Headache

Question 1

What are the red flags of a headache?

Answer 1

New onset age >55
Malignancy
Immunosuppression
Early morning
Exacerbation by valsalva

Question 2

Migraines are commoner in men/women

Answer 2

Women

Question 3

Most migraines occur without an aura. True/false?

Answer 3

True

Question 4

Stress causes what substance to be released in the brain?

Answer 4

Serotonin

Question 5

What is the effect of serotonin release?

Answer 5

Vasoconstriction/dilation

Substance P release

Question 6

What effect does substance P have?

Answer 6

Nerve and blood vessel irritation

Question 7

What is an aura?

Answer 7

A fully reversible visual/sensory/motor/language symptom

Question 8

How long does an aura last?

Answer 8

20-60 minutes

Question 9

What is the most common type of aura?

Answer 9

Visual

Question 10

Give some triggers of a migraine

Answer 10

Sleep
Dietary
Stress
Hormones
Physical exertion

Question 11

What is the main acute treatment for a migraine?

Answer 11

NSAIDs (aspirin, naproxen or ibuprofen)

Question 12

What 5-HTP agonist drugs can be used to treat migraine acutely?

Answer 12

Triptans (rizatriptan/eletriptan/frovatriptan)

Question 13

What is the main benefit of NSAIDs over triptans?

Answer 13

Cost - NSAIDs are much cheaper

Question 14

When is migraine prophylaxis considered?

Answer 14

When a patient has >3 attacks per month

Question 15

What is the main prophylactic drug used in migraines?

Answer 15

Propranolol

Question 16

What other drugs are used in migraine prophylaxis?

Answer 16

Topiramate
Amitriptyline
Gabapentin
Botulinum
Monoclonal antibody

Question 17

What is the main downside of topiramate?

Answer 17

Poor side effect profile (weight loss/impaired concentration)

Question 18

How long should a patient be on a prophylactic drug before stopping?

Answer 18

4 months

Question 19

What lifestyle changes can be made in patients with migraines?

Answer 19

Healthy diet
Reduced caffeine
Reduced stress
Exercise

Question 20

Give some examples of ‘fancy’ migraines

Answer 20

Acephalgic
Basilar
Retinal
Ophthalmic
Hemiplegic
Abdominal

Question 21

Tension type headaches tend to be worse than migraines. True/false?

Answer 21

False - less severe with less adverse effects

Question 22

What drugs can be used to treat a tension type headache?

Answer 22

Antidepressants (dothiepin/amitriptyline)

Question 23

What are trigeminal autonomic cephalgias?

Answer 23

A group of primary headache disorders characterised by unilateral trigeminal pain with cranial autonomic features

Question 24

Give some cranial autonomic features seen in TACs

Answer 24

Ptosis
Miosis
Nasal stuffiness
N+V
Tearing
Eye lid oedema

Question 25

What are the four main types of TACs?

Answer 25

Cluster Paroxysmal hemicrania Hemicrania continua SUNCT

Question 26

Cluster headache tends to affect younger men. True/false?

Answer 26

True

Question 27

How long do cluster headaches tend to last?

Answer 27

45-90 mins

Question 28

What is the treatment for cluster headaches?

Answer 28

High flow O2 Subcutaneous sumatriptan Steroids

Question 29

Paroxysmal hemicrania tends to affects younger men. True/false?

Answer 29

False - elderly women

Question 30

Paroxysmal hemicrania lasts longer/shorter than cluster headache and is more/less frequent

Answer 30

Shorter duration and more frequent

Question 31

What is the absolute treatment for paroxysmal hemicrania?

Answer 31

Indomethicin

Question 32

What does SUNCT stand for?

Answer 32

``` Short-lived Unilateral Neuralgiaform headache Conjunctival injections Tearing ```

Question 33

What is the treatment for SUNCT?

Answer 33

Lamotrigine/gabapentin

Question 34

What imaging is used for new onset unilateral cranial features?

Answer 34

MRI brain | MR angiogram

Question 35

Who tends to get idiopathic intracranial hypertension?

Answer 35

Obese women

Question 36

What does idiopathic intracranial hypertension present with?

Answer 36

Headache Nausea and vomiting Visual loss

Question 37

What investigation is done in idiopathic intracranial hypertension?

Answer 37

Spinal tap (only ever done in IIH)

Question 38

How is idiopathic intracranial hypertension treated?

Answer 38

Weight loss Acetazolamide Ventricular atrial shunt

Question 39

Who tends to get trigeminal neuralgia?

Answer 39

Elderly women

Question 40

What are the features of trigeminal neuralgia?

Answer 40

Severe stabbing unilateral pain | Triggered by touch

Question 41

How is trigeminal neuralgia treated medically?

Answer 41

Anticonvulsants (carbamazepine/gabapentin)

Question 42

How is trigeminal neuralgia treated surgically?

Answer 42

Ablation | Decompression