Headache Syndromes

Question 1

what are the red flag symptoms when a patient presents with headache (5)?

Answer 1

new onset headache >55
known/previous malignancy
immunosuppression
early morning headache
exacerbated by valsalva

Question 2

who is migraine more common in - males or females?

Answer 2

females

Question 3

what is the average number of attacks in a month for patients with migraine?

Answer 3

one a month usually

Question 4

what is the criteria for diagnosing migraine without aura?

Answer 4

> 5 attacks lasting 4-72 hours

two of = moderate/severe, unilateral, throbbing pain, worse on movement

one of = autonomic features, photophobia, nausea etc.

Question 5

what is aura?

Answer 5

fully reversible visual, sensory, motor or language symptoms

Question 6

how does migraine with aura present?

Answer 6

aura lasting 20-60 minutes, followed by migraine <1 hour later

Question 7

state some examples of things that could trigger migraine

Answer 7

sleep
diet
stress
hormones
physical exertion

Question 8

what drugs can be used as acute abortive agents in migraine?

Answer 8

NSAIDs

triptans

Question 9

name some NSAIDs that can abort a migraine and the dose that should be given

Answer 9

aspirin 900mg
naproxen 250mg
ibuprofen 400mg

Question 10

what are triptans?

Answer 10

5-HT agonists

Question 11

what routes can triptans be administered by?

Answer 11

oral
sublingual
subcutaneous

Question 12

name three triptans that can be used to abort a migraine

Answer 12

razatriptan
eletriptan
frovatriptan - for sustained relief

Question 13

when should migraine prophylaxis be considered?

Answer 13

more than three attacks per month OR very severe attacks

Question 14

what are the three options for migraine prophylaxis?

Answer 14

amitriptyline
propranolol
topiramate

Question 15

what dose of amitriptyline should be given for migraine prophylaxis?

Answer 15

10-25mg

Question 16

what are some possible adverse effects of amitriptyline?

Answer 16

dry mouth
postural hypotension
sedation

Question 17

what dose of propranolol should be given for migraine prophylaxis?

Answer 17

80-240mg daily

Question 18

what conditions are contraindications to propranolol?

Answer 18

asthma

PVD

Question 19

what type of drug is topiramate?

Answer 19

carbonic anhydrase inhibitor

Question 20

what dose of topiramate should be given as migraine prophylaxis?

Answer 20

25-100mg daily

Question 21

what are possible side effects of topiramate?

Answer 21

weight loss
paraesthesia
impaired concentration
enzyme inducer

Question 22

how do tension type headaches present?

Answer 22

pressing, tingling pain
bilateral
no N+V

Question 23

what medication can be prescribed if needed for tension type headaches and for how long?

Answer 23

antidepressants - dothiepin or amitryptiline

for three months

Question 24

what characterises the trigeminal autonomic cephalalgias (TACs)?

Answer 24

unilateral trigeminal distribution pain

occurs in association with prominent ipsilateral cranial autonomic features

Question 25

name some examples of ipsilateral cranial autonomic features

Answer 25

``` ptosis miosis nasal stuffiness N+V tearing eye lid oedema ```

Question 26

what are the four types of trigeminal autonomic cephalalgias?

Answer 26

cluster headaches paroxysmal hemicrania hemicrania continua SUNCT

Question 27

what investigations are done for suspected trigeminal autonomic cephalalgias?

Answer 27

MRI brain | MR angiogram

Question 28

who gets cluster headaches?

Answer 28

young people | more common in males

Question 29

how do cluster headaches present?

Answer 29

severe unilateral headache, lasting 45-90 minutes

Question 30

how many headaches a day does someone with cluster headaches usually get?

Answer 30

1-8

Question 31

how are cluster headaches managed?

Answer 31

high flow oxygen 20 mins SCUT sumitriptan 6mg steroids

Question 32

what can be given for prophylaxis for cluster headaches?

Answer 32

verapamil

Question 33

who most commonly gets paroxysmal hemicrania?

Answer 33

elderly patients | more common in females

Question 34

how does paroxysmal hemicrania present?

Answer 34

severe unilateral headache lasting 10-30 mins

Question 35

how many headaches do patients with paroxysmal hemicrania get each day?

Answer 35

1-40

Question 36

how is paroxysmal hemicrania managed?

Answer 36

absolute response to indomethacin

Question 37

who most commonly gets hemicrania continua?

Answer 37

50-60s more common in females

Question 38

how does hemicrania continua present?

Answer 38

constant severe unilateral headaches with unilateral autonomic features

Question 39

how is hemicrania continua managed?

Answer 39

absolute response to indomethacin

Question 40

what does SUNCT stand for?

Answer 40

``` short lived unilateral neuralgiform headache conjunctival injections tearing ```

Question 41

how is SUNCT managed?

Answer 41

lamotrigine | gabapentin

Question 42

what is a key risk factor for idiopathic intracranial hypertension?

Answer 42

obesity

Question 43

how does idiopathic intracranial hypertension present?

Answer 43

diurnal variation morning N+V visual loss

Question 44

what does CSF show in idiopathic intracranial hypertension?

Answer 44

elevated pressure | normal constituents

Question 45

what assessments should be done in idiopathic intracranial hypertension?

Answer 45

visual fields | CSF pressure

Question 46

what are the management options for idiopathic intracranial hypertension?

Answer 46

weight loss acetazolamide ventricular atrial/lumbar peritoneal shunt

Question 47

what triggers trigeminal neuralgia?

Answer 47

touch usually in the area supplied by V2 + V3

Question 48

how does trigeminal neuralgia present?

Answer 48

severe stabbing unilateral pain, lasting 1-90 seconds

Question 49

what medications can be used to manage trigeminal neuralgia?

Answer 49

carbamazepine gabapentin phenytoin baclofen

Question 50

what are the surgical management options for trigeminal neuralgia?

Answer 50

ablation | decompression

Question 51

what investigation is done for trigeminal neuralgia?

Answer 51

MRI brain