Headache

Question 1

what are red flags for headache?

Answer 1

new onset >55

known/previous malignancy

immune-suppressed

early mornign headache

exacerbation by valsalva

Question 2

are migraines unilateral or bilateral?

Answer 2

unilateral

Question 3

who is most commonly affected by migraines?

Answer 3

young women

Question 4

what can trigger a migraine and what is a useful way to identify them?

Answer 4

triggers: sleep, diet, stress, hormones, exercise

headache diary

Question 5

what is a migraine with aura?

Answer 5

sensory distrubance

lasts arounf 20-60mins

Question 6

what are the three kinds of visual aura?

Answer 6

central scotomata

central fortification

hemianopic loss

Question 7

describe central socotomata

Answer 7

area of depresed vision (blurring) on focus point of vision

Question 8

describe central fortification

Answer 8

images floating (zig-zag pattern)

Question 9

describe hemianopic loss

Answer 9

loss of vision on one side

Question 10

what is an acephalgic migraine?

Answer 10

migraine aura without the headache

Question 11

what is a basialr migraine?

Answer 11

vertigo, nausea

Question 12

release of what substance is thought to cause migraines?

Answer 12

release of substance P, neurokinin A, CGRP → irritates blood vessels

Question 13

how is migraine diagnosed?

Answer 13

at least 5 attacks

lasting 4-72 hours

mod/severe unilateral, throbbing pain

worse on movement

1 of photophobia/phonophobia

Question 14

what are the non-pharmacological treatment options for migraine?

Answer 14

avoid triggers

headache diary

relaxtion

Question 15

what are the pharmacoloigcal treatment options for migraine?

Answer 15

NSAID- take as early as possible to reduce headache

triptans- 5-HT agonist

Question 16

what can be given as prophylaxis in migraines?

Answer 16

propanolol (avoif in asthma/HF)

topiramate carbonic anhydrase inhibitor

amitriptyline tricyclic antidepressant

Question 17

how many migraine attacks warrant prophylactic treatment?

Answer 17

>3 attacks a month

(must trial each drug for minimum of 4 months)

Question 18

describe tension headache

Answer 18

episodic

pressign tingling quality

mild-moderate

bilateral

no N&V

Question 19

is photophobia/phonophobia present in tension headaches?

Answer 19

NO

Question 20

what triggers tension headache?

Answer 20

usually environmental i.e. stress

Question 21

what is autonomic cephalgia?

Answer 21

group of primary headahce disorders characterised by unilateral trigeminal ditribution pain

Question 22

what investigation do people with suspected TCA require?

Answer 22

MRI of head and MR angiogram of the brain

Question 23

what are the different types of trigeminal autonomic cephalgias (TAC)?

Answer 23

cluster headaches

paroxysmal hemicrania

SUNCT

idiopathic intracranial hypertension

trigeminal neuralgia

Question 24

who is most commonyl affected by cluster headaches?

Answer 24

young males mostly 30/40s

Question 25

are cluster headaches bliateral/unilateral?

Answer 25

unilateral

Question 26

how often do cluster headaches occur and for how long do they last?

Answer 26

1-4 a day, for days to weeks severe lasting 30mins -2 hrs

Question 27

what pattern can be seen in cluster headaches?

Answer 27

circadian seasonal (spring and autumn)

Question 28

what is the treatment for cluster headaches?

Answer 28

sub cut triptan and oxygen in acute steroids for 2 weeks verapamil as prophylactic

Question 29

who is affected by paroxysmal hemicrania?

Answer 29

elderly 50/60s women \> men

Question 30

how would you describe a paroxysmal hemicrania?

Answer 30

severe unilateral headache

Question 31

what is the frequency of paroxysmal hemicrania?

Answer 31

1-40 day lasts 10-30mins

Question 32

what is the treatment for paroxysmal hemicrania?

Answer 32

indomethacin

Question 33

hwo do you differentiate between cluster headaches and paroxysmal hemicrania both of which are severe unilateral headaches?

Answer 33

paroxysmal hemicrania has shorter duration and much more frequent than cluster

Question 34

how do you treat SUNCT?

Answer 34

lamotrigine gabapentin

Question 35

what is SUNCT?

Answer 35

Short lived Unilateral Neuralgiform headache with Conjuctival infection and Tearing

Question 36

what is idiopathic intracranial hypertension?

Answer 36

increased intracranial pressure

Question 37

what variation is seen in intracranial hypertension?

Answer 37

headaches w diurnal variation

Question 38

how is intracranial hypertension investigated?

Answer 38

fundoscopy visual field testing LP MRI head

Question 39

who suffers trigeminal neuralgia?

Answer 39

tends to be older females

Question 40

how would you describe the pain in trigeminal neuralgia?

Answer 40

severe stabbing pain unilateral

Question 41

what triggers trigeminal neuralgia?

Answer 41

triggered by touch

Question 42

how long does trigeminal neuralgia last and how often does it occur?

Answer 42

lasts 1-90s occuring 10-100 times a day

Question 43

what is the treatment for trigeminal neuralgia?

Answer 43

carbamazepine, gabapentin can surgically intervene with ablation or decompression