Neurology

Question 1

Acute management of migraine?

Answer 1

oral triptan (e.g. sumatriptan) + NSAID

OR

Oral triptan + paracetamol

Question 2

First line acute mx of migraine in young people aged 12-17?

Answer 2

Consider nasal triptan in preference to oral triptan

+ NSAID/ paracetamol

Question 3

Prophylaxis of Migraine?

- indications

Answer 3

if pt experiencing 2 or more attacks/ month

Question 4

Prophylactic management of migraine?

Answer 4

Topiramate or propranolol

*propranolol used in preference in women of child bearing age as topiramate may be teratogenic and can reduce effectiveness of hormonal contraceptives

Question 5

Prophylactic management of menstrual migraine?

Answer 5

Frovatriptan (2.5mg BD) or Zolmitriptan (2.5mg BD/ TDS)

Question 6

2nd line measures for prophylaxis of migraine?

Answer 6

• course of up to 10 sessions of acupuncture over 5-8 wks

- Riboflavin (400mg OD)

Question 7

Holmes Adie pupil?

Answer 7

Unilateral in 80%, dilated pupil. Slowly reactive to accommodation but v poorly (if at all) to light.

Once pupil has constricted, it remains small for an abnormally long time.

Question 8

Holmes-Adie syndrome?

Answer 8

Holmes Adie pupil + absent knee/ankle reflexes