HEADACHE & TRIGEMINAL Neuralgia Flashcards
1
Q
Pain SENSITIVE STRUCTURE of BRAIN
🧠⚡Pain Sensitive Means Dura Feels Chilling² Pain ⚡
A
- Periosteum
- Scalp
- Middle Meningeal ARTERY
- Duramater
- Falx cerebri
- Circle of WILLIS
- CN 5, 9, 10
- Pial Arteries (PROXIMAL part)
2
Q
Pain INSENSITIVE STRUCTURE IN BRAIN
🧠⚡ ABCDE⚡
A
- Arachnoidmater & Piamater
- Brain Parenchyma
- Choroid Plexus
- Dura over convexity of skull
- Ependyma
3
Q
🌸 TYPES of HEADACHE
A
⭐ 1° HEADACHE
⭐ 2° HEADACHE
4
Q
Benign ➕ Recurrent ➕ No Organic Disease
A
1° headache
5
Q
Causes of 1° HEADACHE
🧠⚡T²IME⚡
A
- Tension type
- Trigeminal Autonomic Cephalgias
- Idiopathic STABBING
- Migraine
- Exertional
6
Q
Dangerous vs NON-DANGEROUS HEADACHE
A
Dangerous headache: ICP ⬆️ ⬆️
7
Q
Mechanism of PRODUCTION OF HEADACHE
A
8
Q
⚡⚡ MOST COMMON TYPE OF 1° HEADACHE
A
Tension Type Headache
9
Q
Middle aged Female
➕
Headache: Fullness, Tightness Band like or Pressure
➕
Steady Pain
➕
Stress ± Depression (33%)
➕
Chronicity (> 15 days/month)
A
Tension Type Headache
10
Q
Patient is NEVER DISTURBED FROM SLEEP in which type of HEADACHE
A
Tension Type Headache
11
Q
Duration of HEADACHE in TENSION TYPE HEADACHE
A
> 30 mins (4-6 hrs)
12
Q
Headache symptoms that suggest SERIOUS Underlying DISORDER
A
- Sudden onset
- 1st EVER HEADACHE
- WORST HEADACHE EVER
- VOMITING F/b Headache
- Subacute worsening
- Disturbs sleep
- Pain induced by BENDING, LIFTING or COUGHING
- SYSTEMIC ILLNESS ➕
- Age > 55 yrs
- Abnormal Neurological Examination
- Fever (OR) Unexplained Systemic symptoms
- Pain ASSOCIATED with LOCAL tenderness (TEMPORAL Artery)
13
Q
Raised ICT
⚡⚡ MOST COMMON DIAGNOSTIC FEATURE
A
Papilledema
➕
Bradycardia
Hypertension
14
Q
💊💉 MANAGEMENT of TENSION TYPE HEADACHE
⭐ ACUTE ATTACK
⭐ CHRONIC TTH
A
⭐ ACUTE ATTACK
🎯 NSAID
⭐ CHRONIC TTH
🎯 Prophylaxis with AMITRIPTYLINE (TCA)
15
Q
🌸 TYPES of MIGRAINE
A
- Migraine without AURA (COMMON MIGRAINE)
- Migraine with AURA ( Classical MIGRAINE)
16
Q
RARE TYPES OF MIGRAINE
🧠⚡BOHR Family ⚡
A
- Basilar Migraine
- Opthalmoplegic Migraine
- Hemiplegic Migraine
- Retinal Migraine
- Familial HEMIPLEGIC Migraine (Calcium Channelopathy)
17
Q
Familial HEMIPLEGIC Migraine: 🌸 TYPES
A
- FHM1: Calcium Channelopathy (CACNAIA)
- FHM2: Na-K ATPase (ATP1A2)
- FHM3: Na channel (SCN1A)
18
Q
SCN1A gene mutation is seen in
A
- Familial HEMIPLEGIC Migraine 3
- DRAVET SYNDROME
19
Q
Stages of MIGRAINE headache
A
- Prodrome
- Aura
- Headache
- Postdrome
20
Q
For DIAGNOSIS of
⭐ COMMON MIGRAINE
⭐ CLASSICAL MIGRAINE
A
