Headache

Question 1

tension headache

Answer 1

generated by neurovascular irritation and referred to scalp muscles and soft tissues

pressure / tightness all around the head

no associated features of classic migraine (aura, nausea, photophobia)

Question 2

rx tension headache

Answer 2

explanation and reassurance
analgesic withdrawal
tricyclic antidepressants in some cases

Question 3

what is a migraine

Answer 3

recurrent headache associated with visual and GI disturbance

> F

Question 4

pathogenesis migraine

Answer 4

change in brainstem blood flow
unstable trigem N nucleus and nuclei in basal thalamus
= release of vasoactive neuropeptides incl substance P
= neurogenic inflammation - vasodilation (= pain) and plasma protein extravasation

Question 5

migraine precipitating factors

Answer 5

chocolate
cheese
too much / too little sleep
noise
irritating lights
premenstrually

Question 6

3 types of migraine

Answer 6

migraine with aura (classic migraine)
migraine without aura (common migraine)
migraine variants (unilateral motor or sensory symptoms resembling stroke)

Question 7

clinical features migraine

Answer 7

unilateral throbbing headache that builds up nausea, vomiting and photophobia
auras

Question 8

what are auras

Answer 8

depression of visual cortex function or retinal function & persist for minutes to hours before the headache
may be visual loss, numbness, weakness on one side of the body

Question 9

most common way a migraine attack resolves

Answer 9

sleep

Question 10

differential diagnosis migraine

Answer 10

meningitis

subarachnoid haemorrhage

Question 11

rx migraine - non pharm

Answer 11

avoid dietary precipitating factors

hormonal contraceptives CI in migraine w aura

Question 12

rx mild migraine

Answer 12

mild: paracetamol / NSAID / antiemetic eg metoclopramide

Question 13

rx mod-severe migraine

Answer 13

Triptans (eg sumatriptan, almotriptan, eletriptan) are serotonin (5HT) 1B/1D agonists - they inhibit the release of vasoactive peptides, promote vasoconstriction & block pain pathways

Question 14

who is prophylaxis indicated for

Answer 14

pts w frequent attacks >2/mo or who respond poorly to rx for acute attacks

Question 15

what prophylaxis is available for migraines

Answer 15

sodium valproate
ßblockers - propanolol
Amitriptyline

Question 16

symptoms cluster headaches (migrainous neuralgia)

Answer 16

rapid onset, severe, short lived, unilateral headaches with a clustering of painful attacks over weeks or months w periods of remission

Question 17

rx acute attack cluster headache

Answer 17

subcut or nasal triptans or inhalation of 100% oxygen

verapamil, topiramate, lithium carbonate and / or a short course of steroids helps stop a bout of clusters

Question 18

who do cluster headaches effect

Answer 18

M > W

peak age 20-50y

Question 19

what is giant cell arteritis?

Answer 19

granulomatous arteritis affecting extradural arteries

closely related to polymyalgia rheumatica

Question 20

clinical features giant cell arteritis

Answer 20

headache, scalp tenderness, pain in jaw and mouth worse on eating
blindness - inflammation and occlusion of ciliary and retinal artery
systemic features - weight loss, malaise, fever

Question 21

investigations giant cell arteritis

Answer 21

ESR always elevated
FBC may = normochromic, normocytic anaemia
temporal artery biopsy confirms diagnosis

Question 22

management giant cell arteritis

Answer 22

high dose steroids and temp art biopsy asap

LT steroids due to visual loss risk