Headache

Question 1

Compare primary and secondary headaches in terms of total percentage of headaches, periodicity, pathology, and presence of red flag symptoms.

Answer 1

Primary: 90% of headaches, Recurrent, No underlying pathology, No red flag symptoms. Secondary: 10% of headaches, Constant, Underlying intracranial or systemic pathology, Red flag symptoms may be present.

Question 2

What are the five Red Flag Symptoms to look for in headaches?

Answer 2

SNOOP!! Systemic symptoms (Fever, weight loss), neurologic symptoms (Confussion, Altered LOC), onset (Sudden, abrupt), older (>50yr, GCA), previous headache history (Change in freq, intensity…)

Question 3

What are the criteria for diagnosing migraines?

Answer 3

1 - at least 5 episodes; 2 - 4-72 hour duration; 3 - At least 2 (Unilateral, pulsating, mod-severe, inc w/ physical activity); 4 - At least 1 (Vomiting, nausea, photo or photophobia); 5 - Exclusion of other possibilities

Question 4

What are the criteria for diagnosing an aura?

Answer 4

1 - At least 2 episodes; 2 - Reversible symptom of visual, sensory, language, motor, brainstem, or retina; 3 - 1 or more: homonymous visual field, unilateral sensory change, gradual onset >5min, duration 5 - 60 min.

Question 5

What are the criteria for diagnosing tension-type headaches?

Answer 5

1 - 10 episodes; 2 - 30min - 7day duration; 3 - 2 or more: pressing/tightening, mild-mod intensity, bilateral, not aggravated by phys. act. 4 - no nausea/vomiting 5 - possible photo/phonophobia

Question 6

What are the criteria for diagnosing cluster headaches?

Answer 6

1 - 5 episodes; 2 - severe, unilateral periorbital or temporal; 3 - 15-180min duration; 4 - Freq: every other day to 8x/day; 5 - 1 of: conjunctival injection, lacrimation, nasal congestion, rhinorrhea, eyelid edema, ptosis, myosis, facial swelling, ear fullness, agitation/restless

Question 7

What are the signs and symptoms of meningitis?

Answer 7

Headache, fever, stiff neck, nausea/vomiting, altered consciousness, Kernig/Brudzinski signs (pain with bending spine)

Question 8

What are the signs, symptoms, and common causes of subarachnoid hemorrhage?

Answer 8

Sudden, incapacitating headache, stiff neck, photophobia, N/V, altered consciousness/obtundation; Signs: starfish pattern on CT/MRI; Causes: Trauma, ruptured aneurysm, arteriovenous malformation

Question 9

What are the signs and symptoms of Giant Cell Arteritis?

Answer 9

Headache in older (>50yo) population; Associated with: Jaw claudication, temporal artery tenderness, vision loss, joint pain, Constitutional symptoms (fever, malaise, weight loss)

Question 10

What are the signs and symptoms of elevated ICP?

Answer 10

Exertional headache, retrobulbar pain, N/V, pulsatile intracranial noises, transient visual obscurations, Photopsia, diplopia, vision loss; Signs: Papilledema (loss of definition of veins in eye)

Question 11

What is abortive treatment for migraine headaches?

Answer 11

Aspirin, NSAIDs, Combination NSAIDs/Caffeine/Aspirin, Triptans, Ergotamine derivatives

Question 12

What is preventive treatment for migraine headaches?

Answer 12

B-Blockers, CCB, Tricyclic antidepressants, Anti-epileptics; Sleep, Botox injections for chronic migraine only, B2, Magnesium, Butterbur

Question 13

What is abortive treatment for tension-type headaches?

Answer 13

Aspirin, Acetaminophen, NSAIDs

Question 14

What is preventive treatment for tension-type headaches?

Answer 14

Tricyclic antidepressants, SSRIs, Physical therapy, psychotherapy

Question 15

What is abortive treatment for cluster headaches?

Answer 15

Oxygen, triptan injections, Ergots

Question 16

What is transitional and preventive treatment for cluster headaches?

Answer 16

Transitional: Steroids, nerve blocks; Preventive: CCB, lithium, Antiepileptics