• Classification
• Tension
• Migraine
• Trigeminal autonomic cephalgias
• => Always scan
• Chronic paroxysmal hemicrania
• => Indomethacin

Refractory epilepsy - questions

1. Is it epilepsy?
2. Are they compliant with medication?
3. Are you missing something (e.g. secondary cause)
   

• New onset or change in headache in patients who are aged over 50
• Thunderclap headache
  
• Rapid time to peak headache intensity (seconds to 5 mins)
  
• Focal neurological symptoms
  
• e.g. limb weakness, aura <5 min or >1 hr
  
• Signs of raised ICP
• Headache that changes with posture
  
• Headache wakening the patient up or worse in morning
• Papilloedema
  
• Accompanied by nausea or vomiting
  
• Visual disturbance
  
• History of trauma
• New onset headache in an immunosuppressed patient
  

Migraine

• Try amitriptyline or propanolol first
• Then topiramate (topomax)
  

Epilepsy - Classification

• Localized (partial or focal onset seizures) or distributed (generalized seizures)
• Partial seizures are further divided on the extent to which awareness is affected
• If it is unaffected, then it is a simple partial seizure
• Otherwise it is a complex partial (psychomotor) seizure
• A partial seizure may spread within the brain - secondary generalization

Notes

• Fingolimod
• Immunomodulating drug, approved for treating multiple sclerosis
• Reduces the rate of relapses in relapsing-remitting multiple sclerosis by over half, but has serious adverse effects
• Sphingosine 1-phosphate receptor modulator
• Sequesters lymphocytes in lymph nodes, preventing them from contributing to an autoimmune reaction
• Acuity
  
• FIRST NUMBER IS ALWAYS 6!
• e.g. 6/12 means they can see at 6 metres what a normal person can see at 12
• Tegretol = Carbamazepine
• Topomax = Topiramate
• Cholesteatoma
• Atonic seizure
• IIH / (BIH)