headaches

Question 1

types of primary headaches [3]

Answer 1

migraine

tension

cluster

Question 2

types if secondary headaches (5)

Answer 2

meningitis

fasting

nose/sinus

non-vascular intracranial disease inducing tumours

others

Question 3

mechanism of migraine

Answer 3

neurally induced dilation & inflammation of intracranial and extracranial vessels

Question 4

mechanism of tension headache

Answer 4

unknown; increased sensitivity of pain-mediating systems in brain

Question 5

mechanism of cluster headache

Answer 5

neurally induced inflammation & oedema of internal carotid artery

Question 6

mechanism of intractanial mass lesion

Answer 6

displacement (traction) of pain sensitive vesselso

Question 7

low ICP pressure state headache mechanism

Answer 7

traction through brain sagging on dural attachment, intracranial vasodilation

Question 8

meningitis, SAH headache mechanism

Answer 8

inflammation of meningeal vessels

Question 9

headache red flags [10]

Answer 9

abrupt onset, unusually severe

subacute/progressive (days to months)

a/w n&v, fever, not explained by systemic illness

new onset in adult life >40

change in character

paroxysmal hypertension

precipitation by valsava’s meneuver, postiion change, movement ect

associated with nocturnal occurrence/morning awakening

neurologic s&s

systemic symptoms: fever, weight loss, myalgia

Question 10

migraine without aura dx criteria

Answer 10

at least 5 attacks following:
- lasts 4-72h, treated or untreated
- at least 2: unilateral, pulsating, aggravated by exertion, mod-severe
- at least 1: n/v, photophobia, phonophobia
- no evidence from hx or exam of any other disease

Question 11

migraine with aura charactreistics

Answer 11

• precede headache, last 20-60min
• most are visual
• neurologic dysfunction before the attack

Question 12

headache dx [4]

Answer 12

• hx taking & neurological exam
• papilledema > increased ICP > imaging to rule out differentials
• nuchal rigidity > meningeal irritation w meningitis, SAH, intraparenchymal haemorrhage

Question 13

headache investigations [4]

Answer 13

• bloods: FBC, ESR, CRP, biochem, hormone
• imaging: XR, C-spine CR, sinus XR, head CT, MRI brain
• lumbar puncture
• biopsy of temporal artery/meningeal

Question 14

types of migraine auras

Answer 14

visual
- crescents of light that drift
- glistening points
- shimmering, heat-wave-like

sensory
- tingling, numbness
- originating in mouth/hand

other
- mono/hemi paresis
- dysphasia
- cog changes

Question 15

migraine triggers [7]

Answer 15

hormones

diet

psychological

physical environment

sleep

drugs

misc

Question 16

dietary migraine triggers

Answer 16

• alcohol
• meat w high nitrate
• MSG
• chocolate
• fasting

Question 17

drugs that trigger migraine [5]

Answer 17

• GTN
• histamine
• ranitidine
• hydralazine
• estrogen

Question 18

migraine treatment [4]

Answer 18

• NSAID (ibu, naprox)
• mixed barbiturate analgesics (aspirin, acetaminophen, codeine-containing compound)
• triptants
• antiemetics (promethazine, metoclop)

Question 19

migraine prophylaxis criteria [4]

Answer 19

• > 2 attacks/mo, >3 days significant disability
• contraindication/ineffective symptomatic meds
• abortive meds >2/7
• migraine variants: hemiplegic migraine, risk of permanent neuro injury