CHAPTER 1 3 HEADACHE

Question 1

what are the two types of headache?

Answer 1

primary and secondary headache

Question 2

causes of primary headache

Answer 2

tension-type
migraine
idiopathic stabbing
exertional
cluster

Question 3

causes of secondary headache

Answer 3

systemic infection
head injury
vascular disorder
subarachnoid hemorrhage
brain tumor

Question 4

it is a type of headache in which the headache and its associated symptoms is the disorder itself

Answer 4

primary headache

Question 5

type of headache where it is caused by exogenous disorder

Answer 5

secondary headache

Question 6

pain occurs when?

Answer 6

peripheral nociceptors are stimulated in response to tissue injury, visceral distension or other factors

Question 7

what are the cranial structures that are pain producing

Answer 7

scalp
meningeal arteries
dural sinuses
falx cerebri
proximal segments of the large pial arteries

Question 8

what are the cranial structures that are not pain producing?

Answer 8

ventricular ependyma
choroid plexus
pial viens
brain parenchyma

Question 9

key structures that involved in primary headache

Answer 9

large intracranial vessels
dura mater
peripheral terminals of trigeminal nerve
caudal portion of the trigeminal nerve
rostral pain processing regions such as the ventroposteromedial thalamus and cortex
pain modulatory systems such as hypothalamus and brainstem structures

Question 10

what do you call the innervation of large intracranial vessels and the dura mater by the trigeminal nerve

Answer 10

trigeminovascular system

Question 11

examples of cranial symptoms that may suggest trigeminal autonomic cephalagias

Answer 11

lacrimation
conjunctival injection
nasal congestion
rhinorrhea
periorbital swelling
aural fullness
ptosis

Question 12

What are the symptoms of the headache that suggest that a serious underlying disorder

Answer 12

sudden onset headache
first severe headache
worst headache ever
vomiting that precedes the headache
subacute worsening over days or weeks
pain induced by bending, lifting, cough
pain that disturbs sleep or presents immediately  upon awakening
known systemic illnesses
onset after age 55
fever or unexplained systemic signs
abnormal neurologic symptoms
pain associated with local tenderness

Question 13

what is the essential first step in the evaluation

Answer 13

careful neurologic examination

Question 14

history of recent-onset headache should be evaluated by?

Answer 14

computed tomography

magnetic resonance imaging

Question 15

general evaluation of acute headache includes the?

Answer 15

cranial arteries by palpation
cervical spine by the effect of passive movement of the head and by imaging the investigation of cardiovascular
renal status by blood pressure monitoring and urine examination
eyes by funduscopy
intraocular pressure measurement and refraction

Question 16

what other aspect should be included in the physical examination?

Answer 16

psychological assessment because there is relationship between pain with anxiety and depression

Question 17

what is quiescent migraine syndrome?

Answer 17

when recurrent headache is activated by pain that follows otologic or endodontic surgical procedures

Question 18

brain tumor is a rare cause of headache

Answer 18

True

Question 19

treatment of secondary headache focuses on?

Answer 19

treatment of underlying condition

Question 20

what do acute severe headache with stiff neck and fever suggest?

Answer 20

meninigitis

Question 21

how do you diagnose meningitis?

Answer 21

lumbar puncture

Question 22

in meningitis is there is striking accentuation of pain with eye movement?

Answer 22

yes

Question 23

meningitis is easily mistaken for migraine when there is associated symptoms such as?

Answer 23

pounding headache
photophobia
nausea
vomitting

Question 24

what do acute, maximal in <5 mins, severe headache lasting >5 min with stiff neck without fever suggets?

Answer 24

intracranial hemorrhage

Question 25

if the intracranial hemorrhage is small what would be the result of CT scan and how to confirm it?

Answer 25

CT scan may be normal and LP is used to confirm

Question 26

head pain in tumor is characterized as?

Answer 26

intermittent deep, dull aching of moderate intensity, which may be worsen during exertion and associated with nausea and vomitting

Question 27

vomitting that precedes the appearance of headaches by weeks is characteristic of?

