Headaches

Question 1

headache red flags

Answer 1

new onset >55
known/previuos malignancy
immuno-suppressed
early morning headache 
exacerbated by coughing/sneezing

Question 2

migraine with/without aura is more common

Answer 2

without

Question 3

IHS criteria for migraine without aura

Answer 3

at least 5 attacks lasting 4-72 hours
2 of: moderate/sever pain, unilateral, throbbing, worse on movement
1 of: autonomic features, photophobia/phonophobia

Question 4

pathophysiology of migraines

Answer 4

stress triggers serotonin release in brain
blood vessels constrict and dilate
chemicals (eg substance P) irritate nerves and vessels causing pain

Question 5

how long does aura last in migraine with aura

Answer 5

20-60 mins

Question 6

most common aura in migraine

Answer 6

visual

Question 7

triggers for migraine

Answer 7

sleep deprivation
dietary - chocolate and cheese
stress
hormonal - menstrual cycle 
physical exertion

Question 8

acute pharmacological treatment for migraine

Answer 8

1st line - NSAID (possibly anti-emetic if gastroparesis)

2nd line - triptans (5HT agonist) e.g. rizatriptan

Question 9

when should prophylactic treatment of migraines be considered

Answer 9

> 3 attacks/month or very severe

Question 10

prophylactic drugs used in migraines

Answer 10

propranolol

topriamate (carbonic-anhydrase inhibitor)

Question 11

when should propranolol be avoided

Answer 11

asthma
PVD
heart failure

Question 12

SE of topiramate

Answer 12

weight loss
paraesthesia
impaired concentration
enzyme inducer

Question 13

lifestyle factors in migraine

Answer 13

avoid food triggers
2L water per day - decrease caffeine
decrease stress
regular exercise

Question 14

30-40 year old man

severe unilateral headache lasting 20 mins-3 hours 1-8 times per day

Answer 14

cluster headache

Question 15

how long does cluster bout last

Answer 15

weeks-months

Question 16

when does cluster headache usually come on

Answer 16

striking circadian (sleep) and seasonal variation

Question 17

acute treatment for cluster headaches

Answer 17

high flow O2
sub-cut sumatriptan
steroids

Question 18

prophylaxis used in cluster headaches

Answer 18

verapamil

Question 19

unilateral headache 10-30 mins 1-40 times per day

Answer 19

paroxysmal hemicrania

Question 20

what non-headache feature is present in paroxysmal hemicranias

Answer 20

autonomic features

Question 21

treatment for paroxysmal hemicrania

Answer 21

indomethacin

Question 22

who requires MRI brain and MRI angiogram

Answer 22

new onset unilateral cranialautonomic features

Question 23

elderly woman

stabbing unilateral pain lasting 1-90seconds 10-100 times/day

Answer 23

trigeminal neuralgia

Question 24

trigger for trigeminal neuralgia

Answer 24

touch

Question 25

medical treatment for trigeminal neuralgia

Answer 25

carbamazepine
gabapentin
phenytoin
baclofen

Question 26

surgical treatment for trigeminal neuralgia

Answer 26

abalation

decompression

Question 27

when should an MRI be performed in trigeminal neuralgia

Answer 27

any signs on examination
atypical features
poor response to treatment