9: Headache

Question 0

Status migrainosus

Answer 0

A debilitating migraine attack lasting for more than 72 hrs

Question 1

Primary headache

Answer 1

Migraine
Tension-type headache
Cluster headache
Paroxysmal hemicrania
Primary cough headache
Primary headache associated with sexual activity
Hemicrania continua

Question 2

Chronic migraine

Answer 2

Migraine headache occurring on 15 or more days per month for more than 3 months

Question 3

Persistent aura without infarction

Answer 3

aura sx persist for more than 1 week without radiographic evidence of infarction

Question 4

Migraine triggered seizure

Answer 4

One type of epileptic attack occurs during or within 1hr after a migraine aura

Question 5

Childhood periodic syndrome

Answer 5

1: cyclic vomiting
2: abdominal migraine
3: Benign paroxysmal vertigo of childhood

Question 6

Abdominal migraine

Answer 6

an idiopathic recurrent disorder seen mainly in children and characterized by episodic midline abdominal pain manifesting in attacks lasting 1-72hrs with normally btw episodes. At least 5 attacks should have occurs

Question 7

Cyclic vomiting

Answer 7

recurrent episodic attacks of vomiting and intense nausea lasting from 1hr to 5days. Attacks are associated with pallor and lethargy. There is complete resolution of sx btw attacks. At least 5 attacks

Question 8

Migraine without aura- dx

Answer 8

• at least 5 attacks
• headache lasting 4-72hrs
• at least 2 of following (characteristic of headache)
• -unilateral location
• -pulsating quality
• -moderate or severe pain intensity
• -aggravation by or causing avoidance of routine physical activity
• during headache at least 1
• -nausea and/or vomiting
• -photophobia and phonophobia

Question 9

Migraine with aura

Answer 9

Aura- lasting 5-60mins
-fully reversible..
visual sx
sensory sx
dysphasic speech disturbance

Question 10

Familial hemiplegic migraine (FMH)

Answer 10

presents with transient hemiplegia during aura

• Ophthalmoplegia- double vision
• Strabismus- paralysis of EOMs

Question 11

Basilar migraine**

Answer 11

Visual field disturbances, cerebbellar signs (ataxia, dysarthria)
Cranial nerve involvement (vertigo)
Sensory and motor involvement

Question 12

Bickerstaff’s migraine

Answer 12

basilar migraine in adolescent females
-Total blindness*, accompanied by admixture of vertigo, ataxia, dysarthria, tinnitus, perioral paresthesia, and occasional confusional state

Question 13

Migraine -non-pharmacological tx

Answer 13

identify and remove triggering factors
-alcohol
-food
-hunger
-irregular sleep patterns
-organic odors
-sustained exertion
-glare, flashing light
-acute stress
avoid environmental factors
-time zone shift, weather changes, pressure changes
Menstrual cycle

Question 14

Migraine- pharm tx- acute

Answer 14

NSAIDS
Triptans* (DOC, selective 5HT1 agonist, contraindicated in pts with CVD*)
Ergotamine, dihydroergotamine (non selective 5HT1)
Metoclopromide, prochlorperazine (DA antagonists)
Narcotic analgesics

Question 15

Migraine- prophylactic tx

Answer 15

Indication: 3 or more attacks a month

• beta blocker: propranolol*
• Ca channel blocker: Flunarizine*
• 5HT agonist: methysergide, cyproheptadine
• anticonvulsants: sodium valproate

Question 16

Tension type headache

Answer 16

Headache- bilateral, tight, band like pain (not throbbing)
No nausea or vomiting
No prodrome
Not aggravated by physical activity
Frontal-occipital location

Question 17

Tension type headache- tx

Answer 17

Relaxation
NSAIDS
Prophylactic: TCA anti-depressants (Aitriptyline, Doxepin, Nortriptyline)

Question 18

Cluster headache-info

Answer 18

Sudden periorbital or temporal pain
unilateral
Reaches crescendo within 5mins
Lasts 30mins-2hr
associated with
-homolateral lacrimation
-reddening of eye and nasal congestion
-ptosis
-nausea
Alcohol provokes (70%)
Nocturnal (50%; awakens pt within 2hrs of falling asleep)
Periodic (occur at the same hour everyday)

Question 19

Cluster headache- tx

Answer 19

100% oxygen mask for 15min** (abortive)
Sumatriptan
Prednisone
Lithium
Ergotamine

Question 20

Chronic paroxysmal hemicrania

Answer 20

brief, severe unilateral orbital, supraorbital or temporal throbbing pain
Lasts 2-45mins*
At least 50 attacks a day
Pain with at least one of following
-1: conjunctival injection, 2: lacrimation, 3: nasal congestion, 4: rhinorrhea, 5: ptosis, 6: eyelid edema

Question 21

Chronic paroxysmal hemicrania- tx

Answer 21

Indomethacin (150mg daily or less): absolutely effective***

Question 22

Cough headache

Answer 22

headache on coughing, bending, sneezing, lifting
MRI is usually indicated to rule out structural anomalies/ brain tumor
-Chiari malformation

Question 23

sx associated with SERIOUS underlying cause of headache

Answer 23

• worst headache ever
• first severe headache
• ‘Thunderclap’ headache
• Subacute worsening over days or weeks
• Abnormal neurological exam
• Fever or unexplained systemic signs
• Vomiting precedes headache
• Induced by bending, lifting, coughing
• Disturbs sleep or present immediately upon wakening
• Known systemic illness
• Onset age after 55yrs

Question 24

Headache- brain tumor/ space occupying lesion (SOL)

Answer 24

may worsen with exertion and change in position pain appear with bending, lifting, coughing-> posterior fossa tumor early morning headache that improves with day* Unilateral papilledema

Question 25

Temporal arteritis

Answer 25

Headache- worse at night and on exposure to cold Tenderness and redness over temporal arteries Loss of vision or impaired vision Polymyalgia rheumatica* Jaw claudication* (pain with chewing) Bx: dx Tx: prednisone 4-6 weeks

Question 26

Acute glaucoma

Answer 26

IOP>21mmHg Pathological cupping of optic disc Loss of field of vision

Question 27

Acute glaucoma- tx

Answer 27

- Block aqueous production: Timolol*, Acetazolamide* - Reduced vitreous volume: oral glycerol, mannitol - Facilitate aqueous outflow: pilocarpine* - surgical: Iridotomy

Question 28

Acute sinusitis

Answer 28

Pain or tenderness over sinuses dx- CT shows mucosal thickening tx- decongestants (Pseudoephedrine)

Question 29

Idiopathic intracranial hypertension (IIH)(Pseudotumor cerebri)

Answer 29

Increased ICP without any evidence of brain path associated with VitaminA, Nalidixic acid, Danazol, Steroid withdrawal Tx: Acetazolamide, Corticosteroids, Furosemide, CSF shunt (Ventriculoperitoneal shunt)

Question 30

Analgesic rebound headache- tx

Answer 30

Stop analgesics | Hydroxyzine*

Question 31

Trigeminal neuralgia- tx

Answer 31

Carbamazapine* Radiofrequency ablation of a portion of the trigeminal ganglion Anesthetic blocks

Question 32

Headache after Lumber Puncture

Answer 32

Increases on sitting and standing and decreases on reclining and on increasing abdominal pressure

Question 33

Headache after Lumbar Puncture- tx

Answer 33

if pain persists - Caffeine sodium benzoate** - Epidural blood patch (if CSB fails)