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Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

With regard to headaches, what does TACs stand for?

A

Trigeminal autonomic cephalalgias

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2
Q

What are the headache red-flags?

A

S - systemic symptoms / signs (fevers, myalgias, weight loss), history of secondary diseases (GCA, malignancy, HIV, autoimmune disease)
N - neurological signs (confusion, behavioural change, decreased GCS)
O - onset sudden (thunderclap)
O - older person (onset >50yo), and progressive
P - 1. progressive headache with loss of headache-free periods
2. precipitated by valsalva
3. postural aggravation
4. papilledema or pulsatile tinnitus

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3
Q

Are men or women more affected with cluster headaches? What is the population prevalence?

A

Men (3:1)

Population frequency 0.1%

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4
Q

What are the features of cluster headache?

A

Clusters last 6-12 weeks, with 1-8 attacks per day lasting 15minutes to 3 hours

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5
Q

What are the treatments for cluster headaches?

A

Triptans, highflow oxygen, GONB, oral corticosteroids, verapamil

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6
Q

What are the clinical features of hemicrania?

A

Similar pain to cluster headaches lasting 2-30 minutes (average 13 minutes), more frequent in day, responsive to indomethacin

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7
Q

What are the clinical features of SUNCT / SUNA?

A

Short-lived (seconds) sharp pain, starting with conjunctival injection and tearing

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8
Q

What are the diagnostic features of migraine?

A
  1. recurrent
  2. last hours to 3 days untreated
  3. Have 2 of: unilateral, pulsating, moderate-to-severe, aggravated by activity
  4. Have 1 of: nausea/vomiting or photo-/phonophobia
  5. Not explained by other headache type
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9
Q

What are the different anti-CGRP MABs? Which are available on Australian PBS?

A

Galcanezumab (PBS), Fremanezumab (PBS)

Eptinezumab, Erenumab

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10
Q

What are the different TACs?

A
  1. Cluster headache
  2. Hemicrania
  3. SUNCT / SUNA
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11
Q

Do you need to avoid OCP in migrain with aura or migraine without aura?

A

Migraine with aura

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12
Q

What are the pathophysiologic mechanisms proposed in migraine?

A
  1. CNS dysfunction (impaired habituation of nociceptive specific blink reflexes in patients as well as non-migraineur 1st degree relatives
  2. Trigeminovascular activation
  3. Central sensitisation
  4. Hightened pain sensation
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13
Q

What are the different types of triptans available?

A

Eletriptan
Rizatriptan
Sumatiptan
Zolmitriptan

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14
Q

What are anti-CGRP MABs used for?

A

Migraine

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15
Q

What are contraindications of triptans?

A

Angina / AMI
CVA
Aneurysm
Arterial dissection

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16
Q

What is the MOA of triptans?

A

5-HT 1b/1d agonist

17
Q

What is the threshold for considering prophylactic treatment in migraine?

A

Usually advised if there are 4 or more headache days per month

18
Q

What is the mnemonic for headache red-flags?

A

SNOOP4

Neurology (10 decks)

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