Headache

Question 1

What are the red flags in headache?

Answer 1

new onset in over 55 
known/previous malignancy 
immune-supressed 
early morning headache 
exacerbation by valsalva

Question 2

Are headaches more common in men or women?

Answer 2

women 2.5:1

Question 3

What is the criteria for migraine without aura?

Answer 3

at least 5 attacks of 4-72 hour duration

2 0f : moderate/severe, unilateral, throbbing pain, worse on movement

1 Of: autonomic features, photophobia, photophobia

Question 4

What is the pathophysiology behind migraines?

Answer 4

Susceptible individual 
stress causes changes in the brain 
serotonin released 
blood vessels constrict and dilate 
chemicals (substance P) irritate nerves and blood vessels 
pain

Question 5

Where is the migraine centre?

Answer 5

dorsal ralphe nucleus

lock coeruleus

Question 6

What is aura?

Answer 6

reversible visual, sensory, motor or language symptom

Question 7

How long do aura last?

Answer 7

20-60 minutes

Question 8

What is the most common kind of aura?

Answer 8

visual

Question 9

Name some migraine triggers

Answer 9

sleep 
dietary 
stress 
hormonal 
physical exertion

Question 10

What tool can be used to help identify triggers?

Answer 10

headache diary

Question 11

What non-pharmacological treatment of headaches is there?

Answer 11

education - avoid triggers
headache diary
relaxation

Question 12

What is the first line abortive treatment for migraine?

Answer 12

NSAID
aspiring 900mg
naproxen 250mg
ibuprofen 400mg

Question 13

What are triptans?

Answer 13

serotonin agonists

Question 14

When should triptans be given?

Answer 14

at the start of a headache

Question 15

Name some commonly used triptans

Answer 15

rizatriptan
eletriptan
sumatriptan (less effective)

Question 16

When should prophylaxis be considered?

Answer 16

More than 3 attacks per month

very severe

Question 17

What is the aim with drug dosage?

Answer 17

achieve effect at the lowest dose possible

Question 18

How long should each drug be trialled for?

Answer 18

4 months

Question 19

Propranolol can be used in migraine prophylaxis, which conditions should contraindicate it?

Answer 19

asthma
PVD
CCF

Question 20

What is topiramate?

Answer 20

carbonic anhydrase inhibitor

Question 21

What is the problem with topiramate?

Answer 21

poor side effect profile - start slowly!

Question 22

what are some possible side-effects of topiramate?

Answer 22

weight loss
paraesthesia
impaired concentration
enemy inducer

Question 23

What are some side-effects of amitriptyline?

Answer 23

dry mouth
postural hypotension
sedation

Question 24

What dietary triggers are there for migraines?

Answer 24

caffeine
chocolate
dehydration

Question 25

What is acephalgic migraine?

Answer 25

migraine with no headache

Question 26

What are trigeminal autonomic cephalgias?

Answer 26

group of primary headaches characterised by unilateral trigeminal distribution of pain that occurs in association with cranial autonomic features

Question 27

What are cranial autonomic features?

Answer 27

``` ptosis miosis nasal stuffiness nausea + vomiting tearing eye lid oedema ```

Question 28

What are the 4 main TCA's?

Answer 28

cluster headache paroxysmal hemicrania hemicrania continua SUNCT

Question 29

What are the common features of cluster headache?

Answer 29

30s-40s circadian and seasonal variation severe unilateral headache 45-90mins 1-8/day cluster may last from weeks to months

Question 30

How do you treat cluster headaches?

Answer 30

high flow oxygen 20 mins subcut sumatriptan steroids for 2 weeks verapamil prophylaxis

Question 31

What drug is used in cluster headache prophylaxis?

Answer 31

verapamil

Question 32

Describe paroxysmal hemicrania?

Answer 32

50s-60s unilateral headache and autonomic features 10-30mins 1-40/day

Question 33

What drugs are used to treat paroxysmal hemicranial?

Answer 33

INDOMETHICIN

Question 34

What is SUNCT?

Answer 34

``` short lived unilateral neuralgiform headache conjunctival injections tearing ```

Question 35

What drugs are used to treat SUNCT?

Answer 35

lamotrigine | gabapentin

Question 36

What investigation must be done in a new onset unilateral cranial autonomic features?

Answer 36

MRI brain and MR angiogram

Question 37

Describe trigeminal neuralgia?

Answer 37

elderly women>men triggered by touch - V2/3 severe stabbing unilateral pain 1-90seconds 10-100/day bouts may last weeks to months before remission

Question 38

What is the medical treatment for TN?

Answer 38

carbamazepine gabapentin phenytoin baclofen

Question 39

What can be injected in TN?

Answer 39

glycerol

Question 40

What surgical options are there for treatment in TN?

Answer 40

ablation | decompression

Question 41

What is 1st line in treatment for uncomplicated migraine?

Answer 41

OTC medication