Headache

Question 1

Give common migraine triggers

Answer 1

Cheese
Wine
Chocolate
Relaxation after stress
Menstruation
Bright light

Question 2

Who is most commonly affected by migraine?

Answer 2

Women

Question 3

What are the clinical features of migraine?

Answer 3

Mod-severe pulsatile unilateral headache

A/w photo/phonophobia and worse on movement

Question 4

What is the time frame of a migraine?

Answer 4

Develops over 30 mins and lasts hours

Question 5

When may an aura development with migraine?

Answer 5

15-20 mins before

May last throughout/after migraine

Question 6

What are the common migraine auras?

Answer 6

Visual

Flashing lights; scotoma; blurred vision

Question 7

How is migraine managed acutely first line?

Answer 7

NSAID +/- antiemetic

Question 8

How is migraine managed acutely second line?

Answer 8

Triptans

Rizatriptan, sumatriptan

Question 9

What is first line in migraine prophylaxis?

Answer 9

Propanolol 80-240mg/day

Question 10

What else can be given in migraine prophylaxis?

Answer 10

Topiramate

Amitriptyline, gabapentin, sodium val, botox

Question 11

Who is more commonly affected by tension type headaches?

Answer 11

Young women

Question 12

What may cause tension type headache?

Answer 12

Wrong eye prescription

Stress

Question 13

How does a tension type headache present?

Answer 13

Mild-mod bilateral tight band headahce

Question 14

How is tension type headache treated?

Answer 14

Relaxation

Antidepressant - dothiepin or amitriptyline

Question 15

Who is more commonly affected by cluster headache?

Answer 15

Men
30-40s
Smokers

Question 16

How do cluster headaches present?

Answer 16

Recurring episodes of intense, severe, unilateral pain

A/w nasal congestion, ptosis, eyelid oedema

Question 17

What is the pattern of cluster headaches?

Answer 17

Last approx. 20mins to 1 hour

Get 1-8 per day for weeks/months remission

Question 18

How are cluster headaches managed acutely?

Answer 18

High flow O2 for 20mins

subcut sumatriptan

Question 19

How are cluster headaches managed long term?

Answer 19

Reducing dose of steroids over two weeks

Verapamil or lithium may be used prophylactically

Question 20

Who is commonly affected by paroxysmal hemicrania?

Answer 20

Women 50s-60s

Question 21

How does paroxysmal hemicrania present?

Answer 21

Severe, unilateral headache with autonomic features

Question 22

What is the pattern of paroxysmal hemicrania?

Answer 22

Last 10-30mins

Get 1 to 40 per day

Question 23

How is paroxysmal hemicrania managed?

Answer 23

Indomethacin

Question 24

What is SUNCT syndrome?

Answer 24

Short lived
Unilateral
Neuralgiform headache with 
Conjunctival injections
Tearing

Question 25

How is SUNCT syndrome treated?

Answer 25

Lamotrigine

Gabapentin

Question 26

Who is most commonly affected by trigeminal neuralgia?

Answer 26

Women >60

Question 27

How does trigeminal neuralgia present?

Answer 27

Recurrent, severe shooting/stabbing pain lasting seconds to minute with residual pain after attack
Occurs over V2, V3 regions

Question 28

What is the pattern of trigeminal neuralgia?

Answer 28

Lasts seconds to minutes with residual pain afterward
Can get up to hundreds per day
weeks/months till remission

Question 29

What may trigger trigeminal neuralgia?

Answer 29

Chewing
Eating
Brushing hair
Cold wind
Brushing teeth

Question 30

How is trigeminal neuralgia managed?

Answer 30

Carbamazepine
Gabapentin
Phenytoin
Baclofen

Question 31

How is trigeminal neuralgia which does not respond to medication treated?

Answer 31

Surgical decompression or ablation