CNS Pg No 595 -604
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Questions and Answers

Which of the following is NOT a feature of cluster headaches?

  • Ipsilateral ANS symptoms
  • Severe unilateral pain
  • Nocturnal headache
  • Throbbing pain (correct)

    • Cluster headaches occur more frequently in females than in males.

    False

    What is the typical duration of a cluster headache attack?

    15 minutes to 3 hours

    The type of pain experienced in cluster headaches is often described as _____ and _____ pain.

    <p>stabbing, boring</p> Signup and view all the answers

    Match the following symptoms with their corresponding conditions:

    <p>Cluster headache = Unilateral periorbital non-throbbing pain Paroxysmal hemicrania = Short-lasting headaches SUNCT = Short-lasting unilateral neuralgic headache Hemicrania continua = Continuous headache with varying intensity</p> Signup and view all the answers

    Which symptom is most commonly associated with the aura stage of a migraine?

    <p>Zig-zag lines</p> Signup and view all the answers

    Nausea and vomiting are common symptoms associated with the headache stage of a migraine.

    <p>False</p> Signup and view all the answers

    What is the duration range of a migraine headache?

    <p>4 to 72 hours</p> Signup and view all the answers

    The most common trigger for migraines is __________.

    <p>sleep deprivation</p> Signup and view all the answers

    Match the type of migraine to its criteria:

    <p>Common Migraine = Minimum 5 attacks lasting 4–72 hours Classical Migraine = At least 2 attacks with aura Aura = Visual disturbances like zig-zag lines Postdrome = Lethargy and low mood</p> Signup and view all the answers

    Which treatment is considered effective for very severe migraine attacks?

    <p>Sumatriptan</p> Signup and view all the answers

    Metoclopramide is used for the prophylaxis of migraine.

    <p>False</p> Signup and view all the answers

    What is a common side effect of Topiramate when used for migraine prophylaxis?

    <p>Weight loss</p> Signup and view all the answers

    A __________ migraine involves transient 3rd nerve palsy and pupil involvement.

    <p>ophthalmoplegic</p> Signup and view all the answers

    Match the following medications with their classifications:

    <p>Migranal = Ergotamine Venlafaxine = SNRI Almotriptan = Triptan Pizotifen = 5-HT antagonist</p> Signup and view all the answers

    Which of the following treatments is considered the drug of choice for managing increased intracranial pressure?

    <p>Acetazolamide</p> Signup and view all the answers

    Hearing a pulsatile tinnitus sound is more commonly unilateral than bilateral.

    <p>True</p> Signup and view all the answers

    What should be done as the first step in managing acute increased intracranial pressure?

    <p>Elevate the head</p> Signup and view all the answers

    The type of headache described as worse in the morning and associated with retrobulbar pain is called __________ headache.

    <p>Orthostatic</p> Signup and view all the answers

    Match the following treatments with their corresponding descriptions:

    <p>Weight loss = Non-invasive lifestyle modification Optic nerve sheath fenestrations = Surgical intervention for vision protection Repeated lumbar puncture = Best option for fluid management Mannitol = Osmotic agent for acute management</p> Signup and view all the answers

    What term describes the signs and symptoms of seizure activity?

    <p>Semiology</p> Signup and view all the answers

    Atonic seizures involve fast neuronal activity.

    <p>False</p> Signup and view all the answers

    What is the primary feature of a generalized seizure?

    <p>Loss of consciousness</p> Signup and view all the answers

    In pseudo seizures, there is a significant increase in __________ thrust movements.

    <p>axial</p> Signup and view all the answers

    Match the seizure types with their characteristics:

    <p>Myoclonic = Fastest type of hypersynchronous activity Clonic = Rhythmic muscle contractions Tonic = Sustained muscle contraction Atonic = Loss of muscle tone and slowest type</p> Signup and view all the answers

    Which of the following types of seizures has impaired awareness and may involve automatisms?

    <p>Complex Partial seizures</p> Signup and view all the answers

    Simple Partial seizures include loss of consciousness.

    <p>False</p> Signup and view all the answers

    What is required for a diagnosis of epilepsy syndrome?

    <p>Two unprovoked seizures separated by at least 24 hours.</p> Signup and view all the answers

    The typical features of Generalized Onset seizures include ___ and ___ as non-motor symptoms.

    <p>Typical absent, Atypical absent</p> Signup and view all the answers

    Match the seizure types with their features:

    <p>Tonic Clonic = Motor onset in Generalized Onset seizures Myoclonic = May occur in both Generalized and Complex Partial seizures Typical absent = Non-motor onset in Generalized Onset seizures Cognitive issues = Non-motor symptoms in Complex Partial seizures</p> Signup and view all the answers

    What is the most common cause of unilateral trigeminal neuralgia?

