headache W1

Question 1

2 headache categories?

Answer 1

primary headache
secondary headache (due to underlying disorder)

Question 2

types of primary headache?

Answer 2

tension type headache
migraine
trigeminal autonomic cephalgias including cluster headache
other including primary stabbing headache and benign exertional headaches

Question 3

secondary headache causes?

Answer 3

infection (eg meningitis, covid)
vascular (eg stroke, aneurysmal bleed, giant cell arteritis)
raised ICP (eg trauma, brain tumour)
medication side effects

Question 4

tension type headache - features?

Answer 4

whole head
dull, pressing
mild-moderate severity
usually no associated features, rather non-specific
only considered a disease if arise spontaneously and frequently

Question 5

tension type headache treatment

Answer 5

acutely NSAIDs
preventative tricyclic antidepressant

Question 6

trigeminal autonomic cephalgias - description?

Answer 6

activation of trigeminal and autonomic pathways presenting as unilateral headache attacks with ipsilateral autonomic features, often circadian
(frequent attacks for a while, goes away for a yr then comes back)

Question 7

ipsilateral autonomic features in trigeminal autonomic cephalgias?

Answer 7

red eye
ptosis
lacrimation
rhinorrhea

Question 8

what are trigeminal autonomic cephalgias distinguished by?

Answer 8

duration and frequency

Question 9

most common type of trigeminal autonomic cephalgias? who do these affect most commonly?

Answer 9

cluster headaches
middle ages men

Question 10

less common types of trigeminal autonomic cephalgias?

Answer 10

paroxysmal hemicrania and hemicrania continua

Question 11

types of trigeminal autonomic cephalgias?

Answer 11

cluster headache
paroxysmal hemicrania and hemicrania continua
SUNCT and SUNA

Question 12

what does SUNCT stand for?

Answer 12

short lasting unilateral neuralgiform headache with conjunctival injection and tearing

Question 13

what does SUNA stand for?

Answer 13

short lasting unilateral neuralgiform headache and autonomic features

Question 14

characteristics of a migrane?

Answer 14

often one sided, can be whole head
severe pulsating/throbbing
4-72 hours
lots of associated features

Question 15

associated features of migrane?

Answer 15

photophobia (light), phonophobia (sound), nausea/vomiting, desire to lie still, exacerbated by movement

Question 16

migraine with aura?

Answer 16

occurs before headache, spreads over time, 90% visual, can affect sensation (normally tingling) and speech. can have aura without headache

Question 17

what can aura without headache be mistaken for?

Answer 17

TIA

Question 18

prodromal and postdromal features of migraine?

Answer 18

tiredness, irritability, yawning, poor concentration

Question 19

chronic migraine vs episodic migraine?

Answer 19

chronic = headache ≥15 days/month for ≥3 months, migraine features ≥8 days/month

Question 20

what is chronic migraine often associated with

Answer 20

analgesia overuse

Question 21

migraine epidemiology?

Answer 21

post puberty normally, 3F:1M
peaks 35-45 yrs
genetic factors can increase susceptibility by small degree
hormonal factors
environmental triggers

Question 22

hormonal factors in migraine epidemiology?

Answer 22

gender, puberty, periods, pregnancy, menopause, COCP

Question 23

environmental triggers for migrane

Answer 23

emotional stress, change in sleep pattern, certain foods, weather change

Question 24

pathophysiology of migraine?

Answer 24

involves activation and sensitization of trigeminovascular pathways
disorder of sensory processing and altered brain excitability

Question 25

migraine acute treatment?

Answer 25

aspirin (ideally soluble, high dose 600-900mg)
NSAIDs
triptans (gold standard)
avoid analgesia overdose
lifestyle (hydration, sleep, fresh air, exercise, screen breaks)

Question 26

migraine preventative treatments - drug examples?

Answer 26

propranolol (beta blocker)
pizotifen
amitriptyline
candesartan
topiramate
flunarizine
riboflavin

botulinum injections (botox)

Question 27

new migraine drugs?

Answer 27

CGRP - calcitonin gene related peptide drugs
neuropeptide in trigeminal ganglion neurones. release causes cascade resulting in sensitization of trigeminal nerves
key role in migraine pain pathways through trigeminovascular system
very expensive!