Headache

Question 1

why are cluster headaches named ‘cluster’?

Answer 1

typically occur in clusters lasting several weeks, with the clusters themselves typically once a year

Question 2

who are most at risk of suffering from cluster headaches?

Answer 2

• men
• smokers

Question 3

names triggers for cluster headache

Answer 3

• alcohol
• nocturnal sleep

Question 4

what are the features of cluster headaches?

Answer 4

intense sharp, stabbing pain around **one eye **
* pain typically occurs once or twice a day, each episode lasting 15mins - 2 hours
* patient is restless and agitated during an attack due to the severity
* redness, lacrimation, lid swelling
* nasal stuffiness
* miosis and ptosis

Question 5

how long do clusters typically last?

Answer 5

1-3 months

Question 6

what is the imaging of choice in cluster headaches?

Answer 6

MRI with gadolinium contrast

Question 7

what is the acute management for cluster headaches?

Answer 7

• 100% oxygen
• subcut triptan

Question 8

what is the prophylaxis treatment for cluster headaches?

Answer 8

verapamil

Question 9

what are the features of migraine?

Answer 9

• unilateral throbbing headache
• preceded by an aura
• lasts 4-72 hours
• photophobia
• phonophobia

Question 10

describe aura

Answer 10

• visual (e.g. lines, zigzags)
• sensory (paraesthesia spreading from fingers to face)

Question 11

name some identifiable triggers for migraine

Answer 11

• oral contraceptives
• chocolate

Question 12

what symptom confirms the diagnosis of migraine?

Answer 12

aura

Question 13

what is the diagnostic criteria for a migraine with no aura?

Answer 13

at least 5 headaches lasting 4-72 hours with
* nausea/vomiting
OR
* photo/phonophobia

AND 2 of:
* unilateral headache
* pulsating character
* impaired or worsened by daily activities

Question 14

what is the management of migraine?

Answer 14

• avoid triggers
• prophylaxis
• managing an acute attack

Question 15

what is the prophylaxis for migraines?

Answer 15

propranolol or topiramate

Question 16

how is an acute attack of migraine managed?

Answer 16

• oral triptan (e.g. sumatriptan)
• • paracetamol or NSAID

Question 17

what is the most common cause of chronic recurring head pain?

Answer 17

tension headaches

Question 18

which sex is more likely to experience tension headaches?

Answer 18

females

Question 19

what are the features of tension headaches?

Answer 19

• bilateral, non-pulsatile headaches
• tight, like a band around the head
• tenderness of the scalp muscles

Question 20

what is the management of tension headache?

Answer 20

• paracetamol or NSAID
• associated with stress –> address cause

Question 21

what are the features of trigeminal neuralgia?

Answer 21

• recurrent short episodes of severe stabbing pain, affecting one side of the face
• pain triggered by touching the face, eating or talking
• aged >50 years old

Question 22

how is trigeminal neuralgia diagnosed?

Answer 22

• clinical
• MRI to exclude secondary causes

Question 23

what is the management for trigeminal neuralgia?

Answer 23

1. carbamazepine
2. microvascular decompression

Question 24

what are the features of raised intracranial pressure?

Answer 24

• headaches which are worse in the morning and upon bending over
• improve after vomiting and lying down
• associated with neurological deficits

Question 25

how is raised intracranial pressure diagnosed?

Answer 25

CT head

Question 26

what is the management of raised intracranial pressure?

Answer 26

treatment of the underlying cause

Question 27

in what patient should you avoid triptan use?

Answer 27

**coronary artery disease** potential to cause coronary vasospasm

Question 28

what migraine prophyalxis is preferred in women of childbearing age?

Answer 28

**propranolol** over topiramate