Headache

Question 1

What red flag condition(s) are you worried about with an acute severe headache or a headache thats changed from a previous pattern?

Answer 1