Headache

Question 1

Where are pain receptors in brain?

Answer 1

-Almost none in brain substance itself
BUT
-In brain base, arteries, meninges, veins, scalp, muscles, sinuses, eyes and teeth

Question 2

Types of headache?

Answer 2

Primary: migraine
Secondary: ICP or meningitis

Question 3

Red flags for headaches?

Answer 3

• Any new onset headache in someone over 55
• Anyone with know/previous malignancy
• Anyone immunocompromised
• Early morning headache
• Assoc with nausea and vomiting
• Headache that wakes you
• Headache that is exacerbated by Valsalva manoeuvre

Question 4

What is migraine?

Answer 4

Most common cause of episodic headache

Question 5

Who gets migraines?

Answer 5

More common in women

Question 6

Pathogenesis of migraine?

Answer 6

Primary neurogenic as opposed to vascular

Activation of trigeminal pain neurons

Question 7

Diagnostic criteria for migraines?

Answer 7

• Headache lasting 4-72 hours in adults
• Unilateral pain
• Moderate or sever pain intensity
• Aggravation by routine activities (walking, climbing stairs)
• 1 of nausea and or vomiting OR photophobia

Question 8

25% of people with migraine experience?

Answer 8

AURAS

-Visual eg scotomas, central fortification, hemianopia, sensory or motor disturbances

Question 9

Auras usually last?

Answer 9

20-60 minutes

Question 10

Triggers of migraine?

Answer 10

• Sleep deprivation
• Skipping meals
• Alcohol
• Hormones
• Physical exertion

Question 11

Acute abortive treatments for migraines

Answer 11

-High dose NSAIDs (naproxen, triptans)

Question 12

Supportive medication can be used for migraine episodes suhc as?

Answer 12

Amitriptyline - 1st line
Propranolol - 2nd line
Topiramate - 3rd line

Question 13

What is tension headache?

Answer 13

Classic everyday headache

-Bilateral pain, tight band sensations, pressure behind the eyes, bursting sensation

Question 14

Who gets cluster headaches?

Answer 14

Males aged between 20-40

Question 15

Presnetation of cluster headache?

Answer 15

Excruciating unilateral headache with PS autonomic activation in sam e eye causing redness or tearing, nasal congestion or eveen transient Horner’s

Question 16

Frequency of cluster headaches?

Answer 16

1-8 a day
Last 45-90 minutes
Bouts of 1-2 months

Question 17

Acute treatment for clusters?

Answer 17

Oxygen 100% high flow
SC sumatriptan
Verapamil of steroids may help terminated bot of these

Question 18

What is SUNCT?

Answer 18

Short Lasting Unilateral Neuralgiform Headache
with conjunctival injection and tearing

Attacks are v short lasting 5 seconds to 2 mins and in bouts

Question 19

Treatment of SUNCT?

Answer 19

IV lidocaine for acute

Lamotrigine/gabapentin for prevention

Question 20

Secondary headache disorders example?

Answer 20

Idiopathic intracranial HT

Trigeminal neuralgia

Question 21

What does idiopathic intracranial HT result from?

Answer 21

Reduced CSF resorption

Question 22

Who does idiopathic intracranial HT develop in typically?

Answer 22

Young
Overweight females
With Polycystic ovaries

Question 23

Features of IIH?

Answer 23

Headache worse in morning
Headache with N&V
Headache with visual obscurations due to Papilloedema

Question 24

Investigation for IIH?

Answer 24

MRI

Lumbar puncture: elevated CSF pressure but normal constituents

Question 25

Treatment of IIH?

Answer 25

-Involves monitoring visual fields
Encouraging weight loss
Acetazolamide
Thiazide diuretics

Question 26

What is sometimes necessary treatment of IIH?

Answer 26

Ventriculoperitoneal shunt insertion

Optic nerve sheath fenestration to protect vision

Question 27

Who gets trigeminal neuralgia?

Answer 27

More common in elderly and HT main risk factor

Question 28

What is trigeminal neuralgia due to?

Answer 28

Compression of trigeminal nerve or near the pons by ectatic vascular loop

Question 29

What does trigeminal neuralgia cause?

Answer 29

Severe sharp, stabbing unilateral pain in 5th nerve distribution lasting seconds but attacks can occur 10-100x a day

Question 30

What trivial stimuli can cause trigeminal neuralgia?

Answer 30

Washing, shaving, chewing

Question 31

Treatment of trigeminal neuralgia?

Answer 31

Carbamazepine reduces severity of attacks, can do ablation or decompression of the blood vessel if very severe