Headaches

Question 1

What is the etiology of migraines?

Answer 1

1. irritations of CNS structures
2. Activation of Trigeminal n. (release of neuropeptides)
3. sensitization (neurones get increasingly responsive to stimuli)

Question 2

Drugs used to abort migraine

Answer 2

NSAID (aspirin, NAPROXEN, Ibuprofen) (reduction by 60% in 2hrs)

-TRIPTANS (5ht agonist) —RIZATRIPTAN and ELEtriptan

Question 3

When is prophylactic rx given for migraine?

Answer 3

• if you have more than 3 ATTACKS in a month

- or very debilitating

Question 4

S.E of sumatriptan?

Answer 4

• raises BP

- C.I in CAD and Prinzmetal’s Angina

Question 5

Which drug can be given as a migraine prophylaxis and is a tricyclic antidepressant?

Answer 5

AMITRIPTYLINE

• s.e: dry mouth, postural hypotension, sedation

Question 6

Name other prophylactic drugs for migraines.

Answer 6

1. Propanolol (reduces freq. of migraines in 60-80% of pts)
2. TOPIRAMATE (^ GABA)
3. Valproate

Question 7

What is the AIM of prophylaxis?

Answer 7

• titrate drug as tolerated to achieve efficacy at the LOWEST dose

(start low and keep on)

Question 8

Which drug used for prophylaxis in migrain has a POOR s.e profile?

Answer 8

• TOPIRAMATE

weight LOSS, paraesthesia, impaired conc, enzyme inducer,

Question 9

Which prophylactic drug causes stones in the kidney?

Answer 9

• TOPIRAMATE

- because it a carbonic anhydrase inhibitor (MORE Calcium in the urine)

Question 10

Valproate is ALSO used as a prophylaxis for Migraine. What are its S.E?

Answer 10

• tremor
• hepatootoxicity
• NTD
• wgt gain
• GI distress

Question 11

What is SEEN in migraines and is NOT seen in tension headaches?

Answer 11

• those with migraines may experience N & V

- photo-/phonophobia

Question 12

How to manage Tension headache?

Answer 12

• relaxation physiotherapy
• antidepressant ( Amitriptyline) for 3 MONTHS
• reassure

Question 13

Cluster headaches are often in _____

Answer 13

men and SMOKERS

Question 14

What is key about cluster headache?

Answer 14

• ipsilateral cranial AUTONOMIC fts are seen

Question 15

What are the 4 types of trigeminal autonomic cephalgias?

Answer 15

1. cluster
2. paroxysmal hemicrania
3. hemicrania continua
4. SUNCT

Question 16

When does a cluster headache strike?

Answer 16

• around sleep
• seasonal variation
• same time EVERY day

Question 17

What are the distinct fts of a cluster headache?

Answer 17

• EXCRUTIATING unilateral headache
• last 15mins to several hrs
• as freq. as one EVERY other day to 8 per day

Question 18

How to treat cluster headache?

Answer 18

• HIGH flow oxygen (100% for 20 mins)
• sub. cutaneous sumatriptan 6mg

-PROPHYLAXIS verapamil & prednisolone (reduce over 2 weeks)

Question 19

What is SUNCT?

Answer 19

• Short-lived (12-120s)
• Unilateral
• Neuralgiaforme headache
• Conjunctival injections
• Tearing

Question 20

What is the diff. between SUNCT and the others?

Answer 20

SHORT-LIVED

—the pain can occur 3-200 times a DAY !

Question 21

How to treat SUNCT?

Answer 21

D.t to activation of autonomic nervous system in the Trigeminal nerve—-so …
Gabapentin
Lamotigrine

Question 22

Who is prone to paroxsymal hemicrania?

Answer 22

• women in their 50s-60s

Question 23

How long does paroxysmal hemicrania last?

Answer 23

2-45mins

freq: 1-40 a day

Question 24

How to treat paroxysmal hemicrania?

Answer 24

• Indomethicin

shorter and more frequent than cluster

Question 25

Those with NEW onset unilateral cranial fts require what?

Answer 25

Imaging of the brain | MRI or MR angiogram

Question 26

Idiopathic intracranial hypertension is commonly seen in which demographic gr.?

Answer 26

- Females | - OBESE

Question 27

How does IIH present as?

Answer 27

- Throbbing headache; WORSE in the MORNING, coughing or STRAINING - morning N and V - day time - feeling sick, sleepy, irrtable - --vision maybe DARK or GREYED out for a few seconds

Question 28

What are the findings for IIH in MRI and CSF ?

Answer 28

MRI = normal | CSF: elevated pressure and NORMAL constituents

Question 29

How to manage IIH?

Answer 29

- weight loss - ACETAZOLAMIDE - diuretics - Ventricular-atrial SHUNT - lumbar peritoneal shunt - monitor visual fields and CSF pressure

Question 30

Who gets trigeminal neuralgia?

Answer 30

- >60y.o WOMEN

Question 31

How does Trigeminal neuralgia present as?

Answer 31

- severe STABBING unilateral pain--- made worse by CHEWING and SPEAKING - lasts 1s-90s - freq. of 10-100/day

Question 32

How to treat trigeminal neuralgia ?

Answer 32

- PHENYTOIN/ GABAPENTIN/ CARBAMAZEPINE/ BACLOFEN

Question 33

How to manage trigeminal neuralgia?

Answer 33

by decompression or ablation

Question 34

Why is Ergotamine no longer given as rx?

Answer 34

- causes gangrene and overuse headache

Question 35

Management of migraines?

Answer 35

offer simple analgesia 2. offer triptans ALONE or with PCM (or another NSAID) - ---sumatriptan is FIRST line 3. offer anti-emetic even in the absence of N &V

Question 36

What are said to be triggers for migraines?

Answer 36

``` CHeese OCP Caffeine AlcohOL Anxiety Travel Exercise ``` *chocolate*---atonym

Question 37

Causes of IIH?

Answer 37

- subdural hematoma - brain tumor - iron def. anemia - OBESE or overweight - LUPUS - CKD - hormone problems: CUSHING'S, hypoparathyroidism. hyper-/ hypo- thyroid - meds: some antibiotic, COCP, steroids

Question 38

How to go about investigating IIH?

Answer 38

- neurological examinations (muscle strength/ balance/ reflexes) - assessment of eyes and vision - CT - MRI - LP