Headahce

Question 1

Trigeminal Neuralgia Pathophysiology

Answer 1

Neurovascular compression - tortuous superior cerebellar artery impinging on trigeminal nerve root with pulsation leading to focal demyelination.
MRI demonstrate this.

Question 2

Trigeminal Neuralgia presentation

Answer 2

Age >50, female > male
Distribution: V2/3 > V1
Shooting pain lasting for seconds to minutes, occurring in rapid succession. Triggered by touching area.
Usually examination in normal - subtle sensory deficit possible.

Question 3

Treatment of TN

Answer 3

Carbamazepine (Test for HLA-B 1502 prior to prescription)

Question 4

Migraine pathophysiology

Answer 4

Inherited condition - dysfunction of the ion channels that regular sensory input and cranial vascular tone.

Trigger (unknown) –> release of Calcitonin Gene Related Peptide –> vasodilation and inflammation.

Question 5

Oral Contraceptive Pill and Migraine

Answer 5

OCP is contraindicated in migraine with aura due to increased risk of STROKE.

Question 6

Management of acute migraine

Answer 6

Paracetamol
NSAIDs
Metoclopramide
Triptans (5HT1 BandD agonist) - the earlier the better. Technically contraindicated in cardiovascular disease.