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Question 1

Cluster Headache: General

Answer 1

• Most painful Primary HA
• Piercing, Boring, Stabbing
• Peak: 3-5 mins
• Restless & motor agitation (NOT IN MIGRAINES)
• Circadian & circannual periodicity
  Nocturnal > Daytime attacks
  onset=90 mins after falling alseep (REM Sleep)

Question 2

Cluster Headache: ICHD-3 criteria

Answer 2

1. 5 or more attacks
2. Severe/very severe unilateral pain
   orbital, supraorbital, or temporal pain
   Lasts; 15-180 mins (untreated)
3. Either or both:
   ipsilateral autonomic sign
   restlessness or agitation
4. Frequency b/w:
   1 every other day and 8/day

Question 3

Paroxysmal Hemicrania

Answer 3

• Several Attacks per day
  Mean=11
  ICHD-3: > 5/day
• Median Length: 19 mins
• No Nocturnal Predilection (unlike cluster HA)
• **Indomethacin

Question 4

SUNCT/SUNA

Answer 4

• unilateral neuralgiform HA attacks w:
  Conjunctival Injectioon & Tearing= SUNCT
  Cranial Autonomic Symptoms=SUNA
• Frequent Attacks: 3-200/day
• Short lasting: 1-600 secs
• Lamotrigene

Question 5

Compare Cluster HA, Paroxysmal Hemicranis, SUNCT/SUNA:
-Sex
-Location
-Attacks per day
-Length (min)
-Episodic vs Chronic (%)
-Circadian/circannual periodicity (y or n)
-Tx of choice

Answer 5

Question 6

Hemicrania Continua

Answer 6

• Continuous unilateral HA
• Intensity waxes and wanes
• At least one of:
  Autonomic Symptom
  Restlessness/Aggitation
  Aggravation by movement
• Indomethacin

Question 7

1.1: Migraine w/o aura (MWA)

Answer 7

• Young (<20 y.o.)
• Location: Unilateral HA
  Side-locked migraine
• Quality: Throbbing/pulsate
  Moderate -severe intensity
• Associated Signs:
  Vomit during attack
  Nausea
  Photo or Phonophobia
• Periodic HA: lasts 4-72 hrs
  Longer=Stratus Migranous
• <1 MA/month

Question 8

1.2: Migraine w/Aura (MA)

Answer 8

• Recurrent Disorder
• reversible focal neuro symptoms
  develops over 5-20 mins; lasts < 60 mins
  followed by Headache
• Aura=visual, sensory, speech symptoms
• Visual Aura:
  flickering, uncolored, zigzag line in center of visual field
  affects central veision
• Sensory Disturbance
  Pins & Needles
  Unilateral
  starts in hand-> arm->face-> tongue
• Speech
  dypashic
• Motor
  half sides
  affects hand and arm

Question 9

1.3: Chronic Migraine (CM)

Answer 9

• HA> 15 days/mo for > 3 months; w/no medication overuse
• Location: Bilateral
  frontotemporal region
• Quality: dull and pressing
  Mild to moderate
• Associated Symptoms: Decreased intensity
  Nausea
  Photophobia
• Women=Night-time arousal/ early morning HA

Question 10

Infrequent Episodic TTH: Criteria

Answer 10

• 10 or more episodes on <1 d/mo
• Length: 30 min - 7 days
• 2+ of the following
  bilateral location
  Pressing or tightening(non-pulsating)
  Mild or moderate
  Physical Activity does not aggravate
• Both of:
  No N & V
  Either Photophobia or Phonophobia
• No other ICHD-3 dx

Question 11

Frequent Epidsodic TTH: Critieria

Answer 11

• 10+ episodes on 1-14d/mo for > 3 mo
• Same as Infrequent episodic

Question 12

Chronic TTH: Criteria

Answer 12

• 15+ d/mo for > 3 mo
• length: Hours to days or unremitting
• 2+ of: SAME
• Both of:
  either: Photophobia, phonophobia, mild nausea
  Not Moderate-Severe nausea or Vomitting
• Rest is same

Question 13

Episodic TTH: General

Answer 13

• Bilateral (Band-like or cap-like)
• Quality: Pressure like, dull, or tightness
• Duration: 30 mins-7days

Question 14

Chronic TTH: General

Answer 14

• Middle aged F w/past Hx of TTH
• Location: Bilateral
  frontotemporal
• Temporal Pattern: continous or daily HA

Question 15

Chronic TTH: Associated signs

Answer 15

• Increased pericranial tenderness in muscles
• Photophobia or Phonophobia
• Physical activity worsens pain in a subgroup of pts
• Lack restorative sleep
• Depression
• Anxiety
• Nausea