Primary Headaches

Question 1

Reaches peak intensity with 1-2 hours

Answer 1

Migraine

Question 2

Headache lasts 4-72 hours

Answer 2

Migraine

Question 3

Sensory, motor and visual disturbances arising 15-30 minutes (or days) before and/or during headache

Answer 3

Aura

Question 4

How many people experience auras with migrainous headaches?

Answer 4

~25/30%

Question 5

Classical symptoms that arise in migraines (5)

Answer 5

POUND:

• Pounding, pulsatile, photo/phonophobia
• One day onset (peak intensity over 1-2 hours)
• Unilateral
• Nausea and Vomiting
• Debilitating

Question 6

Main symptoms that arise with aura (3)

Answer 6

• visual disturbance (flashing lights)
• motor symptoms
• sensory symptoms (numbness, paraesthesia)

Question 7

Triggers of migraine (8)

Answer 7

CHOCOLATES
- CHeese 
- Oral contraceptives 
- Caffeine 
- alcohOL 
- Anxiety 
- Travel
- Exercise 
Sleep Deprived

Question 8

Diagnosis of migraines

Answer 8

Clinical: >2 migraines with aura OR

>5 migraines without aura plus classical symptoms

Question 9

Acute management of Migraines (2)

Answer 9

• Paracetamol or NSAIDS and/or Triptans

- Antiemetic (e.g. metochloperamide, prochlorperazine

Question 10

Caution of COCP in which types of patients?

Answer 10

Migraine with aura (or without but risk factors for stroke)

Question 11

Lasts about 15 mins - 2 hours

Answer 11

Cluster

Question 12

Peak onset within 1-2 hours

Answer 12

Migraine

Question 13

Unilateral, pounding headache, usually accompanied by N&V.

Answer 13

Migraine

Question 14

Bilateral headache at the back of the head/neck or frontotemperal

Answer 14

Tension

Question 15

Can be triggered by sustained eye strain

Answer 15

Tension

Question 16

Triggers of tension headaches

Answer 16

• eye strain
• stress
• dehydration
• sleep deprivation

Question 17

Treated with analgesia (NSAIDs, paracetamol, triptans) and antiemetics

Answer 17

Migraine

Question 18

Treatment of tension headaches

Answer 18

simple analgesia

Question 19

Why should opiates typically be avoided in headaches?

Answer 19

Risk of medication overuse headaches

Question 20

Unilateral headache, occurs behind/around the eye or temple

Answer 20

Cluster headaches

Question 21

Which headache is described as a “pressure”

Answer 21

Tension headache

Question 22

Headaches that come on as 1-3 month episodes of daily headaches

Answer 22

Cluster

Question 23

ANS symptoms in Cluster headaches (7)

Answer 23

• lacrimation
• rhinorrhoea
• pstosis
• miosis
• conjunctiva infection
• pupil changes
• red ear

Question 24

Alcohol is a trigger for which headaches? (2)

Answer 24

Migraine and Cluster

Question 25

Treated with subcut Sumatriptan in acute presentation

Answer 25

Cluster

Question 26

Which of the headaches require 100% oxygen in the acute presentation

Answer 26

Cluster

Question 27

Used in the prophylaxis of migraine headaches

Answer 27

Propranolol, Amitryptilin, Topiramate

Question 28

Used in the prophylaxis of cluster headaches

Answer 28

Verapamil (CCB), Prednisolone