Answer 27

posterior fossa brain tumors

Question 28

history of amenorrhea or galactorrhea with head pain is suggestive of?

Answer 28

prolactin-secreting pituitary adenoma

Question 29

headache in patient with known malignancy is suggestive of

Answer 29

cerebral metastasis | carcinomatous meningitis

Question 30

headache appearing abruptly after bending, lifting, or coughing can be suggestive of

Answer 30

posterior fossa mass chiara malformation low cerebrospinal fluid volume

Question 31

what do you call the inflammatory disorder of arteries that frequently involves the extracranial carotid circulation

Answer 31

temporal (giant cell) arteritis

Question 32

incidence of temporal (giant cell) arteritis

Answer 32

a common disease in elderly >50 woman> men

Question 33

untreated temporal arteritis can lead to?

Answer 33

blindless

Question 34

pathophysiology of blindness in untreated temporal arteritis

Answer 34

involvement of ophthalmic artery and its branches

Question 35

treatment for temporal arteritis

Answer 35

glucocorticoids

Question 36

what are the typical symptoms of temporal arteritis

Answer 36

``` headache polymyalgia rheumatica jaw claudication fever weight loss ```

Question 37

dominant symptom?

Answer 37

headache associated with malaise and muscle aches

Question 38

what is the quality of pain in px with temporal arteritis?

Answer 38

throbbing dull and boring superimposed episodic stabbing pains similar to sharp pains that appear in migraine

Question 39

pertinent finding in physical examination in px with temporal arteritis

Answer 39

scalp tenderness | brushing of hair or resting the head on a pillow is not possible

Question 40

what could worsen the headache and aggravate?

Answer 40

nightime and exposure to cold

Question 41

additional findings in pe in px with temporal artheritis

Answer 41

reddened, tender nodules | red streaking of the skin

Question 42

diagnosis of temporal arteritis

Answer 42

erythrocyte sedimentation rate and temporal biopsy

Question 43

treatment for temporal arteritis

Answer 43

prednisione 80 mg daily for the first 4 to 6 weeks

Question 44

characteristic of headache in glaucoma px

Answer 44

prostrating headache associated with severe eye pain

Question 45

physical examination findings in px with glaucoma

Answer 45

eyes is red with fixed moderately dilated pupil

Question 46

when can we say that it is chronic headache?

Answer 46

15 days or more per month

Question 47

treatment for chronic headache

Answer 47

treat the underlying illness give tricylics such as amitriptyline or nortiptyline (1kg) and given 12 hr before the expected time of awakening to prevent excess morning sleepiness

Question 48

what is medication over-use headache

Answer 48

overuse of analgesic medication for headache can aggravate headache

Question 49

how to manage a medication overuse in outpatient?

Answer 49

reduce the medication and practice medication diary

Question 50

how to manage overuse of medication in inpatient?

Answer 50

acute medications are withdrawn and the px must be hydrated well

Question 51

what is the clinical manifestation of new daily persistent headache?

Answer 51

the px can recall the moment of onset

Question 52

what is the most common cause of new daily persistent headache

Answer 52

subarachnoid hemorrhage

Question 52

what is the most common cause of new daily persistent headache

Answer 52

subarachnoid hemorrhage

Question 53

what is the characteristic of low CSF volume headache?

Answer 53

head pain is positional | begins when the px is sitting upright and resolves upon reclining

Question 54

what is the gold standard diagnosis for low CSF headache

Answer 54

MRI with gadolinium

Question 55

initial treatmet for CFS volume

Answer 55

bed rest | with persistent pain, you can give IV caffeine

Question 56

characteristic of head pain in raised CSF pressure headache

Answer 56

chronic migraine | history of generalized of headache that is present in walking and improves as the day goes on

Question 57

how can you diagnose a raised intracranial pressure?

Answer 57

visual obscurations

Question 58

treatment for raised intracranial pressure

Answer 58

acetazolamide (250-500 mg bid)