Headache

Question 1

What type of drugs are the triptans?

Answer 1

5HT1 antagonists

Question 2

Are migraines more common with or without aura?

Answer 2

Without (70%)

Question 3

Does pregnancy tend to exacerbate or cause remission from migraines?

Answer 3

Remission

Question 4

Overuse of which medications can cause headaches?

Answer 4

Triptans
Opioids
Combination analgesics

Question 5

What medications should be avoid when treating pain in migraine?

Answer 5

Opioids

Question 6

What are the red flags when taking a headache history?

Answer 6

New onset headache > 55y/o
Known/previous malignancy 
Immuno-suppressed
Early morning headache
Exacerbation by Valsalva

Question 7

What is the most common type of migraine?

Answer 7

Without aura = 80%

With aura = 20%

Question 8

How is migraine diagnosed?

Answer 8

At least 5 attacks
Duration 4-72 hours
2 of (unilateral, moderate/severe, pulsatile, worse on movement)
1 of (Autonomic features, photophobia/phonophobia)

Question 9

What is the pathophysiology of migraine without aura ?

Answer 9

Stress triggers serotonin release
Blood vessels constrict & dilate
Chemicals irritate nerves and blood vessels causing pain

Question 10

What is the pathophysiology of migraine with aura?

Answer 10

Cortical spreading depolarization
Activate trigeminal vascular system - dilate cranial blood vessels
Release of substance P, neurokinin A, CGRP

Question 11

What is the migraine centre in the brain?

Answer 11

Dorsal raphe nucleus

Locus coenucleus

Question 12

What is an aura?

Answer 12

Fully reversible visual, sensory, motor or language symptom (Visual most common)

Question 13

What can trigger a migraine?

Answer 13

Sleep 
Diet
Stress
Hormonal
Physical exertion

Question 14

What is the treatment of a mild/moderate migraine?

Answer 14

NSAID or aspirin (second line= paracetamol-

Question 15

What is the treatment of a severe migraine?

Answer 15

Prochlorperazine suppository & diclofenacsuppository
or
SC Sumatriptan

Question 16

When is migraine prophylaxis indicated?

Answer 16

> 3 attacks a month

Question 17

What are the options for migraine prophylaxis?

Answer 17

Propranolol
Topiramate
Amitriptyline

Question 18

What are the side effects of amitrptyline?

Answer 18

Dry mouth
Postural hypotension
Sedation

Question 19

What type of drug is topiramate?

Answer 19

Carbonic anhydrase inhibitor

Question 20

What are the side effects of topiramate?

Answer 20

(Start slowly_
Weight loss
Paraesthesia
Impaired concentration

Question 21

When should propranolol be avoided?

Answer 21

Asthma
PVD
Heart failure

Question 22

Why is CHC contraindicated in women with migraine with aura?

Answer 22

Both have stroke risk

Question 23

What is the first line relief for migraine in pregnancy?

Answer 23

Paracetamol

Question 24

What are the ipsilateral cranial autonomic features that might present in TACs?

Answer 24

Ptosis
Miosis
Nasal stuffiness
Nausea/vomiting
Tearing 
Eye lid oedea

Question 25

What are the 4 main types of TACs?

Answer 25

Cluster Paroxysmal hemicranias Hemicrania continua SUNCT

Question 26

What patients tend to get cluster headaches?

Answer 26

Young (30s-40s) | Men > women

Question 27

What is distinctive about the timings of cluster headaches?

Answer 27

Circadian & seasonal variation

Question 28

How are cluster headaches diagnosed?

Answer 28

At least 5 attacks Severe unilateral orbital, supraobrital and or tempora pain lasting 1-10mins if untreated Accompanied by ipsilateral autonomic dysfunction Attacks have a frequency of 1-8 a day

Question 29

What is the acute treatment of a cluster headache?

Answer 29

SC sumatriptan or Nasal zolmitriptan

Question 30

What is the transition treatment for cluster headache?

Answer 30

Steroids (reducing course over 2 weeks)

Question 31

What is the prophylactic treatment for cluster headaches?

Answer 31

Verapamil (requires ECG monitoring)

Question 32

What patients tend to get paroxysmal hemicrania?

Answer 32

Elderly (50s-60s) | Women > men

Question 33

How does paroxysmal hemicrania present?

Answer 33

Severe unilateral headache with unilateral autonomic features 10-30 mins 1 to 40 a day

Question 34

What is the treatment for paroxysmal hemicrania?

Answer 34

Indomethacin

Question 35

What does SUNCT stand for?

Answer 35

``` S = Short lived (15-120 secs) U= Unilateral N= Neuralgia form headache C = Conjunctival injection T = Tearing ```

Question 36

What is the treatment for SUNCT?

Answer 36

Lamotrigine | Gabapentin

Question 37

What individuals are most prone to trigeminal neuralgia?

Answer 37

Elderly (>60) | Women > men

Question 38

What are the clinical features of trigeminal neuralgia?

Answer 38

Severe stabbing unilateral pain 1-90 secs 10-100 a day

Question 39

What are the features of a tension headache?

Answer 39

``` Bilateral Pressing/tightening quality Mild/moderate intensity Not aggravated by physical activity No nausea or vomiting ```