headache

Question 1

RF headache

Answer 1

immuno // history of mets // vomitting unknown cause // + fever // neuro or cognitive or personality or consiousness // trauma // triggered by cough or valsava

Question 2

symptoms migraine

Answer 2

severe, unilateral, throbbing, nausea, photophobia, aura

Question 3

triggers migraine

Answer 3

stress, tired, alcohol, COCP, dehydration, cheese, chocolate, red wine, menstruation, bright lights

Question 4

migraine diagnostic criteria

Answer 4

5 attacks of: headache lasting 4-72 hours // 2 of - unilateral, pulsating, severe pain, aggregated by activity // N+V or photo+phonophobia // no secondary disorder

Question 5

symptoms hemiplegic migraines

Answer 5

aura of motor weakness, strong FH history

Question 6

1st line acute mx migraine

Answer 6

oral triptan + NSAID or paracetamol

Question 7

2nd line mx acute migraine

Answer 7

metoclopramide or prochlorperazine

Question 8

when should prophylactic migraine treatment be started

Answer 8

2 or more a month

Question 9

1st line prophylaxis migraines

Answer 9

topirimate or propanolol // toperimate should be avoided in child bearing women

Question 10

prophylaxis mx menstrual migraines

Answer 10

frovatriptan (2.5mg BD) // zolmitriptan (2.5mg TD) // mx with mefanfemic acid, paracetamol, triptan

Question 11

1st line migraine mx during pregnancy

Answer 11

paracematol

Question 12

2nd line migraine mx during pregnancy + when can it be used

Answer 12

NSAIDs = 2nd + 3rd trimester // avoid opioids

Question 13

what contraception is contraindicated in migrane with aura and what UKMEC is it

Answer 13

COCP - UKMEC 4

Question 14

can you prescribe HRT with migraines

Answer 14

yes - may make them worse

Question 15

mechanism of triptans

Answer 15

spececifc serotonin (B+D) agonists

Question 16

administration triptans

Answer 16

oral, oraldisersile, nasal spray, sub/cut

Question 17

SE triptans

Answer 17

tingling, heat, tightness, heavy chest

Question 18

containdications triptans

Answer 18

IHD or cerebrovascular disease

Question 19

symptoms tension headache

Answer 19

tight band around head, bilatera // lower pain that migraine, no N+V, no photophobia or phonophobia

Question 20

what is chronic tension headaches

Answer 20

headaches occur 15+ days a month

Question 21

acute mx tension headaches

Answer 21

aspirin, paracetamol, NSAIDs

Question 22

2nd line mx migraines + tension headaches

Answer 22

acupuncture over 5-8 weeks

Question 23

what conditions are Trigeminal Autonomic Cephalgia’s (TACs) + what general symptoms

Answer 23

cluster headaches, paroxysmal hemicrania, SUNCT // unilateral pain + trigeminal nerve symptoms

Question 24

who gets cluster headaches + what can trigger them

Answer 24

men, smoking, alcohol

Question 25

symptoms (not frequency + length) cluster headache

Answer 25

intense pain around one eye // agitated and restless patient // redness and lacrimiation around lid // nasal congestion // common at night

Question 26

frequency and duration cluster headaches

Answer 26

need 5 attacks for diagnosis // usually 1-2 times a day // last 15mins - 2 hours // clusters last 4 - 12 weeks

Question 27

invx cluster headache

Answer 27

MRI + gadolium contrast

Question 28

acute mx cluster headache

Answer 28

100% O2, subcut triptan

Question 29

prophylaxis cluster

Answer 29

1 = verapamil (maybe some pred) 2 = topimerate

Question 30

symptoms, duration, frequency SUNCT

Answer 30

unilateral, stabbing heading with conjunctival injection + tearing // attacks last seconds, can occur 300 times a day

Question 31

mx SUNCT

Answer 31

gabapentin or lamotrigene

Question 32

symptoms paroxysmal hemicrania + who usually gets it

Answer 32

unilateral headache around orbital or temporal area, tears or conjunctival injection common, women in their 60s

Question 33

duration and frequency paroxysmal hemicrania

Answer 33

last 10-30 mins but happen lots in a day

Question 34

mx paroxysmal hemicrania

Answer 34

indomethacin

Question 35

what causes trigeminal neuralgia

Answer 35

vascular, demyelination, neoplasms

Question 36

symptoms trigeminal neuralgia

Answer 36

unilateral, sudden pain in trigeminal distribution // pain evoked by touch eg washing, shaving // nasolabial fold or chin v sore // lasts minutes

Question 37

RF trigeminal neuralgia

Answer 37

sensory change, deaf, skin legions, opthalamic division, optic neurits // onset <40

Question 38

what is trigem neuralgia assoc with

Answer 38

MS

Question 39

mx trigem neuralgia

Answer 39

carbamazepine (if does not response refer)

Question 40

what is the most common type of chronic headache

Answer 40

medication overuse

Question 41

how many days a month for medication overuse headache

Answer 41

15 days a month

Question 42

which medications cause overuse headaches

Answer 42

opioids and triptans

Question 43

mx for withdrawing meds in overuse headache

Answer 43

simple analgesia + triptans stop immediately // wean opioids

Question 44

causes secondary headaches

Answer 44

drugs, cough, exercise, post-coital

Question 45

how common is post LP headache and who gets them

Answer 45

1/3, young females, low BMI

Question 46

features post LP headache

Answer 46

develop 24-48 hours after, lasts a few days, worse upright

Question 47

mx LP headache

Answer 47

initally conservative, after 72 hours --> blood patch, epidural saline, IV caffeine

Question 48

what can post LP headaches lead too

Answer 48

subdural haematoma

Question 49

what causes spontaneous intracranial hypotension

Answer 49

CSF leak from thoracic nerve root sleeves

Question 50

RF spontaneous intracranial hypotension

Answer 50

marfans

Question 51

symptoms spontaneous intracranial hypotension

Answer 51

headache worse upright

Question 52

invx spontaneous intracranial hypotension

Answer 52

MRI + gadolium