Headache

Question 1

Are migraines more common in men or women?

Answer 1

Women

Question 2

Are migraines more often uni or bilateral?

Answer 2

Unilateral

Question 3

Decribe the pain in migraine

Answer 3

Dull & throbbing

Question 4

How do you treat migraine?

Answer 4

Analgesia: NSAIDs & paracetamol/aspirin & metoclopramide/ Naproxen/Diclofenac *beware analgesic headache
Antiemetics
Triptans: s/c sumatriptan
Final stage: Botox injections for chronic migraine.

Question 5

What prophylaxis is used for migraine?

Answer 5

Beta blockers (propanolol), or topirimate, amytriptyline or 2md line sodium valproate

Question 6

How many attacks needed for diagnosis of migraine?

Answer 6

5 lasting 4-72 hours

Question 7

When are triptans contraindicated?

Answer 7

Hypertension, coronary artery disease, CV disease and pregnancy

Question 8

What are the differentials for single episode headache?

Answer 8

Head Injury
Sinusitis
Tropical Disease
Acute Glaucoma
Low Pressure Headache (CSF leak)
Meningitis
Encephalitis
SAH
Venous Sinus Thrombosis

Question 9

What are signs of sinusitis?

Answer 9

Dull, constant, tender over sinuses, worsened by leaning forward

Question 10

What are signs of tension headache?

Answer 10

Tight band across forehead, bilateral pain, non pulsatile +/- scalp tenderness
“head in a vice”
7 days long
No vomiting or sensitivity to head movement.

Question 11

What are signs of cluster headache?

Answer 11

Rapid onset & cessation, severe, unilateral eye pain (bloodshot and swollen & flushed face)
Occurs 1-2 daily for 1-3 months with month symptom-free between.

Question 12

How do you treat tension headache?

Answer 12

Stress relief and NSAIDs

Question 13

How do you treat cluster headache?

Answer 13

S/c sumatriptan and high flow O2.
Prednisolone 5 days for short term prophylaxis or Verapimil used for long term (CHECK ECG)
or lithium (CHECK LFTs) or melatonin injections

Question 14

What are signs of Giant Cell Arteritis (GCA)?

Answer 14

Temporal headache with scalp tenderness, jaw claudication and a non pulsatile temporal artery

Question 15

What is the risk of GCA?

Answer 15

Irreversible bilateral vision loss

Question 16

What is treatment of GCA?

Answer 16

Prednisolone

Question 17

Signs of Trigeminal Neuralgia?

Answer 17

Unilateral stabbing pain in V3 region severe and breif, face screws up- triggered by shaving or washing face. Normal neuro exam

Question 18

Treatment of trigeminal neuralgia?

Answer 18

Carbamazepine & surgical decompression

Question 19

Raised ICP signs

Answer 19

Worse on coughing, leaning forwards, and in the morning. Papilloedema and vomit & seizures & odd behaviour.

Question 20

What pain relief most cause analgesic headaches?

Answer 20

Tricyclics

Question 21

Signs of Idiopathic Intercranial Hypertension (IIH)?

Answer 21

Constant throbbing, worse in the morning, blurred/double vision.

Question 22

IIH is usually found in who?

Answer 22

Overweight women

Question 23

What is the sign on CT of Venous Sinus Thromboembolism?

Answer 23

Empty Delta sign

Question 24

Venous Sinus Thromboembolism treatment

Answer 24

Anticoagulate: LMW Heparin then Warfarin

Question 25

Which gender get cluster headache more?

Answer 25

Male

Question 26

Trigger for cluster headache?

Answer 26

Alcohol, Exercise & GTN

Question 27

Where in head is SAH pain?

Answer 27

Occipital

Question 28

Which nerve palsy seen in SAH?

Answer 28

IIIrd

Question 29

ECG changes on SAH?

Answer 29

Deep T wave inversion

Question 30

Management of SAH

Answer 30

CT (less sensitive with more time)- CT angiography to find aneurysms. LP (delay for 12 hours for xanthochromia) NIMODIPINE for vasospasm Saline hydration Endovascular clipping or coil. DEXAMETHASONE for cerebral oedema.

Question 31

SAH prognosis

Answer 31

30% full recovery 30% die 30% disability

Question 32

What is a berry aneurysm?

Answer 32

defect in media and elastica of cerebral arteries such that the media bulges out

Question 33

What diseases are SAH associated with?

Answer 33

PCK & coarctation of aorta

Question 34

What are signs of extradural haemorrhage?

Answer 34

Occur due to skull fracture affecting MIDDLE MENINGEAL ARTERY. LUCID PERIOD then blown pupil, limb weakness, and neuro signs. Lens shape. Coning risk and slow increase in ICP.

Question 35

Extradural haemorrhage treatment?

Answer 35

Mannitol for ICP | Decompression surgically

Question 36

Subdural haemorrhages are caused by?

Answer 36

Trauma - Bleeding from bridging veins between cortex and venous sinuses leading to haematoma between dura and arachnoid.

Question 37

Subdural haemorrhages more common in?

Answer 37

AGE, ALCOHOL & ANTICOAGS (& low ICP & brain metastases)

Question 38

What to subdural haemorrhages cause?

Answer 38

MIDLINE SHIFT & hemiparesis | fluctuating consciousness, slowing physically and intellectually,

Question 39

How long do subdural haemorrhages take to develop

Answer 39

Can be over months

Question 40

CT Subdural Haemorrhage?

Answer 40

Crescent shaped

Question 41

Subdural Haemorrhage treatment

Answer 41

Burr Hole Craniotomy

Question 42

How do you manage trigeminal neuralgia?

Answer 42

Carbamazepine

Question 43

What causes trigeminal neuralgia pain?

Answer 43

Compression of trigeminal nerva

Question 44

What often occurs alongside trigeminal neuralgia?

Answer 44

MS

Question 45

What are complications of trigeminal neuralgia?

Answer 45

Poor dentition as cant brush teeth

Question 46

What are common symptoms of trigeminal neuralgia?

Answer 46

Pain on wind on face Pain in teeth Cant brush hair

Question 47

When do you refer trigeminal neuralgia?

Answer 47

When meds dont work | When eyes involved

Question 48

Medication overuse headache Disorder

Answer 48

15+ days per month with pre existing headache disorder Use for over 3 months of drugs used for headaches 10+ days of opioids or ergotamine OR 15+ days of ibuprofen etc

Question 49

How is MOH treated?

Answer 49

Stop medications causing Advise it takes 2 months to improve and might get worse first- keep headache diary Review and assess underlying headache disorder Prevent relapse- awareness and management

Question 50

When cant you take COCP?

Answer 50

Migraine with aura

Question 51

What drugs are worst for MOH?

Answer 51

Triptans