Headache

Question 1

Primary Headaches (ICD-3)

Answer 1

Tension-Type Headache,

Migraine

Trigeminal Autonomic Cephalgias

New daily persistent headache

Question 2

Red flags for headaches (mnemonic)

Answer 2

SNOOP4

Systemic symptoms/ signs - fevers, myalgias, weight loss
Systemic disease - GCA, malignancy HIV, autoimmune disease

Neurology - focal/ behavioural/ impaired awareness

Onset (sudden)
Orthostatic
Older age

Pattern - progressive, precipitated by valsalva, postural aggravation, papilloedema, pulsatile tinnitus

Question 3

Cluster headaches and gender predilection

Answer 3

Male: Female = 3:1

Question 4

Name for group of headaches with autonomic features

Answer 4

Trigeminal autonomic cephalalgias

Question 5

Common/ differences between Trigeminal Autonomic Cephalalgias?

Answer 5

All have unilateral autonomic symptoms:

• red eye/ tearing, miosis, ptosis
• rhinorrhoea
• fullness or tinnitus

Sub-classified by:
- length of attacks, duration, frequency, response to different treatments

Question 6

What is the pattern of cluster headaches?

Answer 6

A for or more headaches/ day (1-8) in clusters than can last up to 12 weeks
Each headache normally lasts 15minutes - 3 hours

Question 7

What are the shorter Trigeminal Autonomic Cephalgias, and how long do they last?

Answer 7

SUNCT (5 seconds to 5 minutes)

Paroxysmal Hemicrania (2 - 30 mins)

Question 8

What is treatment for Cluster Headaches?

Answer 8

Difficult to treat:

• triptans
• greater occipital nerve injection
• corticosteroids (PO)
• Verapamil (360mg)

In chronic lots of experimental stuff - lithium, melatonin, topiramate, gabapentin

Question 9

Treatment for Paroxysmal hemicrania?

Answer 9

High dose indamethacin

Question 10

What is SUNCT? (Neurology)

Answer 10

Short-lasting Unilateral Neuralgiform headaches with Conjunctival injections and Tearing

Question 11

What is SUNA? (Neurology)

Answer 11

Short-lasting Unilateral Neuralgiform headache with Autonomic features

A subset of SUNCT (where there ironically seems to be less autonomic features)

Question 12

Pattern of SUNCT?

Answer 12

There are 3 patterns:

1. Single Stab
2. Recurrent Stabs
3. Sawtooth pattern

Question 13

ICD Criteria for Migraines

Answer 13

A. 5 or more attacks

B. Headaches 4-72 hours (if untreated)

C. At least a few of:

• unilateral
• pulsatile
• moderate - severe
• worse with movement/ activity

D. Concurrent:

• nausea/ vomiting
• photo/phonophobia

E. Not better explained by …

Question 14

Acute management of migraines?

Answer 14

High dose NSAIDs
- 900mg aspirin or 400-600mg ibuprofen or diclofenac 50mg

Early rescue medications
- triptans (sumatriptan, rizatriptan, eletriptan, zolmitriptan, naratriptan)

Anti-nausea meds

Question 15

Preventative medications for migraine?

Answer 15

Topoiramite

Carbemazapine

Valproate

Amitriptyline,

Nortriptyline

Propanolol

Candesartan

Clonidine

Pizotofen

Verapamil

Question 16

Second line migraine prevention options??

Answer 16

Botox injections through face

CGRP monoclonal antibodies (Erenumab, Galcanezumab, Fremanezumab, Eptinezumab)