Headaches and Migraines

Question 1

what are the migraine centres of the brain?

Answer 1

dorsal saphe nucleus

locus coeruleus

Question 2

red flags in a headache

Answer 2

new onset in >55
known/previous malignancy
immunosuppressed
early morning headache
exacerbated by valsalva

Question 3

types of migraines

Answer 3

1. migraine without aura
2. migraine with aura
3. fancy migraines

Question 4

presentation of migraine without aura

Answer 4

at least 5 attacks lasting 4-72 hours

2 of unilateral throbbing pain that is worse on movement and 1 of autonomic, photophobia/phonophobia

Question 5

presentation of migraine with aura

Answer 5

tends to be visual, but can be sensory, motor or language

lasts 20-60 minutes with headache following <1 hour later

Question 6

migraine triggers

Answer 6

sleep
chocolate
red wine
cheese
stress
exercise
OCP
caffeine
travel

Question 7

non-pharmacological management of migraines

Answer 7

avoid triggers
diary to help identify triggers
stress management

Question 8

acute/ abortive pharmacological management of migraines

Answer 8

analgesics e.g. aspirin, naproxen or ibuprofen

triptans (5HT agonists) e.g. rizatriptan or frovaptriptan

Question 9

prophylaxis pharmacological management of migraines

Answer 9

1st line= propranolol, topiramate or amitriptyline

2nd line= valproate, pizotifen, gabapentin, pregabalin

Question 10

when is prophylaxis given in migraines?

Answer 10

> 3 attacks a month or very severe

Question 11

adverse in amitriptyline

Answer 11

dry mouth
postural hypotension
sedation

Question 12

when to avoid propranolol

Answer 12

asthma
PVD
HF

Question 13

mechanism of action of topiramate

Answer 13

CA inhibitor

Question 14

adverse of topiramate

Answer 14

weight loss
paraesthesia
impaired concentration

Question 15

presentation of tension-type headache

Answer 15

bilateral

Question 16

management of tension-type headache

Answer 16

relaxation
antidepressants
reassurance

Question 17

four types of trigeminal autonomic cephalgia’s

Answer 17

1. cluster headaches
2. paroxysmal hemicrania
3. hemicrania continua
4. SUNCT

Question 18

associations with cluster headaches

Answer 18

30-40s
men
circadian around sleep and season (autumn/spring)

Question 19

presentation of cluster headache

Answer 19

severe unilateral headache (45-90 minutes)
1-8/day
cluster bout can last weeks-months

Question 20

management of cluster headache

Answer 20

high flow O2 for pain for 20 minutes
sumatriptan SC
steroids (reducing course over 2 weeks)
verapamil for prophylaxis

Question 21

presentation of paroxysmal hemicrania

Answer 21

50-60s
women
unilateral headache
unilateral autonomic features
10-30 minutes 
1-40/day

Question 22

management of paroxysmal hemicrania

Answer 22

indomethacin

Question 23

how to distinguish cluster and paroxysmal hemicrania

Answer 23

paroxysmal is shorter but more frequent than cluster

Question 24

define SUNCT

Answer 24

short-lived
unilateral
neuralgiform headache
conjunctival injections
tearing

Question 25

management of SUNCT

Answer 25

lamotrigine or gabapentin

Question 26

presentation of trigeminal neuralgia

Answer 26

>60
women
triggered by touch
usually V2/V3
severe stabbing, unilateral pain, 1-90 seconds, 10-100/day

Question 27

diagnosis of trigeminal neuralgia

Answer 27

MRI brain with FLAIR and cris sequence

Question 28

management of trigeminal neuralgia

Answer 28

carbamazepine, gabapentin, phenytoin, baclofen

surgery= ablation, decompression

Question 29

what is pain on loud noise?

Answer 29

facial nerve palsy

Question 30

painful third nerve

Answer 30

aneurysm