Neurology

Question 1

List three symptoms associated with cluster headache

Answer 1

UNILATERAL symptoms
-Red/watery eye
-Lid lag
-Nasal congestion
-Facial sweating

Question 2

Is photophobia and/or phonophobia common features of cluster headaches

Answer 2

no, usually absent

Question 3

List three drugs associated with medication overuse headaches

Answer 3

paracetamol
opioids
NSAIDs
triptans on 10-15 days/month or more

Question 4

List two premonitory symptoms of migraine

Answer 4

yawning, light sensitivity, GI upset, impaired concentration, fatigue, anxiety, low mood

Question 5

List two auras that can present with migraines

Answer 5

visual/language/sensory disturbance
vertigo
cutaneous allodynia- touch is painful

Question 6

List three red flags for headaches

Answer 6

Thunderclap headache
Impaired consciousness
New onset neuro deficit, cognitive impairment, change in personality
Recent head trauma
History of malignancy
Headache triggered by exercise/cough/sneezing/valsalva

Question 7

What is the management of acute migraine attacks?

Answer 7

Headache- aspirin or ibuprofen. + paracetamol. If insufficient, add triptan e.g. sumitriptan

Nausea + vomiting- metoclopramide or prochloreperazine

Question 8

What is the first line option for migraine prophylaxis?

Answer 8

propranolol

Question 9

List two alternatives to propranolol for migraine prophylaxis

Answer 9

amitriptyline
topiramate
sodium valoproate
candesartan
acupuncture