Neuro CLERKSHIP

Question 1

migraine characteristics

Answer 1

unilateral
pulsating
n &/or v
photophobia & phonophobia
aura- visual, numbness, weakness

Question 2

Abortive treatment of migraine

Answer 2

OTC - NSAIDs, acetaminophen, aspirin
1st line - Triptans (avoid in CAD, pregnancy, complicated migraine)
2nd line - Antiemetics, steroids
3rd line - opiates

Question 3

Migraine prophylaxis treatment

Answer 3

> 2 attacks/month

1st line
beta-blockers
TCAs
AEDs: topiramate, valproate

Question 4

Tension HA characteristics

Answer 4

bilateral, pressing quality
photophobia OR phonophobia
NOT aggrevated by activity
NO n/v

Question 5

Cluster HA characteristics

Answer 5

M>F
Severe, unilateral ORBITAL
Trigeminal autonomic features
-conjunctival irritation, tearing, nasal congestion, miosis, ptosis

Question 6

Cluster HA tx

Answer 6

Acute: O2, triptan, DHE (dihydroergotamine)
Prophylactic: Li, steroids, verapamil

Question 7

Intracranial HoTN

Answer 7

HA better when supine, worse when upright

-idopathic or post LP (tx w blood patch)

Question 8

Giant cell arteritis

Answer 8

subacute onset of temporal HA
visual loss, system sxs (polymyalgia rheumatica)
-jaw claudication
elevated ESR

Question 9

HA of elevated ICP

Answer 9

dull constant HA
Worse in morning, with valsalva
papilledema (enlarged blind spot)
“false-localizing VI palsy”- cannot abduct ipsilateral eye (lateral rectus) and can cause diplopia