⭐ COMMON MIGRAINE
Minimum: 5 ATTACKS, each lasting 4-72 hours
⭐ CLASSICAL MIGRAINE
Minimum: 2 ATTACKS, each lasting 4-72 hours
✨ Features of CLASSICAL AURA MUST be ➕
21
Q
Features of MIGRAINE AURA
A
- Gradual onset > 40min
- Lasting < 60min
- Fully Reversible
- Headache after 60 mins or simultaneously without AURA
22
Q
U/L HEADACHE
A
✨ MIGRAINE
✨ TRIGEMINAL AUTONOMIC CEPHALGIA
23
Q
⚡⚡ MOST COMMON MIGRAINE AURA
🧠⚡ VASE⚡
A
Visual
⬇️
Auditory
⬇️
Sensory
24
Q
⚡⚡ MOST COMMON VISUAL AURA IN MIGRAINE
A
Zig Zag lines
⬇️
Fortification spectra
Scintillating SCOTOMA
Tunnel Vision
transient Visual loss
25
2 Days Prior to Migraine Headache
Mood changes
Irritability
Depression
26
Sensory Aura in MIGRAINE
Tingling sensation in Hand, spreading to ARMS ➡️ Lips & Tongue
27
Features of MIGRAINE HEADACHE
🧠⚡SULTANS ⚡
1. Severe or Moderate INTENSITY
2. U/L
3. Throbbing
4. Activity Worsens Headache
5. Nausea & Vomiting
6. Sensitivity to Light & Sound
(Photophobia, Phonophobia, Osmophobia)
⭐ AFTER HEADACHE, PATIENT FEELS LETHARGIC & DEPRESSED for 2 Days
28
Precipitating FACTOR for MIGRAINE
1. Glare
2. Bright Light
3. Sound
4. Hunger
5. Stress Excess
6. Physical Exertion
7. Hormonal Fluctuations during MENSES
8. Lack (OR) Excess of Sleep
9. Alcohol
10. Chemical stimulation
29
Vascular theory of MIGRAINE
30
Serotonin theory of MIGRAINE
⬇️ Serotonin levels in Brain
31
⚡⚡ MOST IMPORTANT CYTOKINE IN MIGRAINE
CGRP
(Calcitonin Gene Related Peptide)
32
Central Pathogenicity of MIGRAINE
Trigeminovascular complex
33
Ophthalmoplegic MIGRAINE
Headache ➕ TRANSIENT & Reversible U/L 3rd CN PALSY
34
MIGRAINE Headache
➕
Ataxia
➕
Vertigo
➕
Tinnitus
Basilar Migraine
35
Hemiplagia
➕
MIGRAINE headache
Familial HEMIPLEGIC Migraine
36
MIGRAINE
➕
Transient MONOCULAR VISION LOSS
Retinal MIGRAINE
37
Episodic Disabling Headache > 6months duration with NORMAL Neurological Examination is MIGRAINE, unless proven otherwise
38
💊💉 MANAGEMENT of MILD Acute MIGRAINE
🧠⚡ ⚡
1. Paracetamol (OR) NSAID
✨ Naproxen 550mg BD
✨ Ibuprofen 400mg Q4H
➕
2. Anti-ematics
✨ Metoclopramide 5-10 mg OD
39
💊💉 MANAGEMENT of MODERATE MIGRAINE
1. ORAL TRIPTANS
Eletriptan 40-80mg
(OR)
Rizatriptan 5-10mg
(OR)
Almotriptan 12.5-25mg
➕
2. Anti-ematics
✨ Metoclopramide 5-10 mg OD
40
💊💉 MANAGEMENT of SEVERE to VERY SEVERE Acute MIGRAINE
⭐ Sumatriptan 6mg SC inj
(Repeat after 1 hour, if not RESOLVED)
(OR)
⭐ I/N SUMATRIPTAN (OR) ZOLMITRIPTAN
➕
2. Anti-ematics
✨ Metoclopramide 5-10 mg OD
41
Triptans
🧠⚡FRiENdS⚡
1. Frovatriptan
2. Rizatriptan
3. Eletriptan
