headache

Question 1

which headache involves the eye ? intense pain around one eye? lacrimal swelling. recurrent attack which ‘always attacks one side?

Answer 1

cluster headache

Question 2

how many times a day do you get cluster headaches?

Answer 2

once or twice a day (clusters)

Question 3

how long do the clusters last ?

Answer 3

typically 4-12 weeks

Question 4

what is raised in temporal arteritis?

Answer 4

ESR

Question 5

Recurrent, severe headache which is usually unilateral and throbbing in nature
May be be associated with aura, nausea and photosensitivity
Aggravated by, or causes avoidance of, routine activities of daily living. Patients often describe ‘going to bed’.
In women may be associated with menstruation

Answer 5

migraine

Question 6

Recurrent, non-disabling, bilateral headache, often described as a ‘tight-band’
Not aggravated by routine activities of daily living?

Answer 6

tension headache

Question 7

who is typical patient to have a migraine ?

Answer 7

young female

Question 8

how often typically would people have migraines

Answer 8

once a month

Question 9

pain in migraine?

Answer 9

unilateral throbbing pain

Question 10

autonomic features of a migraine?

Answer 10

photophobia/phonophobia

Question 11

what kind of aura can you get in migraine?

Answer 11

visual, seonsory, motor or language

Question 12

triggers for migraine ?

Answer 12

Sleep
• Dietary
• Stress
• Hormonal
• Physical exertion

Question 13

management of migraine?

Answer 13

offer combination therapy with an oral triptan and an NSAID, or an oral triptan and paracetamol

Question 14

prophylaxis for migraine?

Answer 14

offer either topiramate or propranolol (TOTP)

Question 15

what are triptans?

Answer 15

5HT agonist

Question 16

example of triptan?

Answer 16

rizatriptan, eletriptan

Question 17

which NSAID would you give?

Answer 17

aspirin

Question 18

when would you consider prophylaxis?

Answer 18

more than 3 attacks per month or if very severe

Question 19

Consider non-pharmacological methods such as?

Answer 19

accupuncture, relaxation exercises

Question 20

which patients would you need to be careful giving propranolol to?

Answer 20

asthmatic

Question 21

what kind of drug is topiramate?

Answer 21

carbonic anhydrase inhibitor

Question 22

side effects of amytryptilline?

Answer 22

dry mouth, postural hypotension, sedation.

amytryptline is a TCA

Question 23

common unilateral headache of the young?

Answer 23

migraine

Question 24

when would you consider imaging ?

Answer 24

if late onset (>55)

known malignancy

Question 25

Ipsilateral cranial autonomic features. what are they?

Answer 25

Ptosis
Miosis
Nasal Stuffiness Nausea/ vomiting Tearing
Eye lid oedema

Question 26

Severe unilateral headache, Duration: 45- 90mins (20 mins-3 hours)?

Answer 26

cluster

Question 27

frequency per day cluster headache?

Answer 27

1-8 per day

Question 28

Treatment of a cluster headache?

Answer 28

high flow oxygen
Sub cut sumatriptan 6mg
Steroids- reducing course over 2 weeks
Verapamil for prophylaxis

Question 29

prophylaxis of cluster headache?

Answer 29

verapamil

Question 30

SUNCT treatment?

Answer 30

Tears LG

Question 31

unilateral headache, unilateral autonomic features (dizziness/fainting/increased heart rate etc)

Answer 31

Paroxysmal hemicrania

Question 32

Paroxysmal hemicrania treatment?

Answer 32

indomethicin

Question 33

treatment of trigeminal neuralgia?

Answer 33

carbamazepine

Question 34

what condition do you get trigeminal neuralgia in?

Answer 34

MS

Question 35

trigger for cluster headache?

Answer 35

alcohol

Question 36

cluster headache more common in males or females?

Answer 36

males

Question 37

migraine prophylaxis for women associated with period?

Answer 37

frovatipran