headache

Question 1

what is a primary headache

Answer 1

no underlying structural or biochemical causes

Question 2

what is a secondary headache

Answer 2

identifiable structural or biochemical cause

Question 3

what is a tenstion type eheadache

Answer 3

treated with NSAIDS and can carry on with their day

Question 4

what is a migrane

Answer 4

gradually builds up

Question 5

what is aura

Answer 5

can be confused with TIA. loss of vision, speech, sensory

Question 6

how do you classify a chronic migraine

Answer 6

headache more than 15 days a month and more than 8 days has to be a migraine for more than 3 months

Question 7

how do you manage migraines

Answer 7

modify lifestyle triggers (stress, diet, hunger, sleep disturbance)
abortive treatment
preventative treatment

Question 8

what is a medication overuse headache

Answer 8

> 15 days a month which is worse when taking regular symptomatic medication

Question 9

acute treatment of a migraine

Answer 9

aspirins, triptans, CGRP antagonist

Question 10

name some prophylactic (prevent) treatment for migraines

Answer 10

propranolol, tricyclic antidepressants
topiramate

Question 11

what is cranial neuralgias

Answer 11

an intense or stabbing pain
pain is brief but severe
pain extends along the affected nerve

Question 12

what nerves are involved in cranial neuralgias

Answer 12

trigeminal, glossopharyngeal and vagus
nervus intermedius
occipital

Question 13

what is trigeminal neuralgia

Answer 13

unilateral maxilliary or mandibular pain

Question 14

triggers of trigeminal neuraligia

Answer 14

wind, cold, touch, chewing

Question 15

what are the common causes of trigeminal neuralgia

Answer 15

vascular compression of trigeminal nerve

uncommon: MS, intracranial tumour

Question 16

medical treatment for trigeminal neuraliga

Answer 16

carbamazepine, oxcarbazepine, lamotrigine

Question 17

surgical treatment of trigeminal neuraliga

Answer 17

glycerol ganglion injection
stereotactic radiosurgery
microvascualr decompression

Question 18

describe the cluster headache

Answer 18

pain in orbital or temporal region
attacks striclty unilateral
15mins to 3 hrs

Question 19

abortive treatments for cluster headaches

Answer 19

sumatriptan
nasal zolmatripan

Question 20

transitional treatment for cluster headache

Answer 20

oral prednisolone taper
greater occipital nerve block

Question 21

preventative treatment for cluster headache

Answer 21

verapamil
ECG monitoring
lithium
melatonin
surgical- occipital nerve stimulation or deep brain stimulation

Question 22

what is paroxysmal hemicrania

Answer 22

rapid onset which lasts 2-30mins

Question 23

what headache responds to indometacin

Answer 23

paroxysmal hemicrania

Question 24

what features predict a sinsiter headache

Answer 24

head injury, sudden thunderclap headache, change in headache pattern

Question 25

red flags for headaches

Answer 25

new onset headache over 50 neck stiffness or fever headache worse lying down

Question 26

treatment of a subarachnoid haemorrhage

Answer 26

early treatment of aneurysm nimodipine (calcium channel blocker for vasospasm) HHH therphy (hydration, hyperoxia, hypertension)

Question 27

features of a high pressure headache

Answer 27

headache when patient wakes up cough or other valsalva headache seizures

Question 28

investigations for subarchnoid haemorrhage

Answer 28

CT as soon as possibel LP>12 hrs after headache onset CT angiogram if SAH is confirmed

Question 29

what is giant cell arteritis

Answer 29

inflamation of large arteries

Question 30

features of giant cell arteritis

Answer 30

headache is non specific scalp tenderness, jaw claudication, visual disturbance

Question 31

treatment for giant cell arteritis

Answer 31

high dose prednisolone temporal artery biopsy arranged

Question 32

what investigations support diagnosis of giant cell arteritis

Answer 32

elevated ESR (blood test) raised CRP and platelet count

Question 33

treatment for intracranial hypotension

Answer 33

bed rest, fluids, analgesia i.v caffeine epidural blood patch