Headaches

Question 1

Mcc of secondary headache

Answer 1

Systemic infection

Question 2

Mcc of primary headache

Answer 2

Tension headache

Question 3

Headache common in pregnancy and post pregnancy

Answer 3

CVThrombosis

Question 4

Pain sensitive structures in cranium

SMD FP

Answer 4

Scalp
Meningial arteries
Dural sinuses

Falx
Prox seg of pial arteries

Question 5

Pain insensitive structures in cranium

VCPB

Answer 5

Ventricle ependyma
Choroid plexus
Pial veins
BRAIN PARENCHYMA**

Question 6

Age and sex for GCA

Answer 6

F»M (4:1)

Exclusively 50+ years

Question 7

C/f of GCA

Answer 7

Headache (throbbing/stabbing)

Scalp tenderness (pillow+)

Jaw claudication

Pain and stiffness of back shoulders
(POLYMYALGIA RHEUMATICA)

BLINDNESS** (PCA involvement)
Irreversible

Question 8

Temopral artery biopsy GCA

Answer 8

2-5cm needed
Segmental lesions
PANARTERITIS (all three layers)
Giant cells

Question 9

Rx GCA

Answer 9

Prednisone

Ch3pred if visual loss
(AMAUROSIS FUGAX)- Also S/I HOLLENHURST PLAQUES IN RET ARTERY*

Aspirin (for thrombotic cx)

Tocilizumab (IL6)

Question 10

C/f pseudotumor cerebri

Answer 10

Young obese female

ICT+
Papilledema
Headache (awakening/morning/inc on cough sneeze bend fwd)

NO neural deficit
NO hycocephalus

Question 11

Etiology of PTC

Answer 11

IDIOPATHIC (mc)

CEREBRAL VENOUS HTN
(Dt sagittal venous thrombosis—delta sign)

MENINGITIS

IATROGENIC

METABOLIC (hypoPTH/ Cushings/ Addison)

Question 12

Iatrogenic causes of PTC

Answer 12

Hypervitaminosis A ***

Expired tetracyclines

FQ

Estrogen

Lithium

Lead

Amiodarone

Question 13

Rx PTC

Answer 13

Acetazolamide (decrease csf production)

LP shunt

Question 14

Which headache a/w depression

Answer 14

Tension headache

Question 15

Rx tension headache

Answer 15

<15/m = NSAIDS

> 15= TCA (Rx depression)

Question 16

Migraine diagnostic criteria

Answer 16

DURATION(4-72 hrs)

QUALITY OF HEADACHE- PUMA (Puls/uni/mod-sev intensity/ aggravation on movement)
(Minimum 2)

NAUSEA / VOMITING (any 1)

PHOTOPHOBIA(blurring)/ PHONOPHOBIA (any1)

Question 17

Mc symptom of migraine

Answer 17

Photophobia»light headed>scalp tender

Question 18

Migraine with aura called as

Answer 18

Classical migraine

Question 19

Migraine without aura called as

Answer 19

Common migraine

Question 20

Cortical spreading depression theory

Answer 20

Trigger—Monoaminergic areas of brain+(brainstem and hypothalamus)—secrete vasoactive peptides at Trigeminal nerve nucleus—TGN carries signal to VB and P nucleus of thalamus—Cerebral Vasodilation—Vasoconstriction(late)

Question 21

Triggers of migraine

Answer 21

Menses
Red wine
Hunger
Insomnia
Bright light
Stress

Question 22

Vasoactive peptides of migraine

Answer 22

CGRP***
(Calcitonin Gene Related Peptide)

NO
VIP
Substance P

Question 23

Cerebral Vasodilation c/f

Answer 23

Esp in occipital lobe

FORTIFICATION SPECTRA
Flashes of light

Question 24

C/f of Vasoconstriction

Answer 24

Scotoma

Negative symptom

Question 25

Speed of spread of meningeal irritation due to vasodilation

Answer 25

2-4mm/min Occ—par—tempo—frontal

Question 26

5HT4 agonist Rx

Answer 26

Non selective—ERGOTAMINE (Coronary S/E) Selective— 1B/1D = Triptans 1F = lasmi-DITANS Triptans best = RIZATRIPTAN Long acting and tolerable= Nara/Frova

Question 27

Theories of migraine

Answer 27

``` Cortical depression Serotonin deficiency Dopamine stimulation (rx metoclop) ```

Question 28

Prophylaxis of migraine (5-6months) | ABCD

Answer 28

AED- Valproate/Gabapentin BB- Propanolol Ccb- FLUNARIZINE** (Also a DA depletor) Depressants- TCA

Question 29

CGRP antagonists

Answer 29

RemaGEPANT | UbroGEPANT

Question 30

CGRB Ab | FEEG

Answer 30

Erenumab Eptinumab Fremanazemab Galacnezemab

Question 31

Braintumour c/f

Answer 31

ICT Projectile vomiting***

Question 32

Cluster headache sex preference and age

Answer 32

M>>F | 20-50y

Question 33

Cluster headache pain characteristics

Answer 33

Retro-orbital U/L Alcohol ppt Awakens sleep 1-8 attacks/d for 1-8 weeks—relapse after 1 year PERIODICAL**

Question 34

Autonomic symptoms of CH | U/L only

Answer 34

Larimation Ptosis Rhinorrhea Conjunctival congestion

Question 35

Lesion of Cluster headache is in

Answer 35

HYPOTHALAMUS

Question 36

Rx CH

Answer 36

O2 (100%) -10 minutes Sumatriptan VNS (Vagal nerve stimulation)

Question 37

Prophylaxis of CH DOC

Answer 37

Verapamil>>>prednisone>>Lithium

Question 38

Trigeminal Autonomic Cephalgias

Answer 38

CH PH paroxysmal Hemicrania SUNCT- Short Lasting Neuralgia with Conjunctival Tearing

Question 39

Features of TAC

Answer 39

Anterior and Middle cranial fossa (distribution of TGN) A/w pituitary tumors Autnomic symptoms +++ Migranous symptoms (nv photo phono)

Question 40

Paroxysmal Hemicrania freq/durN/rx

Answer 40

<20 attacks/d 2-30 min (CH = 15-180min) INDOMETHACIN

Question 41

SUNCT freq/durN/ trigger / rx

Answer 41

> 20 attacks per day 5-240 seconds CUTANEOUS TRIGGER** Lidocaine