Headache

Question 1

What are the four phases of a migraine?

Answer 1

Prodrome
Aura
Headache
Resolution

Question 2

Irritability, hyperactivity, depression, food cravings are characteristic for which phase of the migraine?

Answer 2

First phase - occurs in the 24h period before headaches

Question 3

Reversible neurological symptoms tha develops gradually over 5-20 min, lasting 1h.
Which phase of migraine is this characteristic for?

Answer 3

Aura visual, sensory, motor, or speech disturbances

85% of migraines presents without aura

Question 4

What is the typical location and character of a migraine headache?

Answer 4

unilateral/bilateral - pulsating

usually starts around orbit

Question 5

What can aggrevate a migraine?

Answer 5

Light, noise, physical activity. Nausea is common

Question 6

What symptoms can appear in the resolution phase of a migraine? (5)

Answer 6

Tiredness
depression
malaise
irritabillity
impaired concentration

Question 7

What is the treatment of an acute migraine?

Answer 7

Paracet(+caffeine?), NSAIDS, triptans
(remember to rule out SAH first time)
- Metocloperamide etc for nausea

Question 8

What is the prophylactic treatment of migraine? (more than 2 attacks/month)

Answer 8

1. CCB (Verapamil, Flunarazine)
   Valporate, Topiramate, Propranolol, Amitryptiline

and many other drugs

Question 9

What is the location and character of the pain in tension-headaches?

Answer 9

Band-like, pressing/tightening constant pain

Lasts 30m - 7 days

Question 10

How is acute and chronic tension headache distinguished?

Answer 10

more than 15 days /month is chronic

less is episodic

Question 11

What is the treatment of episodic tension-headaches?

Answer 11

aspirin, acetaminophen(+-caffein), NSAIDS

Question 12

What is the prophylactic treatment for chronic tension headaches?

Answer 12

TCAs: Amitriptyline, Nortriptyline,
SSRIs: (citalopram, fluoxetine, sertralin etc)

Question 13

In which sex is the prevalence of cluster headaches highest?

Answer 13

men (M:F ,9:1)

Question 14

What is the location and character of the pain in cluster headaches?

Answer 14

Severe sharpe retro-orbital headache

regular (i.e every night at 2 a.m)

Question 15

What neurologic symptoms usually accompany cluster headaches?

Answer 15

Autonomic symptoms:
(rhinorhea
conjunctival injection
Horner syndrome
eylid edema)

Question 16

What is the treatmen of cluster headaches?

Answer 16

100% O2, steriods, TRIPTANS, lidocaine, ergotamine

Prophylaxi: Verapamil, Lithium

Question 17

What are the presentation of headache associated with temporal arteritis?

Answer 17

localized headache
localized tenderness
systemic symptoms: fever, w. loss, polymyalgia,fatigue
(elevated ESR, CRP)

Question 18

What is the treatment of temporal arteritis headaches?

Answer 18

steroids

Question 19

What can be the cause of pseudotumor cerebri (benings intracranial hypertension) ? (4)

Answer 19

ypung obese women with hormonal imbalance
tetracyclin therapy
hypervitaminoses A
steroids withdrawal

Question 20

what is the clinical presentation of pseudotumor cerebri? (3)

Answer 20

severe, global constant headache
papilledema and visual loss
6th nerve palsy with diplopia

Question 21

What is the treatment of pseudotumor cerebri?

Answer 21

Repeated LPS
weight loss
Acetazolamide/Furosemide
Steroids
Mannitol
Topiramate
Surgery

Question 22

What is the clinical presentation of trigeminal neuralgia?

Answer 22

Paroxysmal, sharp/stabbing/electric/ pain
lasting up to 2m
trigeminal distribution

(presence of trigger zones)

Question 23

What is the treatment of trigeminal neuralgia?

Answer 23

Carbamazepine, Gabapentin

Surgical peripheral denervation

Question 24

What is the order of severity for cluster, neuralgias, migraines and tension headaches?

Answer 24

worst: neuralgias >cluster>migraine>tension