4. Naritriptan
5. Sumatriptan
6. Zolmitriptan
42
⭐ Triptan with MAXIMUM EFFICACY
⭐ Triptan with MINIMUM EFFICACY
⭐ Triptan with MAXIMUM EFFICACY
🎯 RIZATRIPTAN
⭐ Triptan with MINIMUM EFFICACY
🎯 SUMATRIPTAN
43
LONGEST ACTING TRIPTAN
🧠⚡Forever lasting ⚡
Frovatriptan
44
SAFEST TRIPTAN IN PREGNANCY
Sumatriptan
45
FASTEST ACTING TRIPTAN
Rizatriptan
46
Triptan with LEAST ORAL BIOAVAILABILITY
Sumatriptan
47
DITANS
5HT1F AGONISTS
⬇️
LASMIDITAN
⬇️
USE: MIGRAINE
48
🤢😳SIDE EFFECTS🥴😵 of TRIPTANS
49
🚫 CONTRAINDICATION of TRIPTAN
1. CVA
2. CAD
3. Peripheral Vascular Diseases
50
Monoclonal antibodies against CGRP Receptor
ERENUMAB
RIMEGEPANT
UBROGEPANT
51
Anti-CGRP
🧠⚡cdEFG... ⚡
EPTINEZUMAB
FREMANEZUMAB
GALCANEZUMAB
52
Prophylaxis of MIGRAINE
🧠⚡Flunarezine Can P-RE-VE-NT Migraine⚡
1. Flunarezine
2. Cyproheptadine
3. Propranolol
4. Pizotifen
5. Release GABA ➡️ Gabapentin
6. Valproate
7. Venlafaxine
8. Nortriptyline & Amitriptyline
9. Topiramate
10. Methysergide
53
Class I DRUGS FOR MIGRAINE Prophylaxis
🧠⚡PVT ⚡
1. Propranolol
2. Valproate
3. Topiramate
54
Class II DRUGS FOR MIGRAINE Prophylaxis
Venlafaxine
TCA
55
Class III DRUGS FOR MIGRAINE Prophylaxis
1. Pizotifen
2. Flunarizine
3. Clonidine
4. Candesartan
56
Newer TREATMENT modalities for MIGRAINE
🧠⚡GOES ⚡
1. Greater Occipital Nerve Block
2. Onabotulinum Toxin A
3. ERENUMAB
4. Supraorbital Transcutaneous Stimulation
57
MIGRAINE is commonly misdiagnosed as SINUS Headache
Why?
1. Pain is often located over Sinus
2. Migraine is TRIGGERED by Weather changes
3. Tearing & Nasal Congestion is COMMON: DUE TO: Autonomic symptoms in MIGRAINE
4. Sinus medications may help to abort Migraine episode
58
🌸 TYPES of TRIGEMINAL AUTONOMIC CEPHALGIA
🧠⚡PCS² H ⚡
1. Paroxysmal Hemicrania
2. Cluster Headache
3. SUNCT: Short lasting U/L Neuralgic Headache with Conjunctival Congestion & Tearing
4. SUNA: Short lasting U/L Neuralgiform Headache with Cranial Autonomic features
5. Hemicrania Continua
59
⚡⚡ MOST COMMON TYPE OF TRIGEMINAL AUTONOMIC CEPHALGIA
Cluster Headache
60
SUNA
Short lasting U/L Neuralgiform Headache with Cranial Autonomic features
61
SUNCT
SUNCT: Short lasting U/L Neuralgic Headache with Conjunctival Congestion & Tearing
62
Diagnostic feature of TAC
I/L headache
➕
Any 1:
1. Conjunctival injection
2. Nasal congestion
3. Rhinorrhea
4. Eyelid edema
5. Forehead & Facial Sweating
6. Flushing of Face & forehead
7. Fullness in Ear
8. Miosis or Ptosis
63
Difference BETWEEN CLUSTER HEADACHE, PAROXYSMAL HEMICRANIA & SUNCT (OR) SUNA
64
