Headache 24-01: Headache

Question 1

What is the pathophysiology of migraine

Answer 1

1. Relates to neuronal dysfunction in the trigeminal system resulting in release of vasoactive neuropeptides

Question 2

What are the clinical findings of a typical migraine us headache

Answer 2

1. Lateralize throbbing headache that occurs episodically
   *associated with Anorexia, nausea, vomiting, photophobia, phonophobia, osmophobia, cognitive impairment, blurring of vision

Question 3

What are scotoma

Answer 3

Visual disturbances that occur and consists of feild defects

Question 4

What is photopsia

Answer 4

Luminous visual hallucinations such a as stars, sparks, unformed light flashes

Question 5

What is migraine aura without headache

Answer 5

Neurologic or somatic disturbance accompanying typical migraines headaches that becomes the sole manifestation of an attack

Question 6

What is migraine with brain stem aura

Answer 6

Where blindness or visual disturbances throughout both visual fields are accompanied or followed by dysarthria, disequilibrium, tinnitus and are sometimes followed by transient loss or impairment of consciousness

Question 7

What is recurrent painful ophthalmoplegic neuropathy

Answer 7

Eye
1. N/V
2. Diplopia
*due to transient external ophthalmoplegia (due to third nerve palsy, with accompanying sixth nerve involvement)

Question 8

What should simple analgesics be limited to when used for migraine treatment?

Answer 8

15 days or less per month

Question 9

What are the different types of treatment options for migraines?

Answer 9

1. Ergotamines
   *avoid during pregnancy, patients with cardiovascular disease, patients taking CYP
2. Serotonin agonists
   *Sumatriptan will abort attacks, give subcutaneously
   *nasal and oral preparations are available but may be less effective due to slower absorption
   *eletriptan is useful for immediate therapy
   *frovatriptan is useful for prolonged attacks or attacks provoked by menstrual periods

Question 10

What are the different types of treatment options for migraines? (Cont)

Answer 10

3. Calcitonin gene-related peptide antagonists
   *rimegepant
   *ubrogepant
4. Other
   *prochlorperazine (rectal, IV, IM)
   *metoclopramide

Question 11

When would preventive treatment be needed?

Answer 11

1. If migraine headaches occur more frequently than two or three times a month
   *use a diary
   *acupuncture is as effective as prophylactic pharmacological treatment

Question 12

What is the MC type of primary headache disroder

Answer 12

Tension-type headache

Question 13

What will a patient with a tension type headache complain about

Answer 13

1. Pericranial tenderness
2. Poor concentration
3. Tight in quality but not pulsatile
4. Generalized
   *back of neck or back of head

Question 14

Are Tristan’s and erotamines indicated for tension-type HA

Answer 14

No

Question 15

What can be used as prophylaxis for tension-type HA

Answer 15

Amitriptyline

Question 16

What is a cluster HA related to?

Answer 16

Activation of cells in the ipsilateral hypothalamus
*triggering autonomic vascular system

Question 17

How do patients present with a cluster HA

Answer 17

1. Restless and agitated
2. Episodes typically occur at night, awake the patient
3. Spontaneous remission occurs

Question 18

What do the trigeminal autonomic cephalgias consist of?

Answer 18

1. Unilateral periorbital pain
2. Ipsilateral autonomic symptoms
   *will respond to indomethacin

Question 19

What is used to treat a cluster Ha

Answer 19

Subcutaneous or inhaled medication
*sumatripatan, zolmitriptan
*oral medications is unsatisfactory

Question 20

What are prophylactic agents

Answer 20

1. Lithium carbonate
2. Verapamil
3. Topiramate
4. Prednisone
5. Ergotamine (rectal or subcutaneous)

Question 21

What are the features of a post traumatic HA

Answer 21

1. Constant dull ache
2. Superimposed throbbing
3. Localized, lateralized or generalized

Question 22

How long does a primary cough HA last for?

Answer 22

1. A few minutes or less
   *self-limited
   *indomethacin may provide relief

Question 23

How will a HA due to intracranial mass lesion present

Answer 23

1. Worse upon lying down
2. Awaken the patient at night or morning

Question 24

What is the key feature to prompt brain imaging

Answer 24

New or worsening Ha in middle or later life

Question 25

What is responsible for chronic daily HA

Answer 25

Medication overuse (more than 10 days per month)
1. Erogtamines
2. Triptans

Question 26

How to treat a medication overuse HA

Answer 26

1. Early initiation of a migraine preventive therapy permits withdrawal of analgesics and eventual relief of HA