Headache

Question 1

What is Trigeminal Neuralgia?

Answer 1

unilateral pain of CN5 (radiating to maxillary or mandibular areas)
brief facial spasm
stabbing

1) paroxysmal attacks
2) intense sharp with precipitation
3) attacks stereotyped
4) no neuro deficit
5) no other disorder

can have 1 per day or 12 per 100 or 100s an hour

Cause?

• central, peripheral or both
• vascular compression at entry into pons or venous/arterial loops at trigeminal

Question 2

What are some triggers for TN?

Answer 2

chewing, talking, smiling, drinking cold/hot fluids

• shaving
• rubbing areas

Question 3

how do you treat TN?

Answer 3

can spontaneously resolve after 6-12 months

carbemazepine 1st line
lamotrigine 2nd line
gabapentin 3rd line

radiation and percutaneous surgery if treatment resistant

Question 4

What are the criteria for migraine?

Answer 4

Pneumonic POUND 
P - Pounding 
O - hours (4-72) 
U - unilateral 
N - nausea 
D - disabling (disrupts DALYs)

Question 5

Treatment for sinusitis?

Answer 5

Sinusitis:
- No antibiotics only if >10 days
- Antibiotics - >1 week (improve then get worse) with fever high, pain over sinus or rash.
Imaging - some need CT but not necessary.

Question 6

Sight threatening visual problems related to headaches?

Answer 6

1) Acute glaucoma
a. Intraocular pressure >20
b. Mildly dilated pupil
c. Nausea and vomiting
2) Temporal arteritis (>50 years old)
a. >50 years
b. Jaw claudication
c. Localised headache
d. Tenderness over the artery with decreased pulse
e. Amaurosis fugax
- Tx 40-60mg prednisolone
3) Idiopathic intracranial HTN
a. Female, obese, pill, steroids, diplopia
b. Px - opening pressure on LP >20
c. Acetallzoldamide
4) Cerebral venous sinus thrombosis
a. Hypercoagulable (local neurologic fluctuation)