Headache

Question 1

How does migraine present?

Answer 1

Moderate to severe throbbing pain
Unilateral 
Worse on movement 
Decreased ability to function 
Associated symptoms: nausea, vomiting, photo/phonophobia

Question 2

How long do migraines usually last?

Answer 2

4-72 hours if untreated

Question 3

What is migraine with aura?

Answer 3

Migraine + fully reversible visual, sensory or motor symptom

Question 4

What can happen in migraine with aura?

Answer 4

Visual: Central scotoma, hemianopia loss, centra fortification
Sensory: deficit e.g. hands and feet
Flashing lights, geometric shapes, funny smells

Question 5

What can trigger a migraine?

Answer 5

sleep
hormonal (pregnancy, premenstrual) 
physical exertion 
dietary 
stress

Question 6

How is migraine diagnosed?

Answer 6

Usually clinical

Question 7

What are some non pharmacological treatments of migraine?

Answer 7

Avoid triggers

Headache diary

Question 8

What is the pharmacological treatment of acute migraine?

Answer 8

NSAIDs, triptans e.g. rizatriptan

Question 9

What can be used as migraine prophylaxis?

Answer 9

propranolol
topiramate
amitryptiline

Question 10

What is the headache like in cluster headache?

Answer 10

Rapid onset of severe unilateral pain
Orbital, supraorbital, temporal
Lasts 15 mins to 3 hours
Can occur e.g. once every 2 days, 8 times a day for that cluster period

Question 11

How long can a cluster bout last?

Answer 11

weeks to months - headaches occur at the same time for this period

Question 12

What are the associated symptoms of a cluster headache?

Answer 12

N&V
lacrimation
rhinorrhea
partial Horners syndrome

Question 13

How is cluster headache diagnosed?

Answer 13

Clinical

CT (looking for secondary cause)

Question 14

What is the treatment of cluster headache?

Answer 14

high flow oxygen
sumatriptan
steroids

Question 15

What is the prophylaxis for cluster headache?

Answer 15

verapamil

Question 16

What is the most common type of primary headache?

Answer 16

Tension headache

Question 17

Describe a tension headache

Answer 17

Generalised, non pulsatile headache

No associated nausea or vomiting, sensitivity to head movements

Question 18

What can cause a tension headache?

Answer 18

Stress
Alcohol 
Caffeine 
Hormones
Dehydration

Question 19

How is tension headache diagnosed?

Answer 19

Clinical diagnosis

Question 20

How are tension headaches treated?

Answer 20

Reduce cause e.g. caffeine, stress

Simple analgesia

Question 21

What is trigeminal neuralgia?

Answer 21

Facial pain syndrome

Distribution of 1 or more divisions of trigeminal nerve (typically V2/3)

Question 22

What are the symptoms of trigeminal neuralgia?

Answer 22

Very severe stabbing unilateral pain

Lasting 1-90 seconds

Question 23

What can trigger trigeminal neuralgia?

Answer 23

Touch - shaving, talking, eating

Question 24

What are some causes of trigeminal neuralgia?

Answer 24

Compression of trigeminal nerve: MS, chronic meningeal inflammation, skull base malformation, trauma, anomalous/aneurysmal intracranial vessels or tumour

Question 25

How is trigeminal neuralgia diagnosed?

Answer 25

Clinical

MRI

Question 26

How is trigeminal neuralgia treated?

Answer 26

carbamazepine 
gabapentin
baclofen 
phenytoin 
lamotrigine 
surgery: decompression, ablation

Question 27

What causes idiopathic intracranial hypertension?

Answer 27

Increased CSF pressure

Question 28

Who typically gets IIH?

Answer 28

Young women, recently gained lots of weight, pregnant

Question 29

How does IIH present?

Answer 29

Headache
Whooshing noises/tinnitus
Worse lying down and in the morning
Nausea, visual field loss

Question 30

What are the investigations for IIH?

Answer 30

Visual field testing
Fundoscopy
LP at L3/4
MRI brain?

Question 31

What is the treatment for IIH?

Answer 31

Weight loss
LP
Acetazolamide, furosemide (to decrease ICP)
Analgesia

Question 32

What are the key risk factors for trigeminal neuralgia?

Answer 32

Age

MS