Trigeminal Autonomic Cephalalgias Headaches

Question 1

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

Answer 1

2 - Trigeminal autonomic cephalgias (TACs)

Question 2

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)

Answer 2

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

• afferent receptors trigger trigeminal nucleus in the medulla oblongata

Question 3

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

Answer 3

3 - increased parasympathetic and sympathetic activation

Question 4

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

Answer 4

2 - ptosis and miosis
- occur due to sympathetic activity

Question 5

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

Answer 5

4 - lacrimation

Question 6

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

Answer 6

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

Question 7

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
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

Answer 7

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

Question 8

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

Answer 8

• unilaterally

Question 9

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

Answer 9

2 - 15-180 minutes

Question 10

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

Answer 10

1 - stabbing eye pain
- described as excruciating pain

Question 11

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

Answer 11

1 - cigarettes and alcohol

Question 12

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

Answer 12

1 - Cluster headache

Question 13

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

Answer 13

1 - 0.1% of the population

Question 14

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

Answer 14

3 - 30-40

Question 15

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

Answer 15

• men
• 4x more likley

Question 16

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

Answer 16

• strictly unilateral

Question 17

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

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

Answer 17

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

Question 18

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

Answer 18

2 - around the eye on one side of the face

Question 19

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 - all of the above

Answer 19

7 - all of the above

Question 20

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

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

Answer 20

2 - sumatriptan
- selective serotonin receptor agonists that inhibit vasodilation and narrows blood vessels in the brain

Question 21

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
3 - steroids
4 - all of the above

Answer 21

4 - all of the above

Question 22

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

Answer 22

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

• treated using Indomethacin a NSAID

Question 23

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?

Answer 23

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

Question 24

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

Answer 24

• 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

Question 25

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

Answer 25

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

Question 26

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

Answer 26

3 - The trigeminal autonomic cephalagias

Question 27

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

Answer 27

2 - neuropathic pain condition of the trigeminal nerve

Question 28

What is the prevalence of Trigeminal neuralgia?

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

Answer 28

3 - 1 / 10,000

Question 29

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

Answer 29

1 - seconds to minutes

Question 30

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

Answer 30

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

Question 31

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

Answer 31

• unilaterally

Question 32

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

Answer 32

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

Question 33

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

Answer 33

1 - electric shock

Question 34

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

Answer 34

4 - all of the above

Question 35

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

Answer 35

6 - all of the above

Question 36

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

Answer 36

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

Question 37

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

Answer 37

4 - all of the above

Question 38

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

Answer 38

• yes
• thin MRI slicing through the trigeminal nerve

Question 39

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

Answer 39

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