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A. MLA Map General Practice and Primary Healthcare > Trigeminal Autonomic Cephalalgias / Cluster Headaches > Flashcards

Trigeminal Autonomic Cephalalgias / Cluster Headaches Flashcards

1
Q

Primary headaches = no known cause
Secondary headaches = have a known cause

Which of these is more common?

A
  • Primary
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2
Q

When looking at different types of headaches, which of the following is the least common?

1 - migraines
2 - Trigeminal autonomic cephalgias (TACs)
3 - tension headaches

A

2 - Trigeminal autonomic cephalgias (TACs)

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3
Q

Trigeminal autonomic cephalgias (headaches) (TACs) are primary headaches. Although the exact pathophysiology is unknown, the theory is that afferent stimulation of a cranial nerve simulates pain and delivers this to the higher brain centres where we perceive pain. What cranial nerve is this linked with?

1 - hypoglossal nerve (12)
2 - vestibulocochlear nerve (8)
3 - trigeminal nerve (CN 5)
4 - glossopharyngeal nerve (9)

A

3 - trigeminal nerve (CN 5)
- provides sensory and motor info

  • afferent receptors trigger trigeminal nucleus in the medulla oblongata
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4
Q

Trigeminal autonomic cephalgias (headaches) (TACs) are primary headaches. Although the exact pathophysiology is unknown, the theory is that afferent stimulation of the trigeminal nerve simulates pain and delivers this to the higher brain centres where we perceive pain. What typically is hypothesised to occur once these higher brain regions receive this information?

1 - increased parasympathetic activation
2 - increased sympathetic activation
3 - increased parasympathetic and sympathetic activation
4 - all of the above

A

3 - increased parasympathetic and sympathetic activation

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5
Q

Typically patients with Trigeminal autonomic cephalgias (headaches) (TACs) will experience pain (afferent CNV) and specific autonomic features from the parasympathetic innervation. Which of the following is NOT a typical feature patients can present with due to parasympathetic activity?

1 - ipsilateral symptoms
2 - ptosis and miosis
3 - lacrimation
4 - nasal congestion
5 - pupil constriction

A

2 - ptosis and miosis
- occur due to sympathetic activity

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6
Q

Typically patients with Trigeminal autonomic cephalgias (headaches) (TACs) will experience pain (afferent CNV) and specific autonomic features from the parasympathetic innervation. Which of the following is NOT a typical feature patients can present with due to sympathetic activity?

1 - ipsilateral symptoms
2 - ptosis
3 - miosis
4 - lacrimation
5 - pupil dilation

A

4 - lacrimation

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7
Q

Which part of the brain has been identified as governing the symptoms Trigeminal autonomic cephalgias (headaches) (TACs)?

1 - hypothalamus
2 - thalamus
3 - brain stem
4 - cerebellum

A

1 - hypothalamus
- linked due to the following festures of TACs:

  • cyclic nature of symptoms
  • relapsing remitting course
  • seasonal variation

All of the these are associated with the biological clock

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8
Q

Trigeminal autonomic cephalalgias (headache) (TAC) is a type of primary headache. Which of the following is NOT a symptom that occurs in patients with TAC?

1 - pain on one side of the head (typically orbital, supraorbital, and/or temporal)
2 - pain felt throughout face
3 - autonomic systems on the same side of head (eye watering and redness or drooping eyelids)
4 - all of the above

A

2 - pain felt throughout face
- pain is felt over the trigeminal nerve only

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9
Q

Do Trigeminal autonomic cephalalgias (headache) (TAC) typically occur unilaterally or bilaterally?

A
  • unilaterally
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10
Q

How long can Trigeminal autonomic cephalalgias (headache) (TAC) last for?

1 - 30 mins to 1 week
2 - 15-180 minutes
3 - 4-72h
4 - all of the above

A

2 - 15-180 minutes

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11
Q

How long can Trigeminal autonomic cephalalgias (headache) (TAC) typically have a number of autonomic symptoms. But what is the sensation patients describe the headache as?

1 - stabbing eye pain
2 - throbbing
3 - squeezing/tightening
4 - can be all of these

A

1 - stabbing eye pain
- described as excruciating pain

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12
Q

Although there are a number of triggers that have been suggested to cause Trigeminal autonomic cephalalgias (headache) (TAC), which of the following is most commonly linked?