⭐ Alcohol is the TRIGGER for which TAC
⭐ CUTANEOUS TRIGGER for which TAC
⭐ Alcohol is the TRIGGER for which TAC
🎯 Cluster Headache
⭐ CUTANEOUS TRIGGER for which TAC
🎯 SUNCT (OR) SUNA
65
Indomethacin is useful for treatment of which TAC
🎯 PAROXYSMAL HEMICRANIA
🎯 HEMICRANIA CONTINUA
66
Shortest LASTING HEADACHE in which TAC
SUNA (OR) SUNCT
67
IV LIGNOCAINE is used for treatment of which HEADACHE
SUNCT
68
No effective Treatment is available for which TAC
Paroxysmal HEMICRANIA
69
SUICIDE HEADACHE
Cluster HEADACHE
70
⚡⚡ MOST SEVERE HEADACHE
Cluster Headache
71
U/L PHOTOPHOBIA seen in
Cluster Headache
72
Young MALE
➕
H/O alcohol intake
➕
SEVERE HEADACHE
➕
RESTLESS & AGGRESSIVE
➕
NOCTURNAL HEADACHE
➕
PHOTOPHOBIA & AUTONOMIC FEATURES
Cluster Headache
73
Headache features of CLUSTER HEADACHE
Site: Orbit & Temple
Type: Stabbing & Boring
Severity: Very Severe EXCRUCIATING
Attack frequency: 1-8 times per day
Duration: 15 min to 3 hrs
Migraine like features ➕
74
TAC predominant in MALES
TAC predominant in FEMALES
TAC predominant in MALES
🎯 Cluster Headache
TAC predominant in FEMALES
🎯 SUNCT
🎯 HEMICRANIA CONTINUA
75
TAC more common in NIGHT
Cluster HEADACHE
76
Migrane-like features is seen in which TAC
1. Cluster Headache
2. Paroxysmal HEMICRANIA
77
🩺 IOC for HEMICRANIA CONTINUA
MRI
78
TRIGEMINAL Neuralgia
Paroxysms of INTENSE BRIEF SHOCK LIKE SUPERFICIAL PAIN along the distribution of TRIGEMINAL NERVE
79
⚡⚡ MOST COMMON BRANCH OF TRIGEMINAL involved in TRIGEMINAL Neuralgia
V2: MAXILLARY
80
Cutaneous Trigger ➕
➕
Refractory Period
➕
U/L Intense Pain
➕
Patient Winces & Sit Silently
TRIGEMINAL Neuralgia
81
⭐ U/L TRIGEMINAL NEURALGIA cause
⭐ B/L TRIGEMINAL NEURALGIA cause
⭐ U/L TRIGEMINAL NEURALGIA cause
🎯 Compressive etiology: Superior Cerebellar Artery
⭐ B/L TRIGEMINAL NEURALGIA cause
🎯 Demyelination etiology: MULTIPLE SCLEROSIS
82
TIC DOULOUREUX
(OR)
Prosopalgia
(OR)
Fothergill's Disease
Trigeminal Neuralgia
83
🔬DIAGNOSIS of TRIGEMINAL NEURALGIA
3D MRI
84
DOC: TRIGEMINAL NEURALGIA
Carbamazepine > > Lamotrigene
Carbamezepine 100-200mg OD, increase im 2-3wks to 200-400mg
Others: SC BOTOX
85
Surgical 💊💉 MANAGEMENT of TRIGEMINAL NEURALGIA
Microvascular Decompression
86
HLA B-1502 ➕ Carbamazepine
SJS
87
Glossopharyngeal NEURALGIA
Synonyms
Eagle's SYNDROME
88
SUDDEN Pain in TONSIL BED, THROAT & ANGLE OF JAW
➕
CARDIAC CONDUCTION ANOMALIES
➕
⬆️ ⬆️ by Swallowing Coughing Yawning
Eagle SYNDROME
89
Small Circumscribed areas of CONTINUOUS PAIN on the HEAD
Nummular Headache
90
Causes of 2° HEADACHE
