Headache/migraine

Question 1

What is Lumbar puncture used ot investigate with headache?

Answer 1

Sus meningitis, SAH, intracranial HPTN

Question 2

What headahces causes are sight threatening?

Answer 2

Intracranial HPTN
Giant cell arteritis
acute glaucoma

Question 3

Red flags for headaches

Answer 3

Immunocompromised
Under 20 and hisotry of malignancy
History of malignancy known brain metastases
Vomit without other obvious cause
Recent head trauma
Worsening headache with fever
New onset neurological deficit, cognitive dysfunction
Change in personality
Impaired LOC
Exacerbated by cough, valsalva, sneeze or exercise
Orthostatic
Symptoms of GCA
Symptoms suggestive of acute angle glaucoma
Substantial change in characteristics of persons headache

Question 4

How long is recent head trauma?

Answer 4

3 months

Question 5

What is pruritis

Answer 5

Itchiness

Question 6

Triggers for migraine

Answer 6

Tired, stress, alcoho, COCP, lack of food or dehydration, cheese, chocolate, red wines, citrus fruits, menstruation, bright lights

Question 7

Clinical features of a migraine

Answer 7

Aura - 1/3
Severe, often unilateral throbbing headache
Nausea/vomitting Photophobia
Phonophobia
Attacks last up yo 72 hours

Question 8

Primary vs secondary headahce

Answer 8

Seconadry = underlying condition

Question 9

What is an aura?

Answer 9

Transient focal neurological symptoms eg scintillating scotoma, hemianopic disturbance, sensory symptoms that precede migraine

Question 10

Headache in a migraine features to diagnose

Answer 10

Unilateral
Pulsating
Mod or severe intensity
Aggravated by ADLs
Ass symptoms

Question 11

Postdromal and prodromal symptoms of migraine

Answer 11

Fatigue, poor concentration, neck stiffness before - hours to 2 days
Fatigue and elevated or depressed mood - 48 hours after

Question 12

Differentials for migraine = secondary headaches

Answer 12

Trauma
Cranial vascular disorders - intracerebral bleed, CentralVT or GCA - ESPECIALLY TIA
Intracranial non vascular eg neoplasm
Esposure or withdrawal - CO, cocaine, alcohol incl medication overuse headache
Intracranial/systemic infection
Hypoxia, HPTN
Disorders of facial/cranial structure eg TMJ, Acute closure glaucoma, dental, otitis media, sinusitis
Psychiatric disorders

Question 13

What conditions can cause facial pains

Answer 13

Trigneminal neuralgia
Post herpatic neuraligia
Optic neuritis

Question 14

What analagesia offer in migraine

Answer 14

Triptain - sumatriptatn 50-100mg 1st line +/-
Simple - paracetemol, ibuprofen
Anti-emetic eg metoclopramide or prochlorperazine10mg

Question 15

Why can metoclopramide not be used reguarly?

Answer 15

Extrapyramidal effects

Question 16

When should acute medication be taken in migraine

Answer 16

Early when pain is mild

Question 17

Why is prevention in migraine importnat

Answer 17

Affect on ADLs
Prevent medication voeruse headahce

Question 18

Why discuss topirimate before prescribe

Answer 18

Teratogenic

Question 19

Preventatitve meds for migraine

Answer 19

Propanolol 80-160mg daily
OR
topirimate 50-100mg
or
Amitryptilline 25-75mg at night

Question 20

Non medical management chronic migraine

Answer 20

Acupuncture
Riboflavin

Question 21

Menstrual migraine what cna offer preventatitve

Answer 21

Frovatriptan or zolmitriptan

Question 22

How does tension type headache present?

Answer 22

Recurrent non disabling bilateral headahce - tight band ass w stress and no other symptoms, not aggravated by ADLs

Question 23

Tension headahce treat

Answer 23

Simple analgesia - paracetemol, NSAIDs
Acupuncture, low dose amitryptilline to prevent

Question 24

What is a medication overuse headache?

Answer 24

Developed or worsened while taking refualre meds specifically for headaches

Question 25

What durgs commonly cause medication Overuse headahce?

Answer 25

Opioids, triptans

Question 26

Treat MOU headache

Answer 26

Withdraw offending drugs - gradually with opioids

Question 27

What is raised ICP headahce ass with

Answer 27

Vomitting, papilloedema, fits, neurological signs

Question 28

Investgiation of choice for Raised ICP

Answer 28

CT or MRI scan

Question 29

Hwo does a cluster headahce present?

Answer 29

Intense pain around one eye - always same side Restless due to pain severeity

Question 30

Frequency of cluster headahces

Answer 30

once or twice a day, 15 min to 2 hours each Clusters last 4-12 weeks

Question 31

Ass eye symptoms in cluster headahces

Answer 31

redness, lacrimation, lid swelling

Question 32

Acute treatment for cluster headaches

Answer 32

100% oxygen, SC triptan

Question 33

Preventaative treatment cluster headahces

Answer 33

Verapamil Tapering prednisolone considered

Question 34

How does trigeminal neuralgia present?

Answer 34

Unilateral - shock like transient electric pains, abrupt One or two divisions of CNV Triggered by light touch or spontaneous

Question 35

Treatment for trigeminal neuralgia

Answer 35

Carbamazepine

Question 36

Headahce in GCA

Answer 36

Rapid onset (<1 month) unilateral headache ass with jaw or tongue claudication and tender, palpable tmeporal artery (scalp)

Question 37

Features of SAH headahce

Answer 37

10/10 thunderclap back of head N+V meningism

Question 38

Sinusitis pain and ass symptoms

Answer 38

Frontal pressure - worse when bend forward Nasal discharge, obstruction, postnasal drip -> chronic cough

Question 39

Acute sinusitis treat

Question 40

Acute glaucoma headahce presentation + ass symptoms and signs

Answer 40

Severe pain - ocular or headahce Decreased visual acuity, red eye, haloes, semi dilated non reacting pupil, hazy cornea N+V, abdo pain Worse with mydriasis eg dark

Question 41

classic presentation meningitis

Answer 41

Fever, photophobia, neck stiffness, headache, purpuric rash

Question 42

Enephalitis classic presentation

Answer 42

Headache, fever, confusion/odd behaviour, seizures, LOC/reduced

Question 43

CENTRAL VENOUS THROMBOSIS HEADAHCE

Answer 43

sudden onset Ass N+V, cranial nerve palsies, vision disturbance, seizures

Question 44

Treatment CENTRAL VENOUS THROMBOSIS

Answer 44

Anticoagulation or thrombolytics

Question 45

Acute single episode headaches

Answer 45

SAH Head injury sinusitis acute glaucoma meningitis/encephalitis Central VST

Question 46

Chronic headaches

Answer 46

Tension Mediation overuse Raised ICP Space occupying lesion

Question 47

Recurrent attack of headaches

Answer 47

Migraine Cluster Trigmeinal neuralgia

Question 48

GCA onset

Answer 48

subacute