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AIP > HEADACHE AND FACIAL PAIN > Flashcards

HEADACHE AND FACIAL PAIN Flashcards

1
Q

What 2 categories of drugs should be used in the first instance when treating acute migraine?

A
  1. simple NSAID
  2. Prokinetic antiemetic (metoclopramide
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2
Q

What migraine specific medications can be trialled if simple analgesia and antiemetics are not successful?

A

Triptans

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3
Q

In what instances may migraine prophylaxis be used?

A
  • When there are 2 migraines per month that produce disability lasting >72 hours
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4
Q

Name 2 options that may be trialled in prophyalxis against migraine?

A
  • Propranolol
  • TCAs
  • SSRIs
  • Anti-epileptic drugs such as topiramate
  • Accupuncture and botox
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5
Q

What investigation should be ordered in all patients suffering from cluster headache? What is the indication?

A
  • MRI head
  • Skull base or meningeal pathology
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6
Q

What is the management in an acute attack of cluster headache?

A
  • High flow oxygen
  • 6mg nasal or subcut sumatriptan
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7
Q

What prophylaxis can be prescribed against cluster headaches?

A
  • Verapamil 40mg BD
  • Prednisolone at 60mg gradually titrated down over 2-3 weeks
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8
Q

What is Cushing’s triad of raised ICP?

A

Cushing’s triad consists of bradycardia (also known as a low heart rate), irregular respirations, and a widened pulse pressure (increased SBP)

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9
Q

What are the two medical therapies which may be recommended in cases of idiopathic intracranial hypertension?

A
  • acetazolamide
  • steroids
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10
Q

What scale can be used grade severity at initial presentation in SAH?

A

Hunt and Hess scale

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11
Q

How long must pass before an LP is done to diagnose SAH?

A

12 hours

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12
Q

This risk of cerebral vasospasm and subsequent cerebral ischaemia can be reduced by prescribing what medication in SAH?

A

Nimodipine 60mg every 4 hours

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13
Q

What is the management of cerebral venous sinus thrombosis?

A

Laoding dose of LMWH and subsequent warfarin titrated to keep INR 2-3

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14
Q

What is the management of temporal arteritis?

A

High dose IV steroids titrated over a long period of time (2-3 years)

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15
Q

What is the only medication shown to be effective in trigemianl neuralgia?

A

carbamazepine

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16
Q

What are the 2 most common causes of bacterial meningitis?

A
  1. Streptococcus pneumniae
  2. Neisseria meningitides
17
Q

What are Kernig’s and Brudzinski’s sign?

A

Kernig’s: pain and resistance on passive knee extension with hips fully flexed

Brudzinski’s: forced flexion of the enck causes hip flexion

18
Q

What should be prescribed prior to admission in patients with query meningococcal disease?

A
  • IM benzylpenicillin 1.2g
19
Q

What is the treatment regimen for TB?

A
  • rifampicin, isoniazid, pyrazinamide ethambutol + steroids for two months
  • continue rifampicin and isoniazid for a further 10 months
20
Q

What is the mangement of viral meningitis?

Which viral meningitides require antiviral therapy?

Which antiviral therapy is used?

A
  • supportive care, antipyretics
  • HSV, CMV, varicella
  • acyclovir
21
Q

Each causative agent of bacterial meningitis requires its own tailored medical therapy. Which abx should be prescribed as broad cover in bacterial meningitis prior to culture?

A

IV ceftriaxone

22
Q

What si the classicial triad of encephalitis?

A

Fever, headache, altered mental state

23
Q

What is the most common management of encephalitis?

A
  • IV antivirals
24
Q

Which type of encephalitis can often lead to psychiatric type symptoms?

How is it managed?

What else is concerning about this condition? (think cause)

A
  • NMDA encephalitis
  • IV steroids and IV Ig +/- plasma exchange
  • This can be a paraneoplastic condition
25
Q
A
26
Q

What is the management of GCA?

A
  • If no visual involvement: 40-60mg prednisolone OD
    • Symptoms should improve in 7-14 days
    • Taper dose after 1-2 months gradually
    • By 10mg every 2/52 to 20mg, then by 2.5mg every 2-4/52 to 10mg, then by 1mg every 1-2 months
  • Vision loss/amaurosis fugax
    • IV methylprednisolone 500mg-1g od for 3 days
    • Consider 60mg prednisolone PO if established visual loss
27
Q

What is the management of acute angle closure glaucoma?

A
  • Supine positioning
  • Timolol
  • Acetazolamide
  • Mannitol
  • Pilocarpine

AIP (19 decks)

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