TACs Flashcards
Which of the following is NOT a typical feature of trigeminal autonomic cephalalgias (TACs)?
A) Lateralized cranial autonomic symptoms
B) Unilateral severe headache pain
C) Long-lasting headaches lasting more than 24 hours
D) Headache attacks occurring more than once a day
Answer: C) Long-lasting headaches lasting more than 24 hours
Rationale: TACs are characterized by short-lasting attacks of head pain, usually occurring multiple times a day. They do not last for more than 24 hours, which distinguishes them from other headache types.
What is the primary distinguishing feature of cluster headache compared to other types of TACs?
A) Chronicity with pain-free intervals
B) Attacks lasting more than 24 hours
C) Presence of nausea and vomiting
D) Bilateral pain distribution
Answer: A) Chronicity with pain-free intervals
Rationale: Cluster headaches are characterized by periodic bouts of pain with frequent attacks lasting several weeks, followed by pain-free intervals. The episodic nature and duration of attacks differentiate it from other TACs.
Which of the following is a common symptom seen during a cluster headache attack?
A) Sensitivity to light (photophobia)
B) Vomiting
C) Nausea
D) Nasal congestion
Answer: D) Nasal congestion
Rationale: Cluster headache attacks are often associated with cranial autonomic symptoms like nasal congestion, lacrimation, and conjunctival injection.
What is the most effective acute treatment for a cluster headache attack?
A) Sumatriptan 6 mg subcutaneous injection
B) Nonsteroidal anti-inflammatory drugs (NSAIDs)
C) Acetaminophen
D) Antidepressants
Answer: A) Sumatriptan 6 mg subcutaneous injection
Rationale: Sumatriptan is fast-acting and effective for treating acute cluster headache attacks. It usually shortens an attack to 10-15 minutes. NSAIDs and acetaminophen are not effective for acute attacks.
Which of the following is the first-line preventive treatment for chronic cluster headache?
A) Prednisone
B) Verapamil
C) Sumatriptan
D) Onabotulinum toxin type A
Answer: B) Verapamil
Rationale: Verapamil is commonly used as the first-line preventive treatment for chronic cluster headache due to its efficacy in reducing attack frequency
Which of the following is the FDA-approved device for acute treatment of episodic cluster headache?
A) Vagus nerve stimulation (nVNS)
B) Deep brain stimulation
C) Greater occipital nerve stimulation
D) Sphenopalatine ganglion stimulation
Answer: A) Vagus nerve stimulation (nVNS)
Rationale: Non-invasive vagus nerve stimulation (nVNS) is FDA-approved for the acute treatment of episodic cluster headache.
What is the most common location of pain during a cluster headache attack?
A) Temporal region
B) Retroorbital area
C) Occipital area
D) Frontal region
Answer: B) Retroorbital area
Rationale: The pain in cluster headache is typically deep and retroorbital (behind the eye), often excruciating in intensity.
Which of the following symptoms is most characteristic of trigeminal autonomic cephalalgias (TACs)?
A) Photophobia and phonophobia
B) Severe unilateral head pain with cranial autonomic symptoms
C) Bilateral throbbing headache
D) Aura preceding the headache
Answer: B) Severe unilateral head pain with cranial autonomic symptoms
Rationale: TACs are characterized by severe unilateral head pain with cranial autonomic symptoms such as lacrimation, conjunctival injection, or nasal congestion
What is the main diagnostic imaging test to consider in patients with trigeminal autonomic cephalalgias (TACs)?
A) MRI of the brain
B) CT scan of the head
C) Pituitary imaging and function tests
D) Carotid ultrasound
Answer: C) Pituitary imaging and function tests
Rationale: Patients with TACs should undergo pituitary imaging and function tests, as there is an increased incidence of TACs in patients with pituitary tumors, particularly prolactin and growth hormone-secreting tumors.
The treatment of acute cluster headache attacks includes all of the following except:
A) Sumatriptan 6 mg SC
B) High-flow oxygen
C) Onabotulinum toxin type A
D) Zolmitriptan nasal spray
Answer: C) Onabotulinum toxin type A
Rationale: Onabotulinum toxin type A has not been shown to be effective for acute treatment of cluster headache attacks, unlike oxygen and sumatriptan, which are commonly used.
