Headache

Question 1

What are the red flags with HA?

Answer 1

new onset headache >55; knownprev malignancy; early morning headache; exacerbation by valsalva or coughing

Question 2

What is the diagnostic criteria for migraine w/o aura?

Answer 2

2 of : mod/severe; unilateral; throbbing pain; worse on movement and 1 of autonomic features; photo/phonophobia

Question 3

What is pathophysiology of migraine/

Answer 3

blood vessels constrict and dilate; chemical incl. substance P irritate nerves and blood vessels causing pain

Question 4

What are the common triggers for migraine?

Answer 4

Chocolate
Hangovers
Orgasms
Cheese/caffeine
Oral contraceptives
Lie-ins
Alchohol
Travel
Exercise

Question 5

What is the most common type of aura with migraine?

Answer 5

visual

Question 6

Where is the migraine centre in the brain?

Answer 6

brainstem

Question 7

What type of visual aura is most ocmmon?

Answer 7

monochromatic

Question 8

If the aura is colourful what should be suspected?

Answer 8

an occipital lobe seizure

Question 9

What is the first treatment fro migraine?

Answer 9

NSAIDs

Question 10

what advice is given with analgesia and migraine?

Answer 10

take as early as possible

Question 11

What are triptans?

Answer 11

5HT agonist

Question 12

What is the problem with triptans in treating migraine?

Answer 12

can get triptan induced headache due to addiction so dont take more than 2x per week

Question 13

When should migraine prophylaxis be considered?

Answer 13

more than 3 attacks/moth or very severe

Question 14

How long does eachprophylactic drug for migraine need to be trialled for?

Answer 14

minimum of 4 months

Question 15

What drugs are used as migraine prophylaxis?

Answer 15

beta-blockers; topiramate; amitriptyline; gabapentin; sodium valproate

Question 16

What is topiramate?

Answer 16

carbonic anhydrase inhibitor

Question 17

What are the SE of topiramate?

Answer 17

weight loss; paraesthesia; imparied conc. enzyme inducer

Question 18

What are the trigeminal autonomic cephalgias?

Answer 18

unilateral trigeminal distribution pain that occurs with prominent ipsilateral crainial autonomic features

Question 19

What autonomic features are seen with trigeminal autonomic cephalgias?

Answer 19

ptosis; miosis; nasal stuffiness; N and V; tearing; eye lid oedema

Question 20

What are the 4 main types of trigeminal autonomic cephalgias?

Answer 20

cluster; paroxysmal hemicraina; hemicrania continua; SUNCT

Question 21

Who gets cluster headaches?

Answer 21

30s and 40s; men

Question 22

When do cluster headaches tend to arise?

Answer 22

around sleep and with seasonal variation

Question 23

What are the features of cluster headahces?

Answer 23

severe unilateral headache lasting for 45-90 mins; 1-8 per day

Question 24

What is the treatment for cluster headahces?

Answer 24

high flow o2; s/c sumatriptan; steroids; verapamil

Question 25

Who gets paroxysmal hemicrainia?

Answer 25

50s-60s; women

Question 26

What are the features of paroxysmal hemicrainia?

Answer 26

severe unilateral headahce and autonomic features; 10-30mins duration; 1-40 a day; response to indomethacin

Question 27

What is the treatment for paroxysmal hemicrainia?

Answer 27

indomethacin

Question 28

What does SUNCT stand for?

Answer 28

``` Short lived (15-120s) Unilateral Neuralgiaform HA Conjunctival injections Tearing ```

Question 29

What is the treatment for SUNCT HAs?

Answer 29

lamotrigine or gabapentin

Question 30

What msut be done with new onset unilateral CN autonomic features?

Answer 30

MRI brain and MR angio

Question 31

Who gets trigeminal neuralgia?

Answer 31

>60s; women

Question 32

What are hte features of trigemnial neuralgia?

Answer 32

severe stabbing unilateral pain- usually in V2/3 and triggered by touch; 1s-90s duration; 10-100/day

Question 33

What is the treatment of trigeminal neuralgia?

Answer 33

carbamazepine; gabapentin; phenytoin; baclofen

Question 34

What triggers cluster HAs?

Answer 34

alcohol