Headaches

Question 1

most important part of SOCRATES for headaches?

Answer 1

onset ie acute/subacute/chronic
exacerbating/relieving factors
associated symptoms

Question 2

what can exacerbate a headache?

Answer 2

posture
sneezing
coughing

Question 3

what symptoms can accompany a headache that you should ask about?

Answer 3

nausea and vomiting
photophobia
phonophobia
visual disturbance
nasal stuffiness

Question 4

headache red flags?

Answer 4

>55 new onset
known/previous malignancy
immunosuppressed
worse in early morning
worse on coughing/sneezing

Question 5

why should you ask if a cough/sneeze exacerbates a headache?

Answer 5

they raise intracranial pressure

Question 6

PMH should look for…

Answer 6

previous cancer

are they thrombolytic?

Question 7

FH should explore…

Answer 7

migraines

cancers

Question 8

migraines are commoner in who?

Answer 8

young women

Question 9

on average people have _ migraine attack(s) per month

Answer 9

1

Question 10

migraine with aura is more common than without T or F

Answer 10

F, without aura is more common (80%_

Question 11

timescale for migraine without aura?

Answer 11

4-72hrs

Question 12

presentation of a migraine without aura

Answer 12

moderate-severe, throbbing

unilateral headache that is worse on movement WITH associated N&V or photo/phonophobia

Question 13

pathophysiology of a migraine

Answer 13

stress triggers changes in the brain causing release of serotonin -> dilates BVs; substance P release causes pain

Question 14

how long does an aura last?

Answer 14

20-60 mins

Question 15

presentation of migraine with aura?

Answer 15

aura for up to an hour followed by a headache (can also happen at the same time)

Question 16

name the different kinds of aura; what is the most common?

Answer 16

visual eg lights, odd smell, hallucinations

visual is most common

Question 17

a central scotomata type of visual aura looks like…

Answer 17

a blurred dark circle in the middle of the visual field

Question 18

a central fortification type of visual aura looks like…

Answer 18

a zigzagged circle in the middle of the visual field

Question 19

hemianopic loss in a visual aura looks like…

Answer 19

half of the visual field is lost

Question 20

migraine triggers

Answer 20

sleep
diet
stress
hormones
physical exertions

Question 21

name a way of finding what triggers a patient’s migraines

Answer 21

getting them to fill out a headache diary

Question 22

Tx of migraines

Answer 22

avoid triggers
headache diary
relaxation/stress management
NSAID +/- antiemetic ASAP

Question 23

when would you consider prophylactic treatment for migraines?

Answer 23

if theyve had >3 attacks a month or are very severe

Question 24

prophylactic drugs for migraines?

Answer 24

propranolol
topiramate (carbonic anhydrase inhibitor)
amitryptiline

Question 25

side effects of topiramate

Answer 25

wight loss paresthesia impaired concentration

Question 26

amitryptiline side effects?

Answer 26

dry mouth postural ht sedation

Question 27

presentation of a tension headache?

Answer 27

mild-moderate pressing/tingling headache that is bilateral

Question 28

associated symptoms are absent in tension headaches T or F

Answer 28

T

Question 29

Tx of tension headache?

Answer 29

relaxation physio reassure antidepressant eg amitryptiline for 3 months

Question 30

what are the trigeminal autonomic cephalgias?

Answer 30

group of primary headache disorders characterised by UNIlateral trigeminal distribution pain PLUS ipsilateral cranial autonomic features

Question 31

name the ipsilateral cranial autonomic features that appear with TACs?

Answer 31

``` ptosis miosis nasal stuffiness N+V crying eyelid oedema ```

Question 32

4 main types of TAC?

Answer 32

cluster paroxsymal hemicrania hemicrania continua SUNCT

Question 33

who gets cluster headaches?

Answer 33

young adult men (30s)

Question 34

when do cluster headaches appear?

Answer 34

striking pain around sleep tme

Question 35

presentation of cluster headache?

Answer 35

SEVERE unilateral headache lasting around an hour that appears up to 8 times a day

Question 36

Tx of cluster headache

Answer 36

high flow O2 for 20 mins sumatriptan SC steroids (decrease over 2 weeks)

Question 37

prophylactic treatment of cluster headaches?

Answer 37

verapamil

Question 38

who gets paroxysmal hemicrania

Answer 38

elderly women (50-60s)

Question 39

clinical presentation of paroxysmal hemicrania

Answer 39

severe unilateral headache with ipsilateral autonomic features lasting about 30 mins

Question 40

how many can headaches can you get a day in paroxysmal hemicrania?

Answer 40

up to 40

Question 41

Tx of paroxysmal hemicrania

Answer 41

indomethicin

Question 42

what does SUNCT stand for?

Answer 42

``` short lived (up to 2 mins) unilateral neuralgiform headache conjunctival injections tearing (Crying) ```

Question 43

Tx of SUNCT

Answer 43

lamotrigine | gabapentin

Question 44

Ix of new onset unilateral cranial autonomic features

Answer 44

all need MRI brain and MR angiogram

Question 45

what is the headache like in idiopathic intracranial hypertension

Answer 45

diurnal variation | morning N+V

Question 46

MRI of IIH would show...

Answer 46

nothing

Question 47

Tx of IIH

Answer 47

weight loss acetazolamide ventricular shunt

Question 48

who gets trigeminal neuralgia?

Answer 48

elderly women

Question 49

what triggers trigeminal neuralgia?

Answer 49

touch over CNV2 and 3

Question 50

presentation of trigeminal neuralgia?

Answer 50

severe stabbing unilateral pain lasting around a minute multiple times throughout the day

Question 51

Tx of trigeminal neuralgia

Answer 51

``` carbamazepine gabapentin phenytpim baclofen Sx = ablation/decompression ```

Question 52

Ix of trigeminal neuralgia

Answer 52

MRI brain