headache treamtment

Question 1

migraine acute treatment

Answer 1

1. nsaid
2. triptans when NSAIDS fail
3. dihydroergotamine

Question 2

migraine prophylaxis

Answer 2

1. anticonvulsants (eg valproate, gabapentin, topiramate),
2. TCAs (eg, amitriptyline),
3. β-blockers(propranolol),
4. CCBs.

Question 3

cluster headache acute treatment

Answer 3

Acute therapy: High-flow O2 or sumatriptan injection.

Question 4

cluster headache prophylaxis

Answer 4

Prophylactic therapy: Verapamil is first line. Alternatives include lithium,
valproic acid, and topiramate.

Question 5

migraine abortive therapy

Answer 5

NSAIDS, acetaminophen, triptans

Question 6

person > 50

Answer 6

check ESR rule any temporal arteritis

Question 7

1. first episode cluster headache best next step.

2. multiple episodes over long period time next best step

Answer 7

1. . First episodes require a work-up (ie, MRI, carotid artery ultrasound) to exclude structural brain lesion or disorders asso- ciated with Horner syndrome (ie, carotid artery dissection, cavernous sinus infection).
2. Classic presentations with a history of repeated attacks over an extended period do not need imaging.

Question 8

pseudotumor cerebri

1. risk factors
2. signs and symptoms
3. dx
4. treatment

Answer 8

1. obesity, vitamin A toxicity , oral contraceptive, venous sinus thrombosis, growth hormone, tetracycline
2. nausea, vomiting, diplopia cranial nerve 6 abducens palsy
3. CT or MRI exclude intracranial lesions and lumbar puncture showing increased pressure. Abnormal pressure, CSF normal,
   4, weight loss, acetazolamide, decrease production of cerebrospinal fluid, repeated lumbar puncture decrease pressure , ventriculoperitoneal shunt if medical therapy fails

Question 9

1.non epileptic drug treatment

Answer 9

1. levetiracetam, phenytoin, carbamazepine, phenobarbital ( first line kids) , and valproic acid have similar effi cacy and can be used as chronic monotherapy.
2. one doesn’t work try alternative
3. alternative doesn’t work try mulitple
4. Absence seizures: First-line is ethosuximide; second-line is valproic acid.
5. Intractable temporal lobe seizures: Consider anterior temporal lobectomy.
6. Treatment is not necessary for a single episode of seizure.

Question 10

pseudotumor

1. risk factors
2. signs/symptoms
3. diagnosis
4. treatment

Answer 10

1. obesity, oral contraceptive, vit A,
2. nausea, vomiting, papilledma with diplopia from 6th cranial nerve, abducens palsy
3. CT or MRI exclude intracranial mass, lumbar puncture (LP) increased pressure. Only pressure is normal, CSF itself is normal.
4. weight loss, acetazolamide to decrease production of cerebrospinal fluid, Steroids help, repeated lumbar puncture rapidly lowers intracranial pressure
   ventriculoperitoneal or fenestrate cut into optic nerve if medical therapy does to control l