Headache and Seizures for NEET PG Medicine: Migraine, Cluster, IIH, Red Flags, Epilepsy Drugs, Status Epilepticus

Start Here

🎯 Exam priority: High. Expect: migraine features and ICMR drugs, triptan contraindications, medication-overuse headache, cluster headache features and oxygen, IIH profile, headache red flags, epilepsy definition and when to treat one seizure, absence and JME, drug adverse effects (phenytoin, carbamazepine, valproate), valproate and folic acid in women, status epilepticus timeline and doses.

CBME mapping: GM 17.1–17.14 (headache) and GM 20.1–20.5 (seizures). SAH is in article 22; meningitis in article 11; antiseizure pharmacology in Pharmacology; febrile seizures in Paediatrics.

Headache types and red flags, epilepsy drugs and status epilepticus. Drawn by TrackNation.

Headache

• Migraine: 4–72 h, often unilateral and throbbing, worse with exertion, with nausea and photophobia; aura in ~25%. ICMR acute: paracetamol 650 mg or indomethacin 50 mg with prochlorperazine 10 mg; prophylaxis if > 2 attacks/month — propranolol 40 mg or flunarizine 10 mg for 2 months; lifestyle (≥ 6 h sleep, avoid triggers). MSD adds triptans, DHE, amitriptyline, topiramate. Triptans/DHE are contraindicated in CAD or uncontrolled hypertension; overuse causes medication-overuse headache.

• Tension-type: bilateral, band-like, spreads over the head; no nausea or vomiting. Chronic: amitriptyline 10 mg at night (ICMR).

• Cluster headache: periorbital/temporal pain with ipsilateral ptosis, lacrimation, rhinorrhoea; alcohol triggers attacks in a cluster. Acute: oxygen, parenteral triptan or DHE; prevent with verapamil or lithium. ICMR: indomethacin 25 mg TID for other trigeminal autonomic cephalalgias.

• IIH: mostly women with obesity; headache, transient visual obscurations, diplopia (VI nerve), pulsatile tinnitus, papilloedema; high opening pressure with normal CSF; acetazolamide or topiramate, weight loss — lost vision rarely returns.

• Red flags (ICMR): first or worst headache, thunderclap onset, fever with neck stiffness, focal signs, altered consciousness, headache waking from sleep, new headache in pregnancy/postpartum, cancer or immunosuppression → imaging and referral. CVT is treated with heparin.

Epilepsy and Antiseizure Drugs

• Epilepsy: ≥ 2 unprovoked seizures > 24 h apart (a single seizure is not epilepsy). ICMR: treat epilepsy; treat a single seizure if recurrence risk is high (focal seizures, neurological deficit, abnormal EEG or imaging, family history). Start one broad-spectrum drug, low and slow. Differentiate from syncope and psychogenic events.

• Generalised seizures: absence, tonic-clonic, others; focal with preserved or impaired awareness. Juvenile myoclonic epilepsy: adolescent onset, myoclonic, tonic-clonic and absence seizures. Absence: ethosuximide, valproate or lamotrigine first-line. Todd paralysis is a transient post-ictal weakness.

• Adverse effects (ICMR): valproate — weight gain, tremor, hair loss, PCOS, thrombocytopenia; carbamazepine/oxcarbazepine — hyponatraemia, rash, SJS; phenytoin — gum hyperplasia, coarse facies, hirsutism, osteomalacia.

• Women: avoid valproate and polytherapy; folic acid 5 mg/day in all women of child-bearing age. Carbamazepine, phenytoin and valproate carry relatively high teratogenic risk.

• Safety: avoid driving, swimming, heights and bathing in a tub until seizures are controlled (often > 6 months).

Traps the Examiner Sets

• No triptans in coronary disease or uncontrolled hypertension.

• Cluster headache: oxygen; IIH: acetazolamide.

• Status epilepticus clock starts at 5 minutes; benzodiazepine first.

• Phenytoin IV no faster than 50 mg/min.

• Valproate is avoided in women of child-bearing age unless others fail.

Memory Hooks & Shortcuts

Shortcuts to lock in this article's numbers and lists. Each one only re-packages facts proven above.

• 🧠 Migraine 'POUND': Pulsatile, One-day (4–72 h), Unilateral, Nausea, Disabling — migraine

• 🧠 Cluster: 'Oxygen for the eye that cries' — cluster headache

• 🧠 IIH: 'Fat, Fertile female, Fuzzy discs' — IIH

• 🧠 Status epilepticus '5-30-60': impending, established, refractory — SE timeline

• 🧠 Phenytoin: 'Twenty per kilo, Fifty per minute' — phenytoin dose

• 🧠 Valproate in women: 'Avoid unless all else fails' — valproate

Rapid-Revision Cards

• Migraine

  Unilateral throbbing 4–72 h; aura ~25%.