1 - cigarettes and alcohol
2 - stress and dehydration
3 - food and weather
4 - can be all of the above

A

1 - cigarettes and alcohol

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13
Q

There are 4 main types of Trigeminal autonomic cephalalgias (headache) (TAC). Which is most common?

1 - Cluster headache
2 - Paroxysmal hemicrania
3 - SUNCT/SUNA
4 - Hemicrania continua

A

1 - Cluster headache

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14
Q

Cluster headaches are the most common form of Trigeminal autonomic cephalalgias (TAC), a primary headache. What is the prevalence of cluster headaches?

1 - 0.1% of the population
2 - 1% of the population
3 - 10% of the population
4 - 25% of the population

A

1 - 0.1% of the population

10 cases per 100,000

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15
Q

What age do Cluster headaches, the most common form of Trigeminal autonomic cephalalgias (TAC), a primary headache typically occur in?

1 - 15-30
2 - 20-40
3 - 30-40
4 - 50-60

A

3 - 30-40

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16
Q

Are cluster headaches, the most common form of Trigeminal autonomic cephalalgias (TAC), a primary headache more common in men or women?

A
  • men
  • 4x more likley
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17
Q

Are Cluster headaches, the most common form of Trigeminal autonomic cephalalgias (TAC), a primary headache always unilateral or bilateral?

A
  • strictly unilateral
18
Q

Cluster headaches are the most common form of Trigeminal autonomic cephalalgias (TAC), a primary headache. How long can cluster headaches last for?

1 - 15 to 180 minutes
2 - 30 mins to 1h
3 - 4-72h
4 - all of the above

A

1 - 15 to 180 minutes
- patients can get 1-2 a day
- occur as clusters then disappear for a while
- can last for 2-3 weeks

19
Q

Which of the following locations would the main symptom of a cluster headache be felt?

1 - on one side of the face
2 - around the eye on one side of the face
3 - across the top of the forehead
4 - all of the above

A

2 - around the eye on one side of the face

20
Q

Is the pain in cluster headaches moderate or severe?

A
  • very severe

Incredibly painful

21
Q

Excruciating pain is the key symptom patients with Cluster headaches, the most common form of Trigeminal autonomic cephalalgias (TAC), a primary headache can get. Which of the following autonomic symptoms can also occur?

1 - Lacrimation
2 - Conjuctival injection
3 - Rhinorrhoea (sinusitis/otitis)
4 - Nasal conjestion
5 - miosis (small pupils)
6 - ptosis (drooping or swelling of eyelid
7 - overly agitated
8 - all of the above

A

8 - all of the above

Essential they are associated with autonomic symptoms

22
Q

If patients have all the signs of cluster headaches, do they always need to be referred to neurology?

A
  • Yes
23
Q

What is commonly the 1st line treatment for cluster headaches?

1 - high flow 100% O2
2 - sumatriptan
3 - verapamil
4 - steroids

A

1 - high flow 100% O2

Sumatriptan may be given as an injectable or intranasal approach

24
Q

Sumatriptan is typically the 1st line treatment for cluster headaches. Which of the followings can also be used?

1 - high flow 100% O2
2 - verapamil (Ca2+ channel blockers)
3 - steroids
4 - all of the above

A

4 - all of the above

25
Q

Paroxysmal Hemicrania is another form of Trigeminal autonomic cephalalgias (TAC). These are very similar to cluster headaches. But what is the key distinguishing features between these and cluster headaches?

1 - affect mainly women
2 - occur bilaterally
3 - age of patient
4 - all of the above

A

1 - affect mainly women
- typically can occur more often than cluster headaches, but do not last as long

  • treated using Indomethacin a NSAID
26
Q

Short-lasting unilateral neuralgiform headaches with cranial autonomic features (SUNA) is another form of Trigeminal autonomic cephalalgias (TAC). These again are similar to cluster headaches, but typically do they last longer than cluster headaches?

A
  • no
  • typically last 1 minute and can occur 30 x in 1h
27
Q

Short-lasting unilateral neuralgiform headaches with cranial autonomic features (SUNA) is another form of Trigeminal autonomic cephalalgias (TAC). Do these just occur randomly?

