Headache

Question 1

headache red flags

Answer 1

new onset >55
early morning/wakes you up 
exacerbated by sneezing/coughing 
neck stiffness
seizures 
change in vision, photophobia

Question 2

classic type of person with migraine (gender, age)

Answer 2

female

teenager-40yo

Question 3

migraine triggers (4)

Answer 3

stress
hormonal (periods)
sleep
diet - cheese, red wine, caffeine

Question 4

what chemical does triggers (eg stress) release

what does this do to blood vessels (in brain)

what does this result in

Answer 4

serotonin

vasodilation of cranial blood vessels

pain = migraine

Question 5

how long can migraines last for (each time)

how often do people get migraines

Answer 5

4-72 hours

once per month (avg)

Question 6

what GI symptoms may migraine present with

Answer 6

nausea and vomiting

Question 7

what ophtho symptoms may migraine present with

Answer 7

photophobia

aura

Question 8

how does the headache feel in a migraine

Answer 8

unilateral throbbing headache

Question 9

acute management for migraine (2)

Answer 9

NSAIDs

triptans - costly

Question 10

prophylaxis for migraines

Answer 10

lifestyle modification - avoid triggers (use diary)
first line - propanolol (not asthmatics), topiramate (carbonic anhydrase inhibitor)
second line - gabapentin, sodium valproate

Question 11

what is contraindicated in people with migraines with aura

Answer 11

oral contraceptives

Question 12

presentation of tension headache

Answer 12

no nausea/vomiting
no photphobia/aura 
bilateral
mild/moderate 
'monday morning'

Question 13

management of tension headache (3)

Answer 13

relaxation
beta blockers
antidepressants

Question 14

pathophysiology of tension headache

Answer 14

nothing, theyre fine

Question 15

what are the 3 types of trigmeninal autonomic cephalgias

Answer 15

cluster headache
paroxysal hemicrania
SUNCT

Question 16

how do trigeminal autonomic cephalgias present (2 categories of symptoms)

Answer 16

unilateral trigeminal distribution (headache)

ipsilateral cranial autonomic features - eg ptosis, miosis, nasal stuffiness, tearing, eye lid oedema

Question 17

who get cluster headache s(gender and age)

Answer 17

young men

Question 18

who get paroxysmal hemicrania (gender and age)

Answer 18

50-60yo women

Question 19

what are the autonomic features in trigeminal cranial cephlagia (5)

Answer 19

ptosis
miosis
nasal stuffiness
tearing
eye lid oedema

Question 20

how often do men get ‘clusters’ of cluster headaches

Answer 20

every couple months

Question 21

how long do the headaches last in cluster headaches

ow many do you get in a day

Answer 21

45-90mins

1-8 in a day

Question 22

how long to paroxysmal hemicrania headaches last

how many do you get in a day

Answer 22

10-30 mins

1-40 in a day

Question 23

acute treatment of cluster headaches

Answer 23

oxygen and sumatriptan SC

Question 24

prophylactic treatment of cluster headaches

Answer 24

verapamil

Question 25

treatment of paroxysmal headaches (in older women)

Answer 25

indomethicin (diagnostic if it works)

Question 26

what is SUNCT how does it differ from other types of trigeminal autonomic cephalgia

Answer 26

stands for; short lived unilateral headache neuralgia headache conjunctival injections tearing it lasts longer than other trigeminal autonomic cephalgia

Question 27

investigations for trigeminal autonomic cephalgia

Answer 27

MRI/CT

Question 28

who get idiopathic intracranial hypertension

Answer 28

obese females

Question 29

when is headache worse in idiopathic intracranial hypertension

Answer 29

morning

Question 30

idiopathic intracranial hypertension causes increased ... and hence ... (eye symptom)

Answer 30

increased ICP = papilloedema = vision loss

Question 31

investigations for idiopathic intracranial hypertension

Answer 31

fundoscopy - for papilloedema | brain MRI - for other causes of papilloedema

Question 32

management of idiopathic intracranial hypertension

Answer 32

LOSE WEIGHT! though no one does lol acetazolamide

Question 33

how does acetazolamide work in relieve idiopathic intrancranial hypertension what is another common drug that would do this same job

Answer 33

decreases ICP diuretics

Question 34

who gets trigeminal neuralgia

Answer 34

elderly women

Question 35

what is the pathophysiology of tirgeminal neuralgia

Answer 35

blood vessel touches trigeminal nerve = extreme pain when nerve is triggered (eg by touch to face, chewing etc)

Question 36

presentation of pain in trigeminal neuralgia how long does pain last for how many times per day do they get pain

Answer 36

sharp stabbing unilateral pain lasts <90 seconds happens 1-100 times per day

Question 37

investigations for trigeminal neuralgia

Answer 37

MRI

Question 38

treatment for trigeminal neuralgia

Answer 38

carbamazepine gabapentin phenytoin ablation decompression (big surgery)

Question 39

20yo female headache with nausea, aura and photophobia once per month lasts 4-72 hours

Answer 39

migraine

Question 40

feels like a band squeezing round head

Answer 40

tension headache

Question 41

bilateral headache no nausea/vomiting/visual loss/photophobia mild/moderate feels like a band squeezing round head

Answer 41

tension headache

Question 42

``` young male unilateral headache eye lid oedema ptosis lasts 45-90mins, 1-8 times per day ```

Answer 42

cluster headache

Question 43

general headache treatment (a good guess in exam)

Answer 43

triptan

Question 44

``` 60yo women unilateral headache miosis tearing nasal stuffiness lasts 10-30mins, 1-40 times per day ```

Answer 44

paroxysmal hemicrania

Question 45

obese female vision loss headache worse in morning nausea and vomiting

Answer 45

idiopathic intracranial hypertension

Question 46

elderly women severe unilateral stabbing pain in face <90secs, 1-100 times per day triggers - chewing, touch face

Answer 46

trigeminal neuralgia