AIM Step 10
4th Year MBBS
Neurosciences-II
4th Year MBBS
Neurosciences-II
Student Memory Support
Migraine, Cluster Headache and Chronic Daily Headache: Clinical Approach and Pharmacotherapy
High-yield memory reinforcement for rapid KMU examination revision.
1. High-Yield Flashcards
Tap each question to reveal the answer.
Which headache pattern is typically unilateral, pulsating and associated with nausea, photophobia or phonophobia?
Migraine.
What clinical combination strongly suggests cluster headache?
Severe unilateral orbital or temporal pain with ipsilateral autonomic features and marked restlessness.
How is tension-type headache commonly described?
Bilateral pressing or tightening pain, usually without prominent cranial autonomic symptoms.
What is meant by migraine aura?
A fully reversible neurological symptom, commonly a visual disturbance, occurring before or around the headache.
Which serotonin receptors are the main targets of sumatriptan?
5-HT1B and 5-HT1D receptors.
How does sumatriptan reduce migraine pain?
It reduces trigeminal neuropeptide release and produces cranial vasoconstriction.
What are the main clinical uses of sumatriptan in this topic?
Acute migraine and acute cluster headache.
Which serious adverse effect makes triptans important to avoid in significant ischemic vascular disease?
Coronary or other vascular vasospasm causing ischemia.
What major pharmacological effect explains both the benefit and toxicity of ergotamine?
Prolonged vasoconstriction.
What is ergotism?
Severe ergot toxicity characterized by excessive vasoconstriction that may cause peripheral ischemia and tissue injury.
Which β-blocker is an important prototype for migraine prophylaxis?
Propranolol.
Which antiepileptic preventive drug commonly causes paresthesia, cognitive slowing and weight loss?
Topiramate.
Which preventive drug may be useful when migraine coexists with poor sleep or tension-type headache features?
Amitriptyline.
Which drug is an important preventive treatment for cluster headache?
Verapamil.
Which headache features should make the clinician think of a dangerous secondary cause?
Sudden onset, focal deficit, altered consciousness, seizure, papilledema, systemic illness or a progressive change in pattern.
2. Mnemonics
Mnemonic Title
Migraine Prophylaxis
Mnemonic Word
PATF
Meaning
Propranolol • Amitriptyline • Topiramate • Flunarizine
Mnemonic Title
Cluster Headache Clues
Mnemonic Word
ORT
Meaning
Orbital unilateral pain • Restlessness • Tearing with autonomic symptoms
Mnemonic Title
Major Headache Red Flags
Mnemonic Word
SNAP
Meaning
Sudden onset • Neurological deficit • Altered consciousness/seizure • Papilledema/progressive pattern
3. Memory Tables
Migraine vs Cluster vs Tension-Type Headache
| Feature | Migraine | Cluster | Tension-Type |
|---|---|---|---|
| Pain | Often unilateral, pulsating | Severe unilateral orbital/temporal | Usually bilateral, pressing |
| Associated clue | Nausea, photophobia, phonophobia | Tearing, nasal symptoms, ptosis/miosis | Prominent autonomic signs absent |
| Behavior | Prefers rest | Restless or agitated | Routine activity often possible |
| Key acute therapy | Analgesic/NSAID or triptan | Rapid triptan or oxygen | Simple analgesic/NSAID when appropriate |
Triptans vs Ergotamine
| Feature | Triptans | Ergotamine |
|---|---|---|
| Main action | Selective 5-HT1B/5-HT1D agonism | Broader serotonergic and adrenergic actions |
| Role | Acute migraine; acute cluster headache | Older acute migraine treatment |
| Key caution | Ischemic cardiovascular/cerebrovascular disease | Vascular disease and pregnancy |
| Major toxicity | Vasospasm and ischemia | Ergotism with prolonged ischemia |
4. Rapid Revision Points — Last-Minute Revision
Must Remember:
- Migraine commonly produces pulsating headache with nausea and sensitivity to light or sound.
- Cluster headache combines severe unilateral orbital pain with ipsilateral cranial autonomic features.
- Restlessness favors cluster headache; preference for quiet rest favors migraine.
- Sumatriptan acts mainly through 5-HT1B/5-HT1D receptors.
- Triptans treat acute attacks; they are not routine daily migraine prophylaxis.
- Ergotamine can cause severe prolonged vasoconstriction and ergotism.
- Propranolol, topiramate, valproate and amitriptyline are important migraine preventive drugs.
- Verapamil is an important preventive drug for cluster headache.
- Frequent use of acute headache medication can perpetuate chronic headache.
- New neurological deficits, papilledema, systemic illness or a major change in headache pattern require assessment for a secondary cause.
Common KMU Trap:
Stress or anxiety may worsen chronic tension-type headache, but their presence does not justify labelling a changed or unexplained headache as purely psychological.
5. Clinical Memory Hooks
Severe unilateral orbital pain + tearing + restlessness
→
Cluster headache pattern.
→
Cluster headache pattern.
Migraine attack treated with sumatriptan
→
5-HT1B/5-HT1D activation reduces trigeminal signaling and causes cranial vasoconstriction.
→
5-HT1B/5-HT1D activation reduces trigeminal signaling and causes cranial vasoconstriction.
Cold painful extremities after repeated ergotamine
→
Excessive vasoconstriction suggests ergot toxicity.
→
Excessive vasoconstriction suggests ergot toxicity.
Persistent headache + frequent acute medication use
→
Consider medication use as a factor maintaining chronic daily headache.
→
Consider medication use as a factor maintaining chronic daily headache.
6. Starred High-Yield Exam Points
- ⭐ Sumatriptan is a 5-HT1B/5-HT1D agonist used for acute migraine and acute cluster headache.
- ⭐ Significant ischemic cardiovascular or cerebrovascular disease is an important caution for triptan therapy because of vasoconstriction.
- ⭐ Ergotamine toxicity can produce ergotism with severe peripheral vasoconstriction and ischemia.
- ⭐ Propranolol is a prototype migraine preventive drug but may be unsuitable in patients with asthma or marked bradycardia.
- ⭐ Verapamil is an important preventive drug for cluster headache.
- ⭐ A new focal neurological deficit, papilledema or sudden major change in headache pattern should trigger assessment for a secondary cause rather than routine primary-headache treatment.