• ICMR migraine acute

  Paracetamol 650 / indomethacin + prochlorperazine.

• ICMR prophylaxis

  > 2/month: propranolol 40 or flunarizine 10 × 2 mo.

• Triptan CI

  CAD, uncontrolled HTN.

• MOH

  Overused triptans/analgesics.

• Tension-type

  Bilateral band; no nausea; amitriptyline 10 mg.

• Cluster

  Orbital pain + tearing, ptosis; O2, triptan; verapamil.

• IIH

  Obese women; papilloedema; VI palsy; acetazolamide.

• Headache red flags

  Thunderclap, fever + neck stiffness, focal signs, pregnancy, immunosuppression.

• CVT

  Heparin.

• Epilepsy

  ≥ 2 unprovoked seizures > 24 h apart.

• Treat single seizure

  If high recurrence risk.

• JME

  Teen; myoclonic + GTC + absence.

• Absence drugs

  Ethosuximide, valproate, lamotrigine.

• Todd paralysis

  Post-ictal weakness.

• Phenytoin AE

  Gum hyperplasia, hirsutism, coarse facies.

• CBZ/OXC AE

  Hyponatraemia, SJS.

• Valproate AE

  Weight gain, tremor, PCOS, low platelets.

• Women with epilepsy

  Avoid valproate/polytherapy; folate 5 mg.

• Status epilepticus

  > 5 min.

• SE step 1

  IV lorazepam 0.1 mg/kg (home: buccal/IN midazolam).

• SE step 2

  Phenytoin 20 mg/kg ≤ 50 mg/min; or valproate/levetiracetam.

• Refractory SE

  60 min, 2 drugs failed → ICU anaesthetic agents.

Sources

Facts in this article were checked against these documents.

• Standard Treatment Workflows: Management of Headache; Management of Epilepsy — Indian Council of Medical Research, DHR, 2019 (link)

• MSD Manual Professional: Migraine; Tension-Type Headache; Cluster Headache; Idiopathic Intracranial Hypertension; Seizure Disorders; Antiseizure Medications — Merck & Co. (MSD Manuals), reviewed 2025–26 (link)

• Competency Based Undergraduate Curriculum, General Medicine (GM 17, GM 20) — National Medical Commission, 2024

Test Yourself: Practice Questions

Thirty questions in NEET PG style, most of them clinical vignettes.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. A woman has recurrent unilateral throbbing headaches lasting a day with nausea and photophobia, worse on exertion. The diagnosis is

• (a) trigeminal neuralgia

• (b) tension-type headache

• (c) migraine

• (d) cluster headache

Q2. Per ICMR, migraine prophylaxis is started when attacks occur more than

• (a) 1 per year

• (b) never

• (c) 10 per day

• (d) 2 per month — propranolol 40 mg or flunarizine 10 mg

Q3. ICMR acute treatment of a migraine attack at PHC level is

• (a) IV morphine

• (b) oral steroids

• (c) oxygen

• (d) paracetamol 650 mg (or indomethacin) with prochlorperazine 10 mg

Q4. Triptans are contraindicated in a migraine patient with

• (a) hypothyroidism

• (b) asthma

• (c) iron deficiency

• (d) coronary artery disease

Q5. A patient taking triptans most days develops daily headaches. The likely cause is

• (a) medication overuse headache

• (b) sinusitis

• (c) brain tumour

• (d) cluster headache

Q6. Bilateral band-like headache spreading over the whole head without nausea or vomiting is

• (a) IIH

• (b) migraine

• (c) cluster headache

• (d) tension-type headache

Q7. A man has recurrent attacks of severe pain around one eye with ipsilateral tearing, ptosis and rhinorrhoea for weeks. The acute treatment is

• (a) oxygen inhalation or a parenteral triptan

• (b) paracetamol only

• (c) acetazolamide

• (d) carbamazepine

Q8. During a cluster period, which substance commonly triggers attacks?

