Headache - Migraine, Cluster, Tension

Question 1

overview of migraine

Answer 1

disorder
tendency to repeated attacks
triggers
easily hungover
visual vertigo
motion sickness

Question 2

list the three forms of migraine attacks

Answer 2

pain
focal symptoms
pain + focal symptoms

Question 3

list phases of migraine

Answer 3

prodrome
aura
headache
resolution
recovery

Question 4

outline the prodrome phase

Answer 4

changes in mood, urination, fluid retention, food craving, yawning

Question 5

outline the aura phase

Answer 5

visual, sensory (numbness/paraesthesia), weakness, speech arrest

Question 6

outline the headache phase

Answer 6

head and body pain, nausea, photophobia

Question 7

outline the resolution phase

Answer 7

rest and sleep

Question 8

outline the recovery phase

Answer 8

mood disturbed, food intolerance, feeling hungover

Question 9

what positive and negative symptoms are present in aura?

Answer 9

scintillations and blindspot
expanding C’s
elemental visual disturbance

Question 10

what are scintillations?

Answer 10

spot of flickering light that eventually expands

Question 11

treatment for an acute migraine attack

Answer 11

aspirin/ibuprofen, paracetamol and metoclopramide (anti-emetic), soluble preparations for absorption, triptans (vasoconstrictors) opiates, short nap, TMS

Question 12

what should you be aware of when prescribing opiates?

Answer 12

analgesic abuse potential

Question 13

how does TMS work to treat migraine?

Answer 13

interrupts complex networks that trigger and perpetuate migraine, which is caused by spreading electrical depression across the cerebral cortex

Question 14

lifestyle issues for those who suffer with migraines

Answer 14

sensitive heads even in between attacks
over-react to any sort of stimulation
can’t ignore the world around them, it overstimulates their brains

Question 15

what are lifestyle triggers? things to avoid?

Answer 15

dietary, environmental, hormonal, weather, dehydration, stress
drink 2 litres water/day
avoid caffeinated drinks, don’t skip meals, eat fresh food
no oversleeping / late nights / electronics
analgesic abuse

Question 16

list prophylactic medications for migraines

Answer 16

over the counter: feverfew, coenzyme Q10, EPO, Mg. TCAs, beta blockers, serotonin antagonists, calcium channel blockers, anti-convulsants, greater occipital nerve blocks, botox, suppress ovulation

Question 17

erenumab is used to treat what types of migraine?

Answer 17

episodic
chronic
cluster

Question 18

what drug class is erenumab?

Answer 18

calcitonin gene-related peptide receptor (CGRP-R) antagonist

Question 19

describe how tension type headache presents

Answer 19

tight muscles around head and neck bilaterally, as though head is in a vice

Question 20

treatment for tension type headache

Answer 20

NSAIDs
paracetamol
tricyclic anti-depressants
SSRI

Question 21

describe how cluster headache presents

Answer 21

severe unilateral pain lasting 15-180 minutes untreated
forehead and facial sweating
miosis and/or ptosis
sense of restlessness or agitation

Question 22

cluster headache is classified as?

Answer 22

classified as a trigeminal autonomic cephalgia.

Question 23

trigeminal autonomic cephalgia presents with at least one of the following ipsilaterally?

Answer 23

Conjunctival redness and/or lacrimation
Nasal congestion and/or rhinorrhoea
Eyelid oedema

Question 24

frequency of cluster headache

Answer 24

between one on alternate days to 8 per day

Question 25

is cluster headache associated with a brain lesion on MRI?

Answer 25

no

Question 26

list sites of pain of cluster headache

Answer 26

eye, forehead, temple, cheek, nostril, upper gum, palate, lower jaw, ear, occiput, neck , half head

Question 27

treatment of acute cluster headache

Answer 27

inhaled oxygen

S/C or Nasal Sumatriptan

Question 28

how does oxygen treat acute cluster headache?

Answer 28

inhibits neuronal activation in the trigeminocervical complex

Question 29

prevention of cluster headache

Answer 29

verapamil, prednisolone, lithium, valproate, gabapentin, topiramate, pizotifen

Question 30

compare distribution between men and women of migraine and cluster headache

Answer 30

migraine: 1/3 men, 2/3 women

cluster headache: 90% men, 10% women

Question 31

compare duration of migraine and cluster headache

Answer 31

migraine: 3-12 hours

cluster headache: 45 min - 3 hours

Question 32

compare frequency of migraine and cluster headache

Answer 32

migraine: 1-8 attacks monthly

cluster headache: 1-3 attacks daily (often at night)

Question 33

compare remission of migraine and cluster headache

Answer 33

migraine: long remission unusual

cluster headache: long remission common

Question 34

compare nausea with migraine and cluster headache

Answer 34

migraine: nausea and vomiting frequent

cluster headache: rare

Question 35

compare pain with migraine and cluster headache

Answer 35

migraine: pulsating hemicranial pain
cluster: steady, exceptionally severe, well localised, unilateral in each cluster

Question 36

compare symptoms of migraine and cluster headache

Answer 36

migraine: visual or sensory auras
cluster: eye waters, nose blocked, ptosis

Question 37

compare activity with migraine and cluster headache

Answer 37

migraine: patients lie in the dark
cluster: patients pace about