Migraine+Headache

Question 1

Migraine what is the average time to maximum intensity

Answer 1

1h

Question 2

Migraine what is the average duration

Answer 2

24h

Question 3

What is the aim of acute treatment for migraine?

Answer 3

Aiming ti be pain free at 2h and remain so for 24h

Question 4

What is considered a good treatment response for triptans?

Answer 4

2 out of 3

Question 5

If you have headache with aura when should you take the trip tab

Answer 5

Start with headache NOT aura

Question 6

What are the options for acute treatment of migraine

Answer 6

Aspirin 900mg
Ibuprofen 400mg (in ineffective 600mg)
Sumitriptan orally 50-100mg
Metoclopramide/prochlorperazine 10mg
Paracetamol 1g

Question 7

What are CI to triptans

Answer 7

Uncontrolled HTN
CVD, PVD, cerebrovascular disease

Question 8

What do NICE recommend as therapy for migraines

Answer 8

Oral triptan plus NSAID/paracetamol

Question 10

What is the aim of migraine prophylaxis

Answer 10

Reduction in headache severity and frequency of 50%

Question 11

When do you review migraine prophylaxis

Answer 11

Use each treatment for >3mo the at the max tolerated dose before deciding if effective. Reassess need for ongoing prophylaxis after 6-12m

Question 12

What is the aim of migraine prophylaxis

Answer 12

Reduction in migraine severity and frequency of 50%

Question 13

When do you review migraine prophylaxis?

Answer 13

Use each for >3months at max tolerated dose
Reassess need for ongoing treatment after 6-12m

Question 14

What are the treatment options for migraine prophylaxis?

Answer 14

Propranolol
Topiramage
Amitriptyline
Candesartan
Riboflavin (B2)

Question 15

What are the non drug options for migraine prophylaxis

Answer 15

Acupuncture
CBT
Mindfulness

Question 16

When do you consider a menstural migraine

Answer 16

Consider is occurs on 2 out of 3 consecutive cycles

Question 17

Why do periods trigger migraines?

Answer 17

Oestrogens drops just before menstruation

Question 18

Migraines improve in pregnancy True or False

Answer 18

KINDA
Migraine WITHOUT aura often improves during pregnancy
Migraine with aura often remains the same

Question 19

What is the acute treatment of migraine in pregnancy?

Answer 19

Paracetamol
Ibuprofen (Avoid after 28weeks)
Triptans of benefits outweigh risks- Sumitriptan preference

Question 20

What is the UKMEC for CHC and migraine with aura

Answer 20

UKMEC 4 (UKMEC 3 if last migraine with aura often improves>5 ago)

Question 21

Contraception (CHC) and migraine without aura. UKMEC

Answer 21

UKMEC 2 for initiation (UKMEC 3 if develops a new history of migraine whilst taking this method)

Question 22

What is CHC use in those with migraine a worry

Answer 22

Associated with 2-4x increased risk of ischaemix stroke (highest if aura)

Question 23

What is SAH?

Answer 23

Sudden explosive headache and then recovery, usually under 60 years. Risk factors include smoking, alcohol, and hypertension.

SAH stands for Subarachnoid Hemorrhage.

Question 24

What are the symptoms of a brain tumour?

Answer 24

Worse with exertion and change in position, nausea, and vomiting.

Symptoms may vary based on the tumour’s location and size.

Question 25

What is the peak incidence age for TA?

Answer 25

60-80 years. ## Footnote TA stands for Temporal Arteritis.

Question 26

List the symptoms of Temporal Arteritis (TA).

Answer 26

* Headaches * Scalp tenderness * Visual disturbance * Jaw claudication while chewing ## Footnote Jaw claudication refers to pain in the jaw while chewing.

Question 27

What are the key symptoms of acute angle glaucoma?

Answer 27

* Painful watering red eye * Age >50 * Halos around light * Photophobia * Oval shape of pupil * Hazy eye ## Footnote Acute angle glaucoma is a medical emergency.

Question 28

What are the symptoms of carbon monoxide poisoning?

Answer 28

* Headache * Nausea * Vomiting * Vertigo * Altered consciousness ## Footnote Carbon monoxide poisoning can be life-threatening and requires immediate medical attention.

Question 29

What should be considered in headache diagnosis?

Answer 29

Headache diary. ## Footnote Keeping a headache diary can help identify triggers and patterns.

Question 30

What are the characteristics of Tension Type headaches?

Answer 30

* Bilateral * Pressing/tightening quality * Mild/moderate intensity * Not aggravated by routine ADL ## Footnote ADL stands for Activities of Daily Living.

Question 31

What are the characteristics of Migraines?

Answer 31

* Unilateral or bilateral * Pulsating quality * Moderate/severe intensity * Aggravated or causes avoidance of ADL ## Footnote Migraines can occur with or without aura.

Question 32

What characterizes Cluster headaches?

Answer 32

* Unilateral (around the eye, above the eye) * Severe/very severe intensity * Restlessness or agitation ## Footnote Cluster headaches often occur in cyclical patterns or clusters.

Question 33

What could be the diagnosis in a child with cold hands and feet, skin changes, leg pain, temperature and irritable

Answer 33

Meningitis

Question 34

What is the first-line treatment for acute tension-type headaches?

Answer 34

Aspirin, paracetamol, or NSAIDs ## Footnote Aspirin is not recommended for individuals under 16 due to the risk of Reye's syndrome. Amitriptyline may also be considered.

Question 35

What is the recommended treatment for chronic tension-type headaches?

Answer 35

Up to 10 sessions of acupuncture ## Footnote Acupuncture can be an effective treatment option for chronic tension-type headaches.

Question 36

What is the acute treatment for cluster headaches?

Answer 36

Oxygen and/or subcutaneous or nasal triptan ## Footnote Neuroimaging may be necessary for further evaluation.

Question 37

What is the recommended oxygen flow rate for treating acute cluster headaches?

Answer 37

At least 12 L/min with a non-rebreathing mask and a reservoir bag ## Footnote This ensures adequate delivery of oxygen to the patient.

Question 38

What is the prophylactic treatment for cluster headaches?

Answer 38

Verapamil 80 mg TDS ## Footnote Verapamil is often used to prevent the occurrence of cluster headaches.

Question 39

When should an antiemetic be considered in migraine treatment?

Answer 39

If nausea and vomiting (N+V) are present ## Footnote Antiemetics can help alleviate symptoms associated with migraine.