Headache

Question 1

What are migraines usually characterised by?

Answer 1

unilateral or bilateral head pain. With or without aura.

Question 2

What is aura in migraines?

Answer 2

Visual manifestations e.g.
Soctomata- dark patches coming and going within the visual field
Photophobia
Visual scintillations- (e.g bright zigzag lines)
Scintillating scotomata

Question 3

Aetiology of migraines?

Answer 3

Primary neurogenic process, with secondary changes in cerebral perfusions.

Question 4

What factors cause a migraine to turn into a chronic migraine?

Answer 4

Acute overuse of symptomatic medication, food triggers e.g. alcohol, caffeine etc

Question 5

What is advised not to give women and girls who have migraines with aura?

Answer 5

COCP

Question 6

What are commonly used treatments for patients with migraines?

Answer 6

Triptans, Nsaids, Paracetamol alone or combined with metoclopramide and prochlorperazine

Question 7

Treatment for the prophylaxis of migraines?

Answer 7

Topiramate
propanolol

Question 8

Treatment and doses for predictable menstrual-related migraine?

Answer 8

Frovatriptan- 2.5mg bd
Zolmitriptan- 3.5mg bd or tds

Question 9

What are cluster headaches characterised by?

Answer 9

Severe and strictly unilateral headaches, which may rarely switch sides, be retro-orbital or periorbital and short lasting.

Question 10

What are prominent cranial facial parasympathetic autonomic features of cluster headaches?

Answer 10

ptosis- drooping eyelid
mitosis- pupil constriction
conjunctival injection- redness of the conjunctiva
lacrimation- tear formation
rhinorrhoea- runny nose

Question 11

How long do cluster headaches usually last, how frequent are they and when do they usually occur?

Answer 11

Typically last 5-180mins
Frequency- once every other day to up to 8 times a day.
They usually take place in the early hours of the morning - corresponding with the onset of REM sleep

Question 12

Presenting features of cluster headaches?

Answer 12

Excruciating, stabbing, sharp and lancitating

Question 13

Triggers of cluster headaches

Answer 13

Alcoholic products
tobacco
hot weather
extreme temperatures
Watching TV
GTN
stress

Question 14

Classifications of cluster headaches

Answer 14

episodic (lasting from 7 days to 1 year where episodes are separated by pain-free intervals lasting at least 2 weeks)
chronic (last more than 1 year without remission or with remissions lasting less than 2 weeks)

Question 15

Treatment of cluster headaches

Answer 15

Symptomatic
oxygen and/or triptan (injection or nasal spray)
Verapamil

Question 16

What are the classifications of Tension headaches?

Answer 16

Acute- associated with a stressful event, of moderate intensity, self-limiting, responsive to OTC analgesics
Chronic- recurs daily, associated with contracted muscles of the neck and scalp, bilateral and occipitofrontal

Question 17

What can trigger a tension headache?

Answer 17

physical stress, result of contraction of neck and poor posture, psychological stress

Question 18

Non-pharmacological treatment of tension headaches

Answer 18

hot or cold packs, ultrasound, TENs, improvement of posture, trigger point injections, occipital nerve blocks, stretching and relaxation techniques

Question 19

Pharmacological management of Tension headaches

Answer 19

Aspirin
Paracetamol
NSAIDs

Question 20

How does medication over used cause tension headaches?

Answer 20

Medication overuse headache is attributed to the depletion of 5-HT by overuse of headache abortive medications. This leads to neuronal hyperexcitability in the cerebral cortex (which can lead to cortical spreading depression) and the trigeminal system (which produces peripheral and central sensitization). The decrease in 5-HT levels leads to increased CGRP release from trigeminal ganglia, which is involved in the subsequent sensitization of nociceptive trigeminal neurons

Question 21

What is temporal arteritis?

Answer 21

also known as giant-cell arteritis and cranial arteritis, is a systemic vasculitis of medium-sized and large-sized arteries

Question 22

Treatment of temporal arteritis?

Answer 22

systemic corticosteroids

Question 23

What is trigeminal neuralgia?

Answer 23

A distinctive facial pain syndrome that may become recurrent and chronic.

Question 24

What is trigeminal neuralgia characterised by?

Answer 24

Unilateral pain following the sensory distribution of the trigeminal cranial nerve (typically radiating to the maxillary or mandibular area in 35% of affected patients) and is often accompanied by a brief facial spasm

Question 25

What triggers trigeminal neuralgia?

Answer 25

Chewing or similar activities or by touching affected areas on the face

Question 26

If pharmacological therapy is not effective for trigeminal neuralgia what can be done?

Answer 26

percutaneous procedures, surgery, and radiation therapy may be considered

Question 27

Treatment of Trigeminal neuralgia?

Answer 27

Carbamazepine, amitriptyline, phenytoin, clonazepam, sodium valproate, oxcarbazepine, gabapentin and lamotrigine are all used in treatment and also botulinum toxin