• (a) alcohol

• (b) coffee withdrawal only

• (c) sugar

• (d) milk

Q9. A woman with obesity has daily headache, transient visual obscurations, pulsatile tinnitus and bilateral papilloedema; MRI is normal. The next test and treatment are

• (a) EEG; valproate

• (b) LP showing high opening pressure with normal CSF; acetazolamide

• (c) nothing; reassure

• (d) CT angiography; nimodipine

Q10. Diplopia in idiopathic intracranial hypertension is due to dysfunction of cranial nerve

• (a) VI

• (b) IV

• (c) III

• (d) VII

Q11. The main danger of untreated IIH is

• (a) permanent visual loss

• (b) stroke

• (c) hearing loss

• (d) hydrocephalus

Q12. Per ICMR, a headache red flag needing urgent imaging is

• (a) headache relieved by sleep

• (b) known migraine with usual aura

• (c) bilateral pressure for years

• (d) sudden thunderclap headache

Q13. Cerebral venous thrombosis presenting with headache is treated with

• (a) steroids

• (b) thrombolysis always

• (c) triptans

• (d) heparin (UFH or LMWH)

Q14. Epilepsy is defined as

• (a) seizures with hypoglycaemia

• (b) two seizures from fever

• (c) ≥ 2 unprovoked seizures occurring more than 24 hours apart

• (d) any single seizure

Q15. Per ICMR, after a single unprovoked seizure, antiseizure medication is started if

• (a) always

• (b) never

• (c) recurrence risk is high (focal seizure, deficit, abnormal EEG or imaging, family history)

• (d) only if aged over 60

Q16. A 15-year-old has myoclonic jerks, occasional tonic-clonic seizures and absences. The syndrome is

• (a) West syndrome

• (b) Lennox–Gastaut syndrome

• (c) juvenile myoclonic epilepsy

• (d) temporal lobe epilepsy

Q17. First-line monotherapy for typical absence seizures includes

• (a) carbamazepine

• (b) oxcarbazepine

• (c) ethosuximide, valproate or lamotrigine

• (d) phenytoin

Q18. After a focal motor seizure of the right arm, the arm stays weak for some hours and recovers. This is

• (a) functional weakness

• (b) Todd paralysis

• (c) stroke

• (d) myasthenia

Q19. Gum hyperplasia, coarse facial features and hirsutism are adverse effects of

• (a) lamotrigine

• (b) phenytoin

• (c) levetiracetam

• (d) ethosuximide

Q20. A patient on carbamazepine for focal epilepsy becomes confused with Na 122 mmol/L. The cause is

• (a) status epilepticus

• (b) carbamazepine-induced hyponatraemia

• (c) valproate toxicity

• (d) SIADH from tumour only

Q21. Weight gain, tremor, hair loss and polycystic ovaries are adverse effects of

• (a) phenytoin

• (b) sodium valproate

• (c) carbamazepine

• (d) levetiracetam

Q22. Per ICMR, in a 24-year-old woman with generalised epilepsy, valproate should be

• (a) given only in pregnancy

• (b) avoided unless other drugs fail

• (c) combined with two other drugs

• (d) first choice

Q23. All women of child-bearing age on antiseizure drugs should take

• (a) iron 200 mg/day

• (b) folic acid 5 mg/day

• (c) vitamin K daily

• (d) nothing extra

Q24. A tonic-clonic seizure lasting more than how long is treated as status epilepticus (impending) per ICMR?

• (a) 5 minutes

• (b) 24 hours

• (c) 60 minutes

• (d) 30 seconds

Q25. The first drug in the emergency department for status epilepticus per ICMR is

• (a) propofol infusion

• (b) oral valproate

• (c) IV phenytoin

• (d) IV lorazepam up to 0.1 mg/kg at 2 mg/min

Q26. A child is having a prolonged seizure at home with no IV access. The ICMR option is

• (a) wait for the seizure to stop

• (b) oral phenytoin

• (c) IM phenobarbitone only

• (d) buccal or intranasal midazolam

Q27. After a benzodiazepine, phenytoin for status epilepticus is given as

• (a) 20 mg/kg IV at no more than 50 mg/min

• (b) 1 g IM

• (c) 100 mg orally

• (d) 5 mg/kg as rapid bolus

Q28. Refractory status epilepticus in the ICMR workflow means

• (a) any seizure > 5 min

• (b) two seizures in a day

• (c) seizures continuing at 60 minutes after a benzodiazepine and an IV antiseizure drug fail

• (d) seizure with fever

Q29. A known alcohol user arrives in status epilepticus. Along with benzodiazepines, give

• (a) thiamine and glucose

• (b) insulin

• (c) naloxone

• (d) flumazenil

Q30. A patient with newly diagnosed epilepsy asks about driving and swimming. Advice is

• (a) never again for life

• (b) no restrictions

• (c) only avoid swimming

• (d) avoid them until seizures are controlled (often > 6 months)

Active Recall

From memory: describe migraine and its ICMR acute and preventive treatment, triptan cautions, tension-type and cluster headache, IIH and headache red flags, define epilepsy and when to treat a first seizure, list adverse effects of phenytoin, carbamazepine and valproate, advice for women, and the ICMR status epilepticus steps with doses.