    <p>Compression on the superior cerebellar artery</p> Signup and view all the answers

    Bilateral trigeminal neuralgia is often associated with compression on the superior cerebellar artery.

    <p>False</p> Signup and view all the answers

    What is the first-line medication used in the treatment of trigeminal neuralgia?

    <p>Carbamazepine</p> Signup and view all the answers

    The acronym TAC stands for __________, __________, and __________.

    <p>MRI brain, Polysomnography, Pituitary function test</p> Signup and view all the answers

    Match the following treatments with their conditions:

    <p>Carbamazepine = Trigeminal Neuralgia Subcutaneous botulinum toxin = Trigeminal Neuralgia Microvascular decompression = Trigeminal Neuralgia HLA B-5801 testing = Allopurinol administration</p> Signup and view all the answers

    Which of the following conditions can be associated with papilledema?

    <p>Bradycardia</p> Signup and view all the answers

    Papilledema can be diagnosed using only MRI findings.

    <p>False</p> Signup and view all the answers

    What is the typical opening pressure for cerebrospinal fluid during a lumbar puncture that indicates papilledema?

    <p>Greater than 25 cm of H₂O</p> Signup and view all the answers

    ____ is a benign condition associated with the pituitary gland remaining intact.

    <p>Primary Empty Sella Syndrome</p> Signup and view all the answers

    Match the secondary causes of papilledema to their categories:

    <p>Outdated tetracycline = Drugs Steroid withdrawal = Endocrine Anabolic steroids = Endocrine Nalidixic acid = Drugs</p> Signup and view all the answers

    What is a characteristic of focal seizures without dyscognition?

    <p>Consciousness is aware</p> Signup and view all the answers

    Focal seizures with dyscognition are also referred to as complex partial seizures.

    <p>True</p> Signup and view all the answers

    What is the most common location of localization for complex partial seizures?

    <p>medial temporal lobe</p> Signup and view all the answers

    The possible etiology for seizures includes __________ and neurocysticercosis.

    <p>brain tumors</p> Signup and view all the answers

    Match the following features with their corresponding characteristics of seizures:

    <p>Todd's palsy = Transient palsy lasting up to 24 hours Jacksonian march = Migration of motor activity from distal to proximal Aura = Subjective internal event not observed by others Automatisms = Coordinated motor activity resembling movement</p> Signup and view all the answers

    Which of the following conditions is characterized by continuous unilateral headaches with episodic attacks?

    <p>Hemicrania Continua</p> Signup and view all the answers

    Paroxysmal Hemicrania can occur 1 to 20 times a day.

    <p>True</p> Signup and view all the answers

    What is the treatment of choice for Hemicrania Continua?

    <p>100% Oxygen</p> Signup and view all the answers

    The frequency of attacks in SUNCT can range from _____ to _____ per day.

    <p>3, 200</p> Signup and view all the answers

    Match the symptom to the corresponding condition:

    <p>ANS symptoms present = Paroxysmal Hemicrania Rapid stabbing pain lasting seconds = SUNCT Continuous headache with episodic attacks = Hemicrania Continua Responsive to Indomethacin = Hemicrania Continua</p> Signup and view all the answers

    Study Notes

    Trigeminal Autonomic Cephalgias (TAC)

    • Group of headaches with short-lasting, severe, unilateral pain and autonomic nervous system symptoms
    • Includes cluster headaches, paroxysmal hemicrania, SUNCT, and hemicrania continua

    Cluster Headaches

    • Primarily affects young males
    • Excruciating pain, often described as stabbing or boring
    • Located unilaterally around the eye
    • Associated with ipsilateral autonomic symptoms like conjunctival congestion, lacrimation, nasal congestion, and forehead/facial sweating
    • Attacks last 15 minutes to 3 hours, typically 30 minutes
    • Occur 1 to 8 times a day, lasting for 8 to 10 weeks followed by a symptom-free period
    • May be triggered by alcohol, but not skin stimulation
    • 20% of cases are chronic

    Other Headache Types

    • Ophthalmoplegic migraine: Transient third nerve palsy, often affecting pupil
    • Retinal migraine: Unilateral visual impairment
    • Basilar type migraine: Occipital involvement, associated with ataxia, tinnitus, vertigo
    • Familial hemiplegic migraine: Inherited condition related to calcium channel dysfunction

    Treatment

    Acute Headache

    • Mild pain: Paracetamol, NSAIDs (Naproxen, Ibuprofen)
    • Moderate to Severe pain: Triptans (Eletriptan, Rizatriptan, Almotriptan, Sumatriptan)
    • Very Severe pain: Sumatriptan (SC) or Zolmitriptan (intranasal)
    • Note: Triptans are contraindicated in cardiovascular or cerebrovascular disease and their efficacy depends on how quickly they reach peak concentration in the body. They are not effective for migraines with aura. Ergotamine is associated with a lower risk of recurrence.

