Headache

Question 1

Red flags

Answer 1

new onset headache >55yrs
known/ previous malignancy
immunosuppressed
early morning headache
exacerbated by valsalva (exhalation against closed airway)

Question 2

Migraine demographics

Answer 2

More common in women
on av- people have 1 attack a month
With aura- 20%

Question 3

IH5 criteria for migraine without aura

Answer 3

At least 5 attacks
Duration 4-72hrs
2 of- mod/ severe unilateral pain, worse on movement,
1 of autonomic features, photophobia, photophobia

Question 4

Pathophysiology of migraine

Answer 4

Stress triggers changes in the brain, these cause serotonin to be released, blood vessels constrict and dilate. Chemicals including substance P irritate nerves and blood vessels causing pain

Question 5

Migraine with aura

Answer 5

Aura- fully reversible, visual, sensory, motor or lang symptom. Duration- 20-60mins

Question 6

Treatment of migraine

Answer 6

non pharmacological- avoid triggers, headache diary, relaxation/stress management
pharmacological- NSAID- aspirin, naproxen, ibuprofen
Triptans- 5HT agonist- treat at start of headache
rizatriptan,

Question 7

prophylaxis of migraine

Answer 7

If > 3 attacks per month or very severe

Topiramate or propranolol

Question 8

Propanolol for prophylaxis dose

Answer 8

80-240mg/ day

avoid in asthma, pvd

Question 9

Topiramate for prophylaxis dose

Answer 9

25-100mg

poor side effect profile, start slowly

Question 10

side effects of topiramate

Answer 10

weight loss, paraesthesia, impaired concentration

Question 11

Lifestyle prophylaxis for migraine

Answer 11

balanced diet, hydration, reduce stress, exercise

Question 12

Cluster headache- age, duration and freq

Answer 12

30/40yrs, M>W
45-90 mins
1-8/day- bout may last weeks- months

Question 13

cluster headache symptoms

Answer 13

striking around sleep, seasonal variation, severe unilateral headache

Question 14

cluster headache treatment

Answer 14

high flow oxygen 20mins, SC sumatriptan, steroids

Question 15

prophylaxis of cluster headache

Answer 15

verapamil

Question 16

Paroxysmal hemicrania- age, duration, freq

Answer 16

50-60s, w>m
10-30mins
1-40/ day

Question 17

paroxysmal hemicrania symptoms

Answer 17

severe unilateral headache, unilateral autonomic features

Question 18

paroxysmal hemicrania treatment

Answer 18

idomethican

Question 19

SUNCT

Answer 19

Short lived
Unilateral
Neuralgiaform headache
Conjunctival injections
Tearing

Question 20

SUNCT duratiion

Answer 20

15-120secs

Question 21

SUNCT treatment

Answer 21

Lamotrigine, gabapentin,

Question 22

Trigeminal neuralgia- age, duration, freq

Answer 22

> 60yrs W>M
1-90secs
1-100/day bouts may last weeks to months

Question 23

trigeminal neuralgia symptoms

Answer 23

triggered by touch- usually v2, v3

severe stabbing unilateral pain

Question 24

Treatment of trigeminal neuralgia

Answer 24

medical- carbamazepine, gabapentin, phenytoin, baclofen

surgical- ablations, decompression