Headache / Pain

Question 1

Differences between Cluster Headaches and Paroxysmal hemicrania

Answer 1

Cluster headaches:

1. Longer (15-180 minutes as opposed to 20-30 minutes)
2. More common in men
3. NOT treated with indomethacin

Question 2

How to differentiate between vestbibular neuronitis versus labyrinthitis

Answer 2

Vestibular neuronitis = no hearing changes

labyrinthitis = hearing changes

Question 3

Diagnosis of Complex Regional Pain syndrome

Answer 3

1. Continuing pain disproportionate to any inciting event
2. must reprot at least one symptom in 3 of 4 categores
   
   1. Sensory: hyperesthesia and/or allodynia
   2. Vasomotor:
      
      1. tempearture asymmetry and/or
      2. skin color changes and/or
      3. skin color asymmetry
   3. Sudomotor / edema:
      
      1. Edema
      2. sweating changes
      3. sweating asymmetry
   4. Motor / trophic
      
      1. Decreased ROM and/or
      2. motor dysfunction and/or
      3. trophic changes (hair, nail, skin)
3. Must display at least one sign at time of evaluation in 2+ of the following
   
   1. Sensory
      
      1. Hyperalgesia and/or allodynia
   2. vasomotor
      
      1. temperature asymmetry
      2. sking color changes / asymmetry
   3. sudomotor / edema
      
      1. edema and/or sweating changes / sweating asymmetry
   4. motor / trophic
      
      1. decreased RoM
      2. motor dysfunction
      3. trophic changes
4. No other cause to explain symptoms

Question 4

rubbing a hurt shin reduces pain. This is an example of

Answer 4

Gate-control theory of apin

Question 5

“wind-up” theory of pain involves what type of pain fibers?

Answer 5

Type-C

Question 6

Migraine with Aura:

Pathophysiology behind aura of migraine

Answer 6

Depolarization of neuronal cells at 2-5 mm/min ventrally from occipital cortex

Question 7

Mechanism of action:

Triptans:
Lasmiditan:

Answer 7

Triptans: 5HT1B and 5HT 1D AGONist.

Lasmiditan: 5HT1F agonism

Question 8

FDA approved SNRIs to treat fibromyalgia

Answer 8

Milnacipran

duloxetine

Question 9

Familial hemiplegic migraine types and associated mutation

FHM1
FHM2
FHM3

Answer 9

FHM1 (50%) - P-Q calcium channel (CACNA1A)
FHM2 (<25%) - NA/K ATP-ase (ATP1A2)
FHM3 (rare) - (SCN1A)

Question 10

Treatment for cervical spondylosis (6)

Answer 10

NSAIDs (first line for mild-moderate)

Corticosteroids (if associated cervical radiculopathy)

TCAs

Cyclooxygenase 2 inhibitors (not preferreed)

muscle relaxants (associated cervical muscle spasm)

opiates (short term)

Question 11

Define Numular headache (2)

Answer 11

pain present only in a rounded and ellipitcal area of 1-6 cm in diameter.

Either continuous or has spontaneous remission periods of weeks to months

Question 12

Diagnostic criteria for migraine with aura

Answer 12

1. at least 2 attacks
2. aura of at least one of the following
   
   1. fully reversible visual symptoms
   2. fully reversible sensory symptoms
3. at least 2 of the following:
   
   1. homonymous visual symptoms and/or unilateral sensory symptoms
   2. one aura symptom develops gradually over >5 minutes and/or different aura symptoms occur in succession over >5 minutes
4. a migraine occuring during or within 60 minutes of the aura

Question 14

Triptans:

Contraindications (3)

Adverse effects (3)

Answer 14

Contraindications

1. Hemiplegic / basilar migraines
2. Cardio/cerebro/peripheral vascular disease
3. MAOI’s within 2 weeks (may increase risk of serotonin syndrome)

Adverse Effects

1. Abnormal vision
2. angina
3. ischemia

Question 15

Treatment for exertional headache

(5)

Answer 15

Indomethacin

NSAIDS

Ergots

MAOIs

Question 16

Contraindications for Triptans and Ergotamines

Answer 16

“Triptans are Mostly a Very Happy Base to start with, DHE is Good but Really Dirty”

Both triptans and ergotamines:

• Maois (within 2 weeks)
• Vascular disease (periphera, cardio, cerebro)
• Hemiplegic migraine
• Basilar migraine

Ergotamines only

• Hepatic disease
• Glaucoma
• Renal disease
• Dirty = dirty triptan

Question 17

Treatment for Hypnic headache

Answer 17

Lithim QHS (main)

Others: Verapamil, indomethacin