Final Exam -- Headaches--Part III

Question 1

What is the cause of postherpetic neuralgia?

Answer 1

Herpes zoster virus

Question 2

What are the risk factors for postherpetic neuralgia?

Answer 2

Older age, severity of initial rash and pain, and immunocompromised

Question 3

The pain of postherpetic neuralgia is ___________ (unilateral/bilateral), sharp/stabbing, and affects which branch(es) of the trigeminal nerve?

Answer 3

Unilateral; V1*

Question 4

What is the treatment for postherpetic neuralgia?

Answer 4

Amitriptyline or gabapentin. Capsaicin may help (decreases substance P)

Question 5

Trigeminal autonomic cephalgias (TACs) are headache disorders with _____________ (unilateral/bilateral) trigeminal pain with _____________ (ipsilateral/contralateral) cranial autonomic features. Which headache disorders fit into this category?

Answer 5

Unilateral
Ipsilateral
Cluster headaches, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing (SUNCT)

Question 6

Trigeminal autonomic cephalgias are thought to be due to abnormal hypothalamus and trigeminal activity.

Answer 6

Free card.

Question 7

Cluster headaches feature excruciating unilateral orbital or temporal pain, accompanied by autonomic symptoms. Its overall prevalence is less than 1%. What percentage of patients experience autonomic symptoms? What sorts of autonomic symptoms are they?

Answer 7

97%*; parasympathetic symptoms such as lacrimation, injection, ptosis, miosis, etc.

Question 8

True or false: patients with cluster headaches act restless and agitated.

Answer 8

True*

Question 9

Cluster headache attacks typically occur 1-3 times daily. How quickly do they onset, and how long do they typically last?

Answer 9

Onset is rapid (5 minutes)*, and duration is between 15 minutes to 3 hours

Question 10

Cluster headaches can occur like clockwork* and are common during ________ (sleep/waking).

Answer 10

Sleep*

Question 11

What are some of the triggers for cluster headaches?

Answer 11

Alcohol, smoking, hypoxia

Question 12

What are some of the acute treatment options for cluster headaches?

Answer 12

100% oxygen therapy, subcutaneous or nasal sumatriptan

Question 13

What are some of the chronic treatment options for cluster headaches?

Answer 13

Verapamil or prednisolone with taper

Question 14

Comparing cluster headaches and paroxysmal hemicranias, one of them can switch sides between attacks and the other always affects the same side. Which always affects the same side?

Answer 14

Paroxysmal hemicranias

Question 15

Comparing cluster headaches and paroxysmal hemicranias, one of them can switch sides between attacks and the other always affects the same side. Which can switch sides?

Answer 15

Cluster headaches

Question 16

Paroxysmal hemicranias last 2-30 minutes and typically occur 11-14 times/day. What feature is required to confirm diagnosis?

Answer 16

Resolution in 1-2 days with indomethacin* confirms diagnosis

Question 17

Short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing (SUNCT) last anywhere between 1 to 240 seconds. How often do they occur per day, on average?

Answer 17

60/day, though can be up to 200/day.

Question 18

What is the most common autonomic finding of SUNCT?

Answer 18

Conjunctival injection and lacrimation.

Question 19

What is the acute treatment for SUNCT?

Answer 19

IV lidocaine

Question 20

What is the chronic treatment for SUNCT?

Answer 20

Lamotrigine, occipital nerve stimulation

Question 21

Thunderclap headaches reach maximal intensity even faster than cluster headaches, in a few seconds to less than a minute. How long do thunderclap headaches last?

Answer 21

At least 5 minutes*, up to 10 days.

Question 22

True or false: thunderclap headaches recur regularly and can be unilateral or bilateral.

Answer 22

False; they can indeed be unilateral or bilateral, but they do NOT recur regularly.

Question 23

If a person has experienced a thunderclap headache, you must use CT* and lumbar puncture to rule out what possible underlying causes?

Answer 23

Subarachnoid hemorrhage or ruptured aneurysm.

Question 24

What type of headache is commonly misdiagnosed as due to sinusitis?

Answer 24

Migraine

Question 25

Are sinus headaches typically unilateral or bilateral?

Answer 25

Bilateral*

Question 26

What is the most common cause of sinus headaches?

Answer 26

Viral infection

Question 27

Sinus headaches are considered acute under _____ weeks, and chronic if more than _____ weeks.

Answer 27

Acute: less than 4 weeks; chronic: more than 12 weeks

Question 28

What are the signs and symptoms of a sinus headache?

Answer 28

``` Nasal congestion* Purulent nasal discharge* Tooth pain Facial pain Pressure worse when bending over ```

Question 29

What is the treatment for a viral sinus headache?

Answer 29

Observation, NSAIDs, saline irrigation, decongestants.

Question 30

What is the treatment for a bacterial sinus headache?

Answer 30

Augmentin

Question 31

Headache is the initial complaint in 20% of patients with what condition?

Answer 31

Brain tumor.

Question 32

True or false: the pain of a brain tumor headache comes and goes, is deep and dull, and is worse in the evening.

Answer 32

False; the pain is constant* and is worse upon waking. (But yes, the pain is deep and dull.)

Question 33

What are some of the symptoms in a patient with a brain tumor?

Answer 33

N&V, seizures, focal weakness, headache, changes in personality, visual changes.

Question 34

What are the most common primary intracranial tumors?

Answer 34

Meningiomas, gliomas, pituitary adenomas

Question 35

Where do the most common metastatic tumors arise from?

Answer 35

Lung cancer, breast cancer

Question 36

What are the symptoms of a giant cell arteritis headache?

Answer 36

New headache, scalp tenderness, jaw claudication, sudden vision loss in one eye.

Question 37

Testing for giant cell arteritis includes a temporal artery biopsy*, ESR, and CRP levels*. What ESR level may indicate GCA? How would you calculate ESR for a patient?

Answer 37

ESR over 50 mm/h may indicate GCA; for males, ESR = (age in years)/2; for females it's (age in years+10)/2

Question 38

Testing for giant cell arteritis includes a temporal artery biopsy*, ESR, and CRP levels*. What is a normal CRP level?

Answer 38

Less than 1 mg/dL (or less than 10 mg/L)

Question 39

How would you treat giant cell arteritis?

Answer 39

IV methylprednisolone if vision loss is present, and oral prednisone, and low dose aspirin.

Question 40

Which headaches discussed in class are more common in women?

Answer 40

``` Migraines* Trigeminal neuralgia* Paroxysmal hemicranias* Tension-type Basilar migraines Hemiplegic migraines Retinal migraines Sinus headaches GCA headache ```

Question 41

Which headaches discussed in class are more common in men?

Answer 41

Cluster headaches* | SUNCT*

Question 42

Which headaches discussed in class are typically in older patients (over age 50)?

Answer 42

``` Trigeminal neuralgia* GCA headache (72)* Postherpetic neuralgia ("older age") ``` Sinus headache is from 45-75

Question 43

Which headaches discussed in class are typically in younger patients (under age 50)?

Answer 43

``` Migraines (30-39)* Basilar migraines (7-20) Hemiplegic migraines (12-17) Retinal migraines (under 40) Recurrent painful ophthalmoplegic neuropathy Cluster headaches (27-37) Paroxysmal hemicranias (34-41) SUNCT (48) ``` Sinus headache is from 45-75.