Neurology

Question 1

phases of migraine

Answer 1

prodome: hours to days
Aura: 5-60 mins (most migraine doesnt have aura)
Headache: 4-72 hrs
Post drome: 24-48hrs

Question 2

acute tx of migraines

Answer 2

triptan: rizamelt 10mg STAT, then repeat Q2hrs, sumatriptan 50mg STAT, then repeat Q 2hrs
NSAIDS (including 1g aspirin)
paracetamool
caffeine
anti nausea - metoclopramide, propchlorperazine, ondansetraion

Question 3

preventative treatment options for migraines

Answer 3

propanolol
candesartan
amitriptyline, nortriptyline
topamax (topirimate)
botox - not funded
CGRP monoclonal Abs - new non funded medications, low SE profile

if menstrual related give COCP (for migraine w/o aura) or POP (for migraine w aura)

Question 4

rules to avoid medication overuse headache

Answer 4

Triptans/opiods: maximum 10 days/month
paracetamol / NSAIDs: maximum 15 days/month

Question 5

Features of overuse headahe

Answer 5

onset on waking
transient improved with dose of overused drug
headache easily triggered

Answer 6

trial indomethazin to exclude proxysmal hemicrania

Question 7

duration of a cluster headache

Answer 7

15 mins - 3 hrs
more severe then migraine
autonomic sx (conjunctiva lacrimation, nasal stuffiness)

Question 8

Treatment of cluster headache

Answer 8

preventative: prednisone at the onset + increasing dose of verapamil
Acute: SC sumatriptan + high flow oxygen

CGRP monoclonal Abs (emality) - new non funded medications, low SE profile
greater occipital nerve block

Question 9

bad prognostic markers for concussion

Answer 9

• immediate onset of symptoms post concussion
• LOC > 30 mins
• Amnesia > 24 hrs
• previous concussion
• Age >40 years
• pre-existing mood disorder/headaches

Question 10

What are some indicators for imaging post concussion

Answer 10

persistent vomiting
presence of red flags
Severe/persistent pain
On anticoagulation