    Prophylaxis

    • First-line: Beta-blockers, Valproate, Topiramate
    • Second-line: SNRIs (Venlafaxine), TCAs
    • Third-line: Pizotifen, Flunarizine, Clonidine, Candesartan
    • Newer drugs and therapies: Erenumab (CGRP antagonist), supraorbital transcutaneous stimulation, Onabotulinum toxin A, greater occipital nerve block

    Prophylactic side effects

    • Topiramate: Weight loss, kidney stones
    • Valproate: Weight gain, liver disease, high ammonia levels, low platelet count

    Migraine

    • Prodrome: Mood changes, irritability, depressive symptoms
    • Aura: Zig-zag lines (most common), flashes of light, shimmering spots in vision

    Headache Phase

    • Unilateral, throbbing, and pounding pain
    • Located in the frontotemporal area
    • Lasts 4 to 72 hours
    • May be accompanied by nausea, vomiting, photophobia, phonophobia, and sensitivity to smells
    • Postdrome: Lethargy, low mood/depression

    Triggers

    • Most common: Sleep deprivation
    • Other triggers: Menstruation, stress, environmental factors (traffic, climate, etc.), food, mosquito bites, henna

    Migraine Criteria

    Common Migraine

    • At least 5 attacks lasting 4 to 72 hours
    • At least 2 characteristics:
      • Unilateral pain
      • Pulsating pain
      • Moderate to severe pain
      • Worsening with physical activity
      • Nausea or vomiting
      • Photophobia or phonophobia
    • Not attributed to another disorder

    Classical Migraine

    • At least 2 attacks lasting 4 to 72 hours
    • Aura phase with at least 3 of the following:
      • Gradual onset
      • Fully reversible
      • Duration of 5 to 60 minutes
      • At least one neurological symptom

    Other Headache Types

    • Orthostatic Headache: Headache that worsens with standing or sitting upright
    • Frequency: Daily
    • Location: Bilateral
    • Timing: Worsens in the morning
    • Aggravating factors: Coughing, straining

    Visual Symptoms

    • Transient visual obscuration: Most common visual symptom
    • Blackouts or greyouts: Loss or dimming of vision
    • Duration: Seconds to minutes
    • Location: Unilateral or bilateral

    Tinnitus

    • Type: Pulsatile (third most common) tinnitus
    • Location: Heard in silent surroundings
    • Location: Unilateral (more frequent than bilateral)

    Benign Intracranial Hypertension

    • Clinical Features: Papilledema (swelling of the optic nerve) and no neurological symptoms, except possible sixth nerve palsy
    • Diagnostic Tests:
      • MRI: Normal findings in benign intracranial hypertension
      • CT/MRI: Normal results
      • Lumbar Puncture: Opening pressure greater than 25 cm of H₂O, normal cerebrospinal fluid (CSF) biochemistry and cytology
    • Causes:
      • Drugs: Outdated tetracycline, nalidixic acid, NSAIDs, retinol, danazol, tamoxifen
      • Endocrine: Steroid withdrawal, growth hormone, anabolic steroids
    • Treatment:
      • Acetazolamide
      • Weight Loss
      • Topiramate
      • Repeated lumbar puncture
      • Surgery (optic nerve sheath fenestrations, shunting)

    Trigeminal Neuralgia

    • Clinical Features:
      • More common in females aged 50 to 60 years
      • Sudden, intense, sharp pain lasting seconds to minutes
      • Unilateral pain, usually affecting V2 and V3 branches of the trigeminal nerve
      • Triggered by skin stimulation
      • Refractory period (time when pain does not occur after a trigger)
    • Diagnosis: Specialized MRI
    • Treatment:
      • Carbamazepine is the most effective treatment
      • Lamotrigine
      • Subcutaneous botulinum toxin
      • Microvascular decompression in severe cases

    Glossopharyngeal Neuralgia (Eagle Syndrome)