A
  • can be spontaneous
  • BUT can also be stimulated just by touching the face
  • typically feels like a stabbing pain that gets less severe, but is constant
28
Q

Short-lasting unilateral neuralgiform headaches with cranial autonomic features (SUNA) is another form of Trigeminal autonomic cephalalgias (TAC). Do these have autonomic features?

A
  • yes, just like cluster headaches
  • patients are also very agitated
29
Q

Of the 3 types of primary headache, which one typically requires an MRI to rule out other pathology?

1 - Medication overuse headaches
2 - Tension-type headaches
3 - The trigeminal autonomic cephalagias
4 - Migraines

A

3 - The trigeminal autonomic cephalagias

30
Q

What is trigeminal neuralgia?

1 - loss of sensation of the trigeminal nerve
2 - neuropathic pain condition of the trigeminal nerve
3 - loss of motor function in trigeminal nerve
4 - all of the above

A

2 - neuropathic pain condition of the trigeminal nerve

31
Q

What is the prevalence of Trigeminal neuralgia?

1 - 1 / 100
2 - 1 / 1000
3 - 1 / 10,000
4 - 1 / 100,000

A

3 - 1 / 10,000

32
Q

Typically how long does Trigeminal neuralgia symptoms last for?

1 - seconds to minutes
2 - minutes to hours
3 - hours to days
4 - days to weeks

A

1 - seconds to minutes

33
Q

Trigeminal neuralgia is neuropathic pain condition of the trigeminal nerve. Is this always idiopathic?

A
  • no
  • can be idiopathic, but can also be caused by tumours pressing on the trigeminal nerve
34
Q

Does Trigeminal neuralgia is neuropathic pain condition of the trigeminal nerve, occur both unilaterally or bilaterally?

A
  • unilaterally
35
Q

Which part of the trigeminal neuralgia occur?

1 - 1 region of CN V
2 - 2 regions of CN V
3 - all 3 regions of CN V
4 - mix of all of the above

A

4 - mix of all of the above
- typically affects >1 area of the trigeminal nerve
- can affect the inside of the mouth

36
Q

How do patients describe the sensation of Trigeminal neuralgia is neuropathic pain condition of the trigeminal nerve?

1 - electric shock
2 - stabbing pain
3 - compressing pain
4 - throbbing pain

A

1 - electric shock

37
Q

Which of the following are used to characterise Trigeminal neuralgia is neuropathic pain condition of the trigeminal nerve?

1 - abrupt in nature
2 - abrupt in resolution
3 - affects >1 branch of trigeminal nerve
4 - all of the above

A

4 - all of the above

38
Q

Trigeminal neuralgia is neuropathic pain condition of the trigeminal nerve typically last. Which of the following can trigger trigeminal neuralgia?

1 - light touch
2 - washing/shaving
3 - smoking
4 - talking
5 - brushing teeth
6 - all of the above

A

6 - all of the above

39
Q

Trigeminal neuralgia is neuropathic pain condition of the trigeminal nerve. Do these patients experience autonomic symptoms?

A
  • yes
  • typically in the same region as where the pain is felt
40
Q

Which of the following are common secondary causes of Trigeminal neuralgia is neuropathic pain condition of the trigeminal nerve?

1 - tumour at the cerebellopontine angle
2 - arteriovenous malformation
3 - multiple sclerosis
4 - all of the above

A

4 - all of the above

41
Q

In patients with Trigeminal neuralgia, a neuropathic pain condition of the trigeminal nerve, do they typically receive imaging?

A
  • yes
  • thin MRI slicing through the trigeminal nerve
42
Q

All of the following are treatments for trigeminal neuralgia, a neuropathic pain condition of the trigeminal nerve. But which is 1st line treatment?

1 - carbamazepine
2 - gabapentin
3 - pregabalin
4 - lamotrigine

A

1 - carbamazepine
- suggested mechanisms include inhibiting Na+ channels and GABA agonist

In rare cases microvascular surgery may be performed to ensure no contact between the trigeminal nerve and blood vessels

A. MLA Map General Practice and Primary Healthcare (28 decks)

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