Headache

Question 1

Describe the pathophysiology of venous sinus thrombosis

Answer 1

Thrombus within the venous sinuses of the brain, which prevents blood from drainage from the brain, resulting in raised ICP

Question 2

Describe the clinical presentation of venous sinus thrombosis

Answer 2

• Headache
• Vomiting
• Papilloedema

Question 3

What are the risk factors for venous sinus thrombosis?

Answer 3

• Oestrogen e.g. pregnancy, COCP use
• Clotting disorders, e.g. antiphospholipid syndrome, Factor V Leiden mutation
• AZ COVID vaccine?

Question 4

Describe the investigation of venous sinus thrombosis

Answer 4

Brain imaging (CT/MRI)

Question 5

Describe the management of venous sinus thrombosis

Answer 5

Anticoagulation

Question 6

Give some risk factors for idiopathic intracranial hypertension

Answer 6

• Female

- High BMI

Question 7

What are the symptoms and signs of idiopathic intracranial hypertension?

Answer 7

• Headache
• Vomiting
• Papilloedema

Question 8

Describe the conservative, medical and interventional management of idiopathic intracranial hypertension

Answer 8

Conservative:
- Weight loss

Medical:
- Diuretics, e.g. acetazolamide

Interventional:
- Repeated LP

Question 9

Describe the acute and prophylactic management of cluster headaches

Answer 9

Acute:
- 100% oxygen and S/C sumatriptan

Prophylaxis:
- Verapamil

Question 10

When are triptans contraindicated?

Answer 10

Ischaemic heart disease

Question 11

Describe the acute and prophylactic management of migraine

Answer 11

Acute:
- Sumatriptan

Prophylaxis:

• Propanolol
• Topiramate

Question 12

Give an example of a situation where you WOULDN’T prescribe beta blockers for prophylactic management of migraines and would instead choose an alternative medication

Answer 12

Patient has asthma