Headaches

Question 0

Migraine

Answer 0

Sex predilection: F>M
Family history: often

Onset: variable
Location: unilateral
Character: pulsatile and throbbing, worse with exertion
Duration: 4-72 hours
Associated symptoms: auras (sparking flashing light, zig zag lines, spots), photophobia, phonophobia, and nausea and vomiting

Irritation of CN V, meninges or blood vessels (release of substance P, CGRP, vasoactive peptides)-neurogenic inflammation due to vasodilation and plasma protein extravasation

Treatment: 5HT1 agonists (triptans), ergots, NSAIDS, antihistamines, alpha adrenergic blockers, occipital, supra-orbital nerve block
Prophylactic (best 3): propranolol, Topiramate and valproate

Question 1

Cluster headaches

Answer 1

Sex predilection: M>F
Family history: no
Onset: during sleep
Location: behind 1 eye
Character: excruciating, sharp and steady
Duration: 15-90 mins can be pain free for a year
Associated symptoms: sweating, facial flushing, nasal congestion, Lacrimation, and pupil change, may induce horner syndrome

Treatment: prophylactic: calcium channel blockers, anticonvulsants, antipsychotics, indemethacin, ergotamine at night time
Oxygen also helps

Question 2

Tension headaches

Answer 2

Sex predilection: F>M
Family history: no
Onset: under stress, start in morning get worse throughout day
Location: bilateral-band around head
Character: dull, tight and persistent
Duration: 30 mins to 7 days
Associated symptoms: muscle tenderness in head and neck or shoulders
Treatment: identify stress triggers, identify neuromuscular triggers (squinting, frowning), hydrate, rest, eat regular meals, NSAIDS, anxiolytics

Question 3

Trigeminal neuralgia

Answer 3

Severe pain in face, stabbing, electric shock like pain in distribution of CN V2 and V3
Secondary to: compression or inflammation of CN V

lasts less than 1 min!!!!

Stimulated by washing face, brushing teeth, swallowing, exposure ot hot or cold

Treatment: Carbamazepine