    • Clinical Features:
      • Sudden, severe, short-lasting pain that recurs in bouts
      • Affects the tonsil bed, throat, and angle of the jaw
      • Triggered by coughing, yawning, swallowing
      • May be associated with cardiac conduction abnormalities
    • Treatment:
      • Surgery to remove the elongated styloid bone

    Seizures

    • Semiology: Signs and symptoms of seizure activity
    • Types:
      • Focal onset (partial):
        • Simple partial: No loss of consciousness, may involve motor (tonic, clonic, atonic, myoclonic) or sensory symptoms
        • Complex partial: Impaired awareness or dyscognition (altered consciousness), may involve automatisms (repetitive movements), autonomic symptoms, behavioral arrest, or cognitive and emotional issues
      • Generalized onset:
        • Motor seizures: Tonic-clonic, clonic, tonic, myoclonic, atonic
        • Non-motor seizures (absent): Typical, atypical, or myoclonic absent
      • Unknown onset: Seizures where the onset is unclear

    Focal Onset Seizures

    • Complex partial seizures: Most common type, typically involve the medial temporal lobe, associated with a higher risk for future seizures
    • Etiology:
      • Structural lesions in the frontal or fronto-parietal lobes
      • Tuberculomas, neurocysticercosis, brain tumors, stroke
    • Presentation:
      • Clonic movements (2-3 Hz)
      • Abnormal synchronous facial and limb movements
      • Todd's palsy (post-ictal weakness lasting up to 24 hours)
      • Jacksonian march (spread of motor activity from distal to proximal)
      • Epilepsia partialis continua (continuous activity lasting hours to days)
      • Aura (rare)

    Generalized Onset Seizures

    • Motor seizures (Grand Mal):
      • Tonic-clonic: Stiffening followed by rhythmic jerking
      • Clonic: Rhythmic jerking of muscles
      • Tonic: Stiffening of muscles
      • Myoclonic: Brief, sudden muscle jerks
      • Atonic: Loss of muscle tone, causing a sudden collapse
    • Non-motor seizures (Absent):
      • Typical absent: Brief lapse of consciousness, often with staring
      • Atypical absent: Longer duration, possible motor components, more subtle consciousness changes
      • Myoclonic absent: Brief jerks, often associated with absent seizures

    Epilepsy

    • Diagnosis: Brain MRI, electroencephalography (EEG) to evaluate the type of seizure, frequency, and presence of loss of consciousness.
    • Epilepsy Syndrome: Defined as experiencing at least two unprovoked seizures separated by more than 24 hours with no identifiable cause, or a single seizure along with MRI or EEG findings suggesting a high risk for further seizures

    Paroxysmal Hemicrania

    • More commonly affects women than men
    • Headache features:
      • Unilateral, throbbing, boring, or stabbing
      • Excruciating pain
      • Attacks last 2 to 30 minutes, typically 5 minutes
      • Occur 1 to 20 times a day
    • Autonomic symptoms: Present
    • Migraine-like features: Absent
    • Triggers: No alcoholic trigger
    • Treatment:
      • Short-term: Steroids (most effective), verapamil, galcanezumab, greater occipital nerve injection
      • **Long-term:**Verapamil (the most effective long-term treatment), topiramate, lithium
      • During an attack: Indomethacin (reduces frequency but is not effective for treating an ongoing attack)

    SUNCT

    • Pain:
      • Unilateral, stabbing or throbbing, located in the orbital or temporal region
      • Attacks last 5 to 240 seconds
      • Occur 3 to 200 times a day
    • Migraine-like features: Absent
    • Treatment:
      • During an attack: Intravenous lignocaine
      • Prevention: Lamotrigine or topiramate
    • Triggers:
      • No alcoholic trigger
      • Cutaneous trigger (skin stimulation)
      • No refractory period

    Hemicrania Continua

    • More common in older females
    • Description: Continuous, unilateral, background headache with episodic TAC
    • Migraine-like features: Present
    • Autonomic symptoms: Present
    • Treatment:
      • 100% oxygen (12-15 L/min for 10-20 minutes)
      • Sumatriptan 6 mg subcutaneously
      • Indomethacin is the treatment of choice for this headache type
    • Responsive to: Indomethacin

    Investigation of TAC

    • Diagnostic tests:
      • MRI of the brain
      • Polysomnography (sleep study)
      • Pituitary function tests

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    Description

    This quiz focuses on the various types of Trigeminal Autonomic Cephalgias (TAC), including cluster headaches and other related headache syndromes. Explore the characteristics, symptoms, and triggers associated with these painful conditions for a deeper understanding of TAC.

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