Headache syndromes

Question 1

Red flags for headache

Answer 1

New onset >55
Known/previous malignancy
Immunosuppressed (intra-cranial infection)
Early morning headache
Exacerbated by valsalva

Question 2

Migraine without aura criteria

Answer 2

At least 5 attacks with duration 4-72 hours.

Includes 2 of: moderate/severe, unilateral, throbbing, worse on movement

Includes 1 of: autonomic features, photophobia/phonophobia

Question 3

Where is the migraine center in the brain?

Answer 3

Dorsal raphe nucleus

Locus coeruleus

Question 4

Abortive management of migraine

Answer 4

NSAID
If gastroparesis then anti-emetic

Maybe triptan

Question 5

When would you consider migraine prophylaxis?

Answer 5

More than 3 attacks per month or very severe attacks

Question 6

First, second and third line migraine prophylaxis.

Answer 6

1st - low dose amitriptyline
2nd - propanolol
3rd - topiramate (CA inhibitor)

Question 7

4th line migraine prophylaxis (lots of options)

Answer 7

Gabapentin
Pizotifen
Sodium valproate
Botulinum toxin injection
Anti-calcitonin gene related peptide Ab

Question 8

What is the minimum trial required for pharmacological migraine prophylaxis?

Answer 8

Minimum of 3 months

Question 9

Tension headache management

Answer 9

Relaxation physiotherapy
Antidepressant (dothiepin or amitriptyline for 3 months)
Reassure

Question 10

When do cluster headaches most often occur?

Answer 10

Around sleep

Seasonal variation

Question 11

Duration, frequency and how long the cluster bout lasts of cluster headache

Answer 11

Duration - 45-90 minutes
Frequency - 1 to 8 a day
How long it lasts - a few weeks to months

Question 12

Cluster headache management

Answer 12

High flow oxygen for 20 mins
Sub cut sumatriptan
Steroids - reducing course over 2 weeks
Verapamil for prophylaxis

Question 13

Investigation of all trigeminal autonomic cephalgias

Answer 13

MRI brain and MR angiogram to check there is nothing there

Question 14

Paroxysmal hemicrania duration and frequency

Answer 14

Duration - 10-30 minutes

Frequency - 1-40 a day

Question 15

Management of paroxysmal hemicrania

Answer 15

Absolute response to indomethacin

Question 16

What does SUNCT stand for?

Answer 16

S - short lived (15-120 seconds)
U - unilateral
N - neuralgiform headache
C - conjunctival injections
T - tearing

Question 17

Management of SUNCT

Answer 17

Lamotrigine

Gabapentin (2nd line)

Question 18

Trigeminal neuralgia symptoms

Answer 18

Severe stabbing unilateral pain

Triggered by tough usually over V2/3

Question 19

Duration, frequency and length of bouts of trigeminal neuralgia

Answer 19

Duration - 1-90 seconds
Frequency - 10 to 100 a day
Bouts may last from a few weeks to months

Question 20

Trigeminal neuralgia medical treatment

Answer 20

Carbamazepine
Gabapentin
Phenytoin
Baclofen

Question 21

Trigeminal neuralgia surgical management

Answer 21

Ablation

Decompression

Question 22

Trigeminal neuraglia investigations

Answer 22

MRI brain

Question 23

Acronym for migraine triggers (CHOCOLATE)

Answer 23

C - chocolate
H - hangovers
O - orgasms
C - cheese/caffeine
O - oral contraceptives
L - lie-ins
A - alcohol
T - travel
E - exercise