Headaches

Question 1

who is most likely to develop migraines

Answer 1

young women

obese people

Question 2

what are the triggers for developing migraines

Answer 2

travel
stress
diet - caffeine, alcohol 
exercise
pre-menstrual

Question 3

describe the features of an aura before a migraine

Answer 3

visual - central scotoma, hemianopia, zigzags of colour
somatosensory - paraesthesia
motor - ataxia and ophthalmoplegia
speech - dysphasia

Question 4

how long does an aura usually last before a migraine

Answer 4

20-60 minutes

Question 5

which is more common, migraine with or without aura

Answer 5

without aura

Question 6

describe the headache associated with migraine

Answer 6

unilateral, throbbing, pulsatile headache
lasts 4-72 hours can have multiple attacks within that time
made worse on movement
associated with photophobia, phonophobia

Question 7

what drugs are used to manage migraines acutely

Answer 7

NSAIDs + paracetamol

aspirin or Triptan second line

Question 8

what type of drug is a Triptan

Answer 8

serotonin agonist that reduces symptoms of migraines

shouldn’t use more than twice a week as can become dependent

Question 9

what is the symptom classification to receive migraine prophylaxis

Answer 9

> 3 attacks in a month or very severe

Question 10

what drugs are used as migraine prophylaxis

Answer 10

propanolol
amitriptyline
gabapentin
topiorimate

Question 11

describe the features of a tension headache

Answer 11

bilateral pressure/tightness that is mild-moderate in severity and lasts up to 7 days

Question 12

what are the risk factors for developing tension headaches

Answer 12

stress
tiredness
excessive concentration/looking at a screen for too long

Question 13

how are chronic tension headaches managed

Answer 13

discourage regular use of analgesia

Question 14

cluster headaches are more common in male or females

Answer 14

males

Question 15

for a diagnosis of cluster headaches, how many must be present

Answer 15

more than 5 - multiple attacks happen over a period of 1-3 months

Question 16

describe the clinical presentation of cluster headaches

Answer 16

severe unilateral headache around the orbit, supra-orbit and temporal areas lasting up to 3 hours

Question 17

when do cluster headaches typically occur

Answer 17

occur at night

Question 18

describe some of the ipsilateral autonomic features that are associated with cluster headaches

Answer 18

lacrimation 
miosis and ptosis 
conjunctival infection 
facial flushing and sweating 
nasal congestion and rhinorrhoea

Question 19

how are cluster headaches managed acutely

Answer 19

high flow oxygen
triptan
prednisolone

Question 20

what is given as prophylaxis for cluster headaches

Answer 20

verapamil
topiramate
gabapentin, pregabalin

Question 21

what are the main differences between paroxysmal hemicrania and cluster headaches

Answer 21

hemicrania does not have autonomic features

hemicrania attacks are of shorter duration

Question 22

paroxysmal hemicrania and hemicrania continua show good response to which drug

Answer 22

indomethacin