headaches

Question 1

what is the onset time for a sub-acute headache

Answer 1

mins to hours

Question 2

describe red flags fro headache

Answer 2

new onset headache if >55 
known or prevent malignant history 
immunosuppressed
early morning headache 
mode worse by valsalva

Question 3

is a migraine unilateral or bilateral? describe migrain symtoms

Answer 3

unilateral
severe stabbing
photophobai/phonophobia , n and V

Question 4

how many attacks must a person have had to class as migraines

Answer 4

5 minimum lasting 4-72 hours

Question 5

what is feature criteria for migraine

Answer 5

2 of : mod/severe unilateral throb, worse on movement

1 of autonomic features: photophobia, photophobia, N&V

Question 6

what are the migraine centres

Answer 6

dorsal raphe nuclei and locus corealus

Question 7

what substances are released in migraine

Answer 7

substance P , neurokinin A and CGRP

Question 8

what is the most common type of aura

Answer 8

visual eg central scotoma, central fortification or hemianopic loss

Question 9

what is acute treatment of a migraine

Answer 9

NSAIDS- aspirin , naproxen, ibuprofen possibly an anti-emetic
triptan -rizatriptan

Question 10

mechansim of action of triptans

Answer 10

5-HT agonist

Question 11

prophylaxis of migrains . 1st 2nd and 3rd line

Answer 11

1st amitriptyline
2nd propanalol
3rd topiramate

Question 12

mechanism of action for topiramate

Answer 12

carboni anhydrase inhibitor

Question 13

lifestyles factors to reduce migraine

Answer 13

avoid trigger, drink 2L min, reduce caffeine , reuce stress, exercise

Question 14

describe symptoms of tension headache

Answer 14

pressing band
bilateral
no autonimc featues

Question 15

treatment of tension headache 1st line and prophlaxis

Answer 15

relaxation physio

prophylaxis is amitrityline or dothiepin for 3 months

Question 16

name the 4 kinds of trigeminal autonomic cephalgia

Answer 16

cluster
paroxysmal hemicrania
SUNCT
hemicrania continua

Question 17

who most comonly gets cluster heacahes ? age and gender

Answer 17

young men 30-40s

Question 18

what is seen alongside trigeminal autonomic cepalgias

Answer 18

cranial autonomic features
ptosis
miosis
nasal stuffiness
n &  
taering
eye lid oedema

Question 19

where in the head do cluster heaches tend to occur

Answer 19

severe unilateral around eye that wake you from sleep

Question 20

what time of day do cluster headahes commonly occur

Answer 20

around sleep - circadian

Question 21

how many cluster headaches happen in a day and for how long

Answer 21

1-8 a day

around 45-90mins

Question 22

treatment of cluster headache

Answer 22

high flow oxygen

sumatriptan sub cut

Question 23

prophylaxis of cluster headaches

Answer 23

verapamil - ccb

Question 24

describe continua /paroxysmal hemicrania and who gets

Answer 24

elderly females (50-60) most common
severe unilat headaceh
unilat autonomic features
10-30 mins 1-40 times a day

Question 25

treatment of hemicrania

Answer 25

indomethicine

Question 26

describe SUNCT

Answer 26

s-short 15-120 s
u-unilat
n- neuralgioform headache 
c- conjunctival injections
t -tearing

Question 27

treatment of a sunct headache

Answer 27

lamotrigene , gabapentin

Question 28

describe isiopathic intercranial hypertensio

Answer 28

obese 
woman >men 
diurinal variation 
morning n&v 
vision loss- papillodema 
if vision loss on standing then emergency

Question 29

what is the opening pressure like in idiopathic intercranial hyeprtension

Answer 29

increased opening pressure

Question 30

treatment of intracranial hypertension

Answer 30

weight loss and acetozolamide

ventricular atrial/lumbar shunt

Question 31

drug class of acetazolamide

Answer 31

carbonic anhydrase inhibitor

Question 32

pathophysiology behind trigeminal neuralgia

Answer 32

blood vessels touching CN V and irritating

Question 33

treatment of trigeminal neuralgia

Answer 33

carbamazapine