Headaches and migraine

Question 1

Cluster headache, paroxysmal headache, SUNCT/SUNA and hemicranial continua are all what?

Answer 1

Trigeminal autonomic cephalagias

primary headaches

Question 2

Duration of migraine vs cluster headache:

Answer 2

Migrane = 4-72 hours

Cluster headache = 15-180 minutes

Question 3

What are trigeminal autonomic cephalagias?

Answer 3

Group of headaches characterised by ipsilateral cranial autonomic features such as lacrimation, ptosis, conjunctival infection, rhinorrhoea, nasal congestion and eyelid oedema

Question 4

Criteria for cluster headache:

Answer 4

Unilateral supra/orbital/temporal severe pain for 15-180 minutes
Either or both of: one autonomic feature and a sense of restlessness/agitation

Question 5

Criteria for migraine:

Answer 5

Duration of 4-72 hours with 2 of:
Unilateral, pulsating, moderate-severe pain, aggravated by exercise
1 of during headache:
N/V or photophobia and phonophobia

Question 6

Headache worse when lying suggests what?

Answer 6

Due to CSF pressure

Question 7

What does thunderclap headache ‘like a stone fell on my head’ suggest?

Answer 7

Subarachnoid haemorrhage

Do CT and lumbar puncture

Question 8

What does thunderclap headache + behavioural change/confusion suggest?

Answer 8

Cerebral venous thrombosis

Do CT angiography/venography

Question 9

What does thunderclap headache in occipital region suggest?

Answer 9

Vertebral artery dissection

Question 10

What does thunderclap headache on side of head suggest?

Answer 10

Carotid dissection

stenosis or stroke

Question 11

Sudden onset of symptoms suggests what kind of problem?

Answer 11

Vascular

Question 12

Causes of thunderclap headaches:

Answer 12

Meningeal haemorrhages
Intracerebral haemorrhages
Cerebral venous thrombosis
Arterial dissection
Reversible cerebral vasoconstriction syndrome
Pituitary apoplexy

Question 13

Features of raised CSF pressure:

Answer 13

Worse in the morning
Better upright
Worse with valsalva

Question 14

Features of low CSF pressure:

Answer 14

Worse as day goes on

Better lying down

Question 15

Which condition commonly affects young very obese women?

Answer 15

Idiopathic intracranial hypertension

Question 16

Features of IIH:

Answer 16

Bilateral, dull, pressing, frontal-retroorbital localisation
Lesions of optic nerve causing ongoing vision loss
Aggravated by coughing, pressing and physical activity
Nausea and photophobia
Papilloedema and diplopia

Question 17

What is neuralgia?

Answer 17

Pain only for a second but 10/10 intensity

80 y/o patients

Question 18

Differential for hemiparesis:

Answer 18

Migraine aura causing depolarisation in different brain areas past the gyrus
Moving character

Question 19

What causes aura?

Answer 19

Occipital depolarisation of an area

Moving character, 20-30mins per symptom - normally stops at gyrus

Question 20

Visual aura pattern:

Answer 20

Visual deficit will start in the centre of the vision then move outwards and disappear

Question 21

Migraine treatment:

Answer 21

NSAIDs
Triptans
Anti-emetics (metoclopramide and domperidone)

Question 22

Preventative migraine treatment if >10 days in a month:

Answer 22

Metoprolole
Flunavizine
Topiramate (anti-depressant)
Valproate
Anti-tryptyline
Magnesium
Candesartan
Botox

Question 23

Preventative biologic migraine treatment:

CGRP and CGRPR Abs

Answer 23

Fremanezumab
Galcanezumab
Eptinezumab
Ereumab

Question 24

Definition of a medication overuse headache:

Answer 24

A. Headache on >14 days/month in a patient with pre-existing headache disorder
B. Regular overuse for >3 months of a symptomatic treatment for headache
C. No better diagnosis from ICHD-3

Question 25

Which headache is the worst pain imaginable/smash head against wall bad?

Answer 25

Cluster headache

Question 26

Treatment of cluster headache?

Answer 26

Only headache that responds to O2 - give 100% (12-15 L/min, re-breathe bag)
Triptans (subcutaneous/nasal)

Question 27

Preventative treatment of cluster headache:

Answer 27

Verapamil
Topiramate
Lithium