Headache

Question 1

What causes Aura in migraine?

Answer 1

Cortical depression in the occipital lobe.

Question 2

What constitutes chronic migraine?

Answer 2

More than 15 days a month of headache and more than 8 days a month of migraine.

Question 3

Name prophylactic medications for migraine.

Answer 3

Bisoprolol or candesartan
Anti epileptic drugs (gabapentin,topiramate, valproate etc)
Tricyclic antidepressants (amitriptylline)
Propanalol

Question 4

Define cluster headaches

Answer 4

Strictly unilateral pain in head that lasts for 15 minutes to 3 hours and occurs on 1 or 2 for a day for a while then goes away (hence cluster)
Can also get Prominent ipsilateral autonomic symptoms.

Question 5

What is the definition of chronic cluster headache?

Answer 5

Remissions lasting less than a month.

Question 6

Define SUNCT

Answer 6

Unilateral stabbing or pulsating pain. Triggered by cold, touch and chewing. Get 3-200 a day.
Tablets don‘t work so Need subcutaneous or nasal triptans. Verapimil used for prophylaxis.

Question 7

What are signs of raised ICP?

Answer 7

Progressive headache
Headache worse in morning or wakes patient up
Valsalva manoeuvres make it worse
Focal or non focal signs
Seizures
Visual disturbances and pulsatile tinnitus are signs of CSF causing raised ICP

Question 8

What causes intracranial hypotension, what’s a sign for it and how is it investigated and treated?

Answer 8

Leaking CSF from either a spontaneous causes or iatrogenic cause (lumbar puncture)
Worse headache when standing up and better when lying down
Do MRI brain and spine
Treat with bed rest, analgesia, caffeine (IV and oral) and epidural blood patch.

Question 9

What is a contraindication for triptan use for migraine?

Answer 9

Vascular problems

Question 10

Name a CGRP antagonist

Answer 10

Telcagepant

Question 11

What migraine suppressive treatment is first line for tension type headaches?

Answer 11

Tricyclic antidepressants

Question 12

What is seen on functional imaging studies during a cluster headache attack?

Answer 12

Hypothalamic activation

Question 13

What drugs can be used to acutely treat cluster headaches?

Answer 13

Subcutaneous sumatriptan for acute

Lithium, verapamil or a short course of steroids to get rid of a cluster of headaches

Question 14

Define paroxysmal hemicrania

Answer 14

Similar to cluster headaches but last less time and more frequently and not in clusters.
Responds to indometacin

Question 15

What other headache condition can accompany migraine?

Answer 15

Primary stabbing headache

Question 16

What investigations need to be done after experiencing a primary sex headache?

Answer 16

Need to rule out a SAH with CT etc

Question 17

What causes idiopathic intracranial hypertension and in what kind of patients does it usually occur in?

Answer 17

Reduced resorption of CSF

Young and overweight females usually with polycystic ovaries

Question 18

What are the presenting features of IIH?

Answer 18

Headache
Transient visual obscurations due to papilloedema
Optic nerve damage from papilloedema
Sixth CN nerve palsy which is a false localising sign

Question 19

Name a risk factor for trigeminal neuralgia

Answer 19

Hypertension which leads to a vascular loop compressing the nerve from the pons area

Question 20

How does Giant cell arteritis present?

Answer 20

Headache
Tenderness of the scalp
Non pulsatile arteries
Jaw claudication
Tenderness/swelling of temporal and occipital arteries
Tiredness
Malaise 
Fever
Sudden painless loss of vision in one eye due to ophthalmic artery involvement

Question 21

What are the investigational findings in GCA?

Answer 21

Raised ESR (50-120mm/h)
Raised CRP
Can get abnormal LFTs and low albumin
A temporal artery biopsy is patchy and abnormal and is the main diagnostic test

Question 22

What condition is GCA associated with?

Answer 22

Polymyalgia rheumatica

Question 23

What is the main treatment for GCA?

Answer 23

60-100mg prednisolone

Treatment should not be delayed for tests especially if vision has been affected or a stroke has happened