candesartan, Botulinum,
CGRP monoclonal erenumab

Question 10

Migraine with FND?

Answer 10

STop OCP

Question 11

predictable menstrual migraine

Answer 11

Frovotriptan/zolmitriptan on those days.

Question 12

Trigeminal Autonomic Cephalgias (5)

Answer 12

Cluster, Paroxysmal Hemicrania, SUNCT, SUNA, Hemicrania Continua

Question 12

Cluster features?

Answer 12

Severe around eye sharp stabbing pain, always same side, tearing, lid edema, conjunctival/ nasal congestion, ptosis, horner, at nights, agitated, Stereotyped, 15 mins-2 hours, up 8 times a day, 1-3 month attack, 6 month free

Question 13

Cluster Epidemiology?

Answer 13

below 40, Male 3x, smoking, alcohol

Question 14

Cluster Diagnosis needs?

Answer 14

MRI on first episode

Question 15

Cluster Prophylaxis?

Answer 15

Verapamil , lithium, Topiramate, (Gabapentin, valproate?)

Question 16

Cluster Treatment?

Answer 16

(like migraine): O2 100%, triptan SC or nasal

Question 17

SUNCT

Answer 17

Above 40, seconds to minutes, up to 75 times a day

Question 17

Paroxysmal Hemicrania

Answer 17

Females, 2-30 min, up to 40 times a day, Dramatic response to Indomethacin

Question 18

SUNA

Answer 18

like SUNCT but less tearing/conjunctival injection

Question 19

Hemicrania Continua

Answer 19

continues unilateral pain with exacerbation+autonomic features, responds to indomethacin

Question 20

Spontaneous intracranial hypotension headache/Orthostatic headache

Answer 20

better in supine position, Horizontal diplopia, N/V, vertigo, hearing, neck pain/stiffness, leak from thoracic nerve root

Question 21

Diagnosis IC hypotension headache?

Answer 21

CSF pressure at LP/Dry tap ( could be normal cause of intermittent)

Question 21

Triggers IC hypotension headache?

Answer 21

LP, trauma

Question 22

MRI in IC hypotension headache?

Answer 22

diffuse pachymeningeal enhancement, sagging brain, tonsillar descent, posterior fossa crowding

Question 23

Treatment of IC hypotension headache?

Answer 23

Epidural blood patch, epidural saline, IV caffeine

Question 24

RF of IC hypotension headache?

Answer 24

Conventional cutting needle, big needle, direction bevel, not replacing/ re insertion stylet, increased number of attempts

Question 25

No effect on IC hypotension headache?

Answer 25

Volume of CSF removed, position patient, pressure opening CSF, bed rest, fluid intake,

Question 26

Preventing effect on IC hypotension headache?

Answer 26

Atraumatic (non cutting) needle

Question 27

Idiopathic Intracranial hypertension other name?

Answer 27

pseudotumor cerebri

Question 28

Idiopathic Intracranial hypertension RF?

Answer 28

Trigger: fat women, pregnancy, vitamin A, tetracycline. steroids, OCP, isotretinoine, amiodarone, lithium, levothyroxine, cimetidine, minocycline, phenytoin

Question 29

Idiopathic Intracranial hypertension which position makes it worse?

Answer 29

supine position/morning

Question 30

Idiopathic Intracranial hypertension features?

Answer 30

Papilledema, enlargement of blind spots, 6th nerve palsy (can be unilateral, false localizing sign), loss of visual changing position,

Question 31

Idiopathic Intracranial hypertension what diagnosis should be ruled out

Answer 31

Cerebral venous thrombosis must be excluded

Question 32

Idiopathic Intracranial hypertension CT features?

Answer 32

Papilledema with flattening of posterior sclera, bilateral venous sinus stenosis, distension perioptic subarachnoid space

Question 33

Idiopathic Intracranial hypertension Treatment?

Answer 33

Weight Loss, LP, acetazolamide, topiramate ( Both weight loss carbonic anhydrase inhibitor ), surgery optic nerve sheath decompression and shunt

Question 34

Cerebral venous thrombosis Risk factor?

Answer 34

OCP, DVT, behcet , pregnancy, septic (otitis media, facial cellulitis, meningitis ),

Question 35

Cerebral venous thrombosis features?

Answer 35

increased headache with papilledema , 6th nerve palsy, and tonic clonic seizure, FND

Question 36

Cerebral venous thrombosis CT?

Answer 36

small areas of SA blood in convexity

Question 37

Cerebral venous thrombosis Treatment?

Answer 37

LMWH

Question 38

Cerebral venous thrombosis Diagnosis?

Answer 38

MR/CT Venography superior sagittal sinus (hemorrhage, empty delta sign)

Question 39

Trigeminal Neuralgia trigger

Answer 39

touching face,chewing, speaking, brushing teeth, cold air

Question 40

Trigeminal Neuralgia Treatment?

Answer 40

Carbamazepine, gabapentin, botulinum , resistant: Microvascular decompression surgery ( cause is vascular compression )

Question 41

Trigeminal Neuralgia Alarm sign?

Answer 41

if the patient has sensory loss/ no triggers/deafness, only in ophthalmic division, then its a Tumor. Physical examination must be normal or else it’s also a tumor.

Question 42

Analgesic overuse headache Management?

Answer 42

Stop acetaminophen abrupt, codeine slowly, start NSAID