IC5 headache

Question 1

MOA for NSAIDs in tx of migraine

Answer 1

blocks COX enzymes, and subsequently inhibits prostaglandin synthesis

Question 2

How many 5-HT1 receptor classes are there?

Answer 2

5 (A,B,D,E,F)

Question 3

Typically, triptans achieve pain relief for migraine in ____

Answer 3

2h

Question 4

CGRP is a peptide found throughout the body which acts as a ____

Answer 4

Vasodilator

Question 5

CGRP levels increase/ decrease during a migraine attack?

Answer 5

Increase

Question 6

Gepants act as ____

Answer 6

CGRP receptor antagonists; prevents signalling

Question 7

S in SNNOOP10 stands for

Answer 7

Systemic symptoms including fever

Question 8

What guide is used to identify red flags in secondary headache?

Answer 8

SNNOOP10

Question 9

Primary Vs Secondary headache

Answer 9

Primary headache includes TTH, migraine, cluster headache

Secondary headache are headache caused by other sources e.g. infection, trauma, disorders (cranial, psychiatric, hormonal), facial structures

Question 10

N in SNNOOP10 stands for

Answer 10

• Neoplasm in history
• Neurologic deficit or dysfunction

Question 11

Features of TTH

Answer 11

• Bilateral
• Not aggravated by routine ADL
• Mild-moderate pain
• Tightening/ pressing pain
• Lasts around 30mins-7days

Question 12

Is migraine always unilateral?

Answer 12

No, can be bilateral

Question 13

Frequency of infrequent, episodic TTH per month

Answer 13

< 1 day/ month

Question 14

Frequency of frequent, episodic TTH per month

Answer 14

1-14 days/ month

Question 15

Frequency of chronic TTH per month

Answer 15

> /= 15 days/ month

Question 16

Most common type of primary headache

Answer 16

TTH

Question 17

O in SNNOOP10 guide stands for

Answer 17

• Onset of headache is sudden
• Older age > 50 y/o

Question 18

Effective drugs for acute migraine treatment

Answer 18

• NSAIDs
• Triptans
• Ergotamine
• Ditans
• Gepants

Question 19

Contraindication for triptans

Answer 19

• arterial hypertension, coronary heart disease, Hx of ischemic stroke
• pregnancy, lactation
• Raynaud’s disease

Question 20

Ergot alkaloid vs Triptan: which is more efficacious?

Answer 20

Triptans; less side effects & faster pain relief at 2h mark

Question 21

Effective drugs for preventative migraine treatment

Answer 21

• Antiepileptics
• BB
• Anti-CGRP antibodies
• Gepants

Question 22

How is CGRP involved in migraine pathology

Answer 22

• CGRP released by trigeminal nerves can bind to CGRP receptors on 2nd order neuron -> pain transmission
• CGRP released by trigeminal nerves can bind to CGRP receptors on smooth muscle cells of meningeal blood vessel & mast cells -> neurogenic inflammation

Question 23

Which beta blocker to consider for preventative migraine tx?

Answer 23

Propranolol, metoprolol

Question 24

Contraindication for Ergotamine

Answer 24

cardio disease, coronary heart disease, cerebrovascular disease or uncontrolled HTN

Question 25

Acute treatment for TTH

Answer 25

• Paracetamol (alone or with caffeine), Aspirin
• NSAIDs: Ibuprofen, naproxen, diclofenac, ketoprofen

Question 26

Prophylactic treatment for TTH

Answer 26

• Amitriptyline (1st line)
• Mirtazapine, venlafaxine

Question 27

Duration of symptoms: TTH

Answer 27

30 mins to 7 days

Question 28

Duration of symptoms: Migraine

Answer 28

4 to 72h