Neurology - Headache

Question 1

How to characterise cluster headaches and what is the treatment?

Answer 1

1. Part of the TAC group. Usually 1-8 attacks a day lasting 15mins to 3 hours, clusters lasting 6-12 weeks. Very agitated, pacing. Associated eith Ipsilateral blocked nostril, rhinorrhoea, lacrimation, miosis, partial ptosis.
2. Treatment: oxygen up to 15L, nasal or injectable triptan, verapamil, steroids for short clusters. For chronic - lithium, melatonin, topiramate, gabapentin

Question 2

What is paroxysmal hemicrania and how to treat?

Answer 2

It is a rare cluster headache but shorter. Leas agitation. Very responsive to indomethacin. For high dose indomethacin.

Question 3

What is sunct/suna and treatment?

Answer 3

Sunct/suna is usually short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. Can be single stab or recurrent stabs or sawtoorh pattern.

Question 4

How do triptans work and side effects?

Answer 4

5HT1b/1d receptor agonist. Can cause vasoconstriction on intracranial and systemic blood vessels. Do not use in cardiovascular disease, recent stroke, aneurysm

Question 5

New class of migraine preventing therapies

Answer 5

Cgrp monoclonal antibody therapies. Erenumab is against receptor. Galcanezumab, fremanuzumab, epinezumab is against ligand. Side effects is mild constipation. Usually safe. Usually 3 month trial.

Question 6

Seizure: topiramate and OCP

Answer 6

Topiramate can induce metabolism of OCP (especially above 100mg/day)

HRT and pregnancy reduces the dose of lamotrigine.

Question 7

What antiepileptics follow a non linear pharmacokinetics?

Answer 7

Phenytoin. Disproportionate increase in serum concentration after 300mg/day. Can cause a paradoxical increase in seizures >30mg/L.

Gabapentin. Disproportionate decrease in serum concentration despite increasing dose.

Question 8

Antiepileptics for focal epileptics and the mechanism of action

Answer 8

Carbamazepine - inhibits sodium channel 
Phenytoin - sodium channel blockade
Lamotrigine - sodium channel blockade
Lacosamide - sodium channel blockade 
Zonisamide

Question 9

Antiepileptics for generalised epilepsies

Answer 9

1. Sodium valproate - calcium channel blockers
2. Levetiracetem - SV2a (synaptic vesicle 2a) agonist - release of neurotransmitter
3. Lamotrigine - sodium channel blockade