cluster headache

Question 1

which nerve is responsible for cluster headaches?

Answer 1

trigeminal nerve

Question 2

what is the 5th cranial nerve?

what are the three divisions of this nerve?

Answer 2

trigeminal nerve

ophthalmic
maxillary
mandibular

Question 3

define cephalgia?

Answer 3

headache

Question 4

what type of cephalgia is cluster headache?

Answer 4

trigeminal autonomic cephalgia

Question 5

is PNS or CNS responsible for cluster headache?

Answer 5

PNS

Question 6

in a cluster headache what happened to the sensitivity of the trigeminal nerve reflex arc?

Answer 6

increased sensitivity

Question 7

is vascular dilation or vascular constriction responsible for this headache?

Answer 7

dilation

Question 8

nociceptive info from the trigeminal nerve travels to what nucleus?

where is said nucleus located in brain?

Answer 8

trigeminocervical complex

brainstem

Question 9

risk factors for cluster headache?

-5

Answer 9

Male (3x)
Age: 20 – 40  
FHx
Smoker 
Alcohol excess

Question 10

is male or female more likely to have cluster headache?

Answer 10

male

Question 11

which age group is more likely to have cluster headache?

Answer 11

20-40

Question 12

is obesity or smoking a risk factor?

Answer 12

smoking

Question 13

are these headaches severe or mild?

Answer 13

severe

Question 14

how long do cluster headaches last for?

Answer 14

15min-3hours

Question 15

is pain unilateral or bilateral?

Answer 15

unilateral

Question 16

which organ of the face is there a lot of pain?

Answer 16

eye

Question 17

why is it called a cluster headache?

Answer 17

because headaches occur in cluster

Question 18

how long might a cluster of these headaches last for?

• give typical time range

Answer 18

2weeks to 3 months

Question 19

pt is suffering from cluster headaches.

how many attacks will they have in one day?

• give typical range

Answer 19

1-8 attacks/day

Question 20

what is the least remission time between episodes of cluster headaches?

Answer 20

1 month

Question 21

which ophthalmological condition must be a differential for a pt with a typical cluster headache Hx?

Answer 21

acute glaucoma

Question 22

to which sensory stimulus does a person become agitated and restless?

what is this called?

Answer 22

light

photophobia

Question 23

non-autonomic symptoms of cluster headaches?

Answer 23

unilateral orbital pain/temporal pain
N&V
photophobia

Question 24

autonomic symptoms of cluster headache?

-5

Answer 24

Lacrimation 
Rhinorrhoea 
Ptosis 
Miosis 
conjunctival injection

Question 25

are autonomic symptoms unilateral or bilateral?

Answer 25

unilateral

Question 26

are autonomic symptoms contralateral or ipsilateral?

Answer 26

ipsilateral

Question 27

simply put why do these autonomic symptoms occur?

Answer 27

↑↑↑ PNS activity

Question 28

medical word for flow of tears? etymological root of above word?

Answer 28

lacrimation lacrima (latin) = tear

Question 29

droopy eyelid is called what?

Answer 29

ptosis

Question 30

contraction of the pupil is called what? etymological root of above word? dilation of the pupil is called what?

Answer 30

miosis muein (greek) = shut eyes mydriasis

Question 31

cluster headache diagnosis is what type of diagnosis?

Answer 31

clinical diagnosis

Question 32

pt comes to GP with typical cluster headache Hx and signs. what must GP do for all such patients?

Answer 32

refer everyone to neurologist

Question 33

Why might you do an ESR Ix?

Answer 33

rule out giant cell arthritis

Question 34

why might you do an MRI of brain?

Answer 34

rule out pituitary adenoma or any brain lesion

Question 35

prophylactic treatment of cluster headache? -strength, route, frequency

Answer 35

verapamil 80mg orally tds

Question 36

what drug is given prophylactically to treat cluster headaches? moa of this drug?

Answer 36

verapamil Ca2+ channel blocker

Question 37

the prophylactic drug for cluster headache is more commonly used to treat what conditions? -2

Answer 37

high blood pressure | angina

Question 38

the prophylactic drug for cluster headaches is taken via what route?

Answer 38

orally

Question 39

the prophylactic drug for cluster headaches is taken how many times a day?

Answer 39

3x/day

Question 40

the prophylactic drug for cluster headaches is of what strength?

Answer 40

80mg

Question 41

what is the acute Mx for cluster headaches? | -2

Answer 41

triptans + O2

Question 42

which triptan is likely given?

Answer 42

sumatriptan

Question 43

by what route should the triptan definitely not be given?

Answer 43

oral

Question 44

by what route can the triptan be given? | -2

Answer 44

subcutaneously | intra-nasally

Question 45

pt with acute cluster headache. which drug should definitely not be given? -4

Answer 45

paracetamol NSAIDs opioids ergots

Question 46

pt with acute cluster headache in hospital. O2 is given. via what mask is it given?

Answer 46

non-rebreather mask

Question 47

pt with acute cluster headache in hospital. O2 is given. how long is it given for?

Answer 47

15 minutes

Question 48

pt with acute cluster headache in hospital. O2 is given. what is the strength of O2 given?

Answer 48

100% at 12-15L/minutes

Question 49

what side effect can occur from overusing triptans? what should do if you get this side effect?

Answer 49

overuse headache taper down triptans

Question 50

moa of triptans? effect of this drug in the brain? -2

Answer 50

5HT agonist vasoconstricts cerebral blood vessels + serotonin inhibits nerve firing

Question 51

which neurotransmitter is essentially being exploited to alleviate symptoms? what does this neurotransmitter do at the synapse to help stop symptoms?

Answer 51

serotonin inhibits neuropeptide release at synapse so less nerve firing

Question 52

what is prognosis for cluster headache?

Answer 52

variable | some better, some better with age, some do not improve

Question 53

is prognosis easy or hard to predict?

Answer 53

difficult to predict