Which of the following is required for a diagnosis of SUNCT?
A) A history of migraine headaches
B) At least 20 attacks of pain
C) Pain lasting for more than 24 hours
D) A positive response to indomethacin
Correct Answer: B) At least 20 attacks of pain
Rationale: The diagnosis of SUNCT requires at least 20 attacks lasting 5–240 seconds. Indomethacin response is not part of the diagnostic criteria for SUNCT.
Which condition is SUNCT often confused with due to similar symptoms?
A) Cluster headache
B) Trigeminal neuralgia (TN)
C) Tension headache
D) Migraine without aura
Correct Answer: B) Trigeminal neuralgia (TN)
Rationale: SUNCT is often confused with trigeminal neuralgia, particularly when involving the first division (V1) of the trigeminal nerve.
What is a key feature distinguishing SUNCT from trigeminal neuralgia (TN)?
A) Presence of cranial autonomic symptoms
B) Response to indomethacin
C) Lack of a refractory period to triggering
D) Bilateral head pain
Correct Answer: C) Lack of a refractory period to triggering
Rationale: One distinguishing feature of SUNCT is the lack of a refractory period to triggering, unlike TN, which typically shows a clear refractory period.
What is the most effective treatment for the long-term prevention of SUNCT/SUNA?
A) Indomethacin
B) Lamotrigine
C) IV lidocaine
D) Occipital nerve injection
Correct Answer: B) Lamotrigine
Rationale: Lamotrigine (200–400 mg/d) is the most effective treatment for long-term prevention of SUNCT/SUNA. Other treatments like IV lidocaine and occipital nerve injections are more for acute or short-term relief.
In addition to clinical evaluation, which diagnostic test is recommended for patients with SUNCT/SUNA?
A) Electromyography (EMG)
B) Brain MRI with pituitary views
C) CT scan of the chest
D) Electroencephalogram (EEG)
Correct Answer: B) Brain MRI with pituitary views
Rationale: A brain MRI with pituitary views is necessary for all SUNCT/SUNA patients to rule out secondary causes, such as posterior fossa or pituitary lesions.
Which of the following is a possible secondary cause of SUNCT?
A) Brain aneurysm
B) Pituitary lesions
C) Chronic sinusitis
D) Ocular migraine
Correct Answer: B) Pituitary lesions
Rationale: Secondary SUNCT can occur with posterior fossa or pituitary lesions, making it important to assess pituitary function and perform brain imaging.
What is the hallmark feature of hemicrania continua that helps distinguish it from other headache disorders?
A) Bilateral pain with a pulsating quality
B) Complete resolution of pain with indomethacin
C) Pain exacerbations related to weather changes
D) Migraine-like aura
Correct Answer: B) Complete resolution of pain with indomethacin
Rationale: A defining characteristic of hemicrania continua is the complete resolution of pain with indomethacin, which is a key diagnostic feature. This sets it apart from other headache disorders, which do not typically respond to indomethacin in such a manner.
Which of the following autonomic features can be seen in patients with hemicrania continua during exacerbations?
A) Nausea and vomiting
B) Conjunctival injection and lacrimation
C) Unilateral weakness
D) Bilateral ptosis
Correct Answer: B) Conjunctival injection and lacrimation
Rationale: Exacerbations of hemicrania continua may be associated with autonomic features, including conjunctival injection, lacrimation, and photophobia on the affected side. These are characteristic of the condition during flare-ups.
What is the preferred first-line treatment for hemicrania continua?
A) High-dose corticosteroids
B) Indomethacin
C) Antidepressants
D) Triptans
Correct Answer: B) Indomethacin
Rationale: The treatment of choice for hemicrania continua is indomethacin, which typically leads to complete resolution of pain. Other NSAIDs are not effective, and indomethacin is central to both diagnosis and treatment.
Which of the following treatments may be considered for patients with hemicrania continua who cannot tolerate indomethacin?
A) Opioids
B) Occipital nerve stimulation
C) Acupuncture
D) Ergotamine
Correct Answer: B) Occipital nerve stimulation
Rationale: For patients who cannot tolerate indomethacin, occipital nerve stimulation may be considered. This treatment has shown promise in managing hemicrania continua in such cases, whereas opioids, acupuncture, and ergotamine are not considered effective or appropriate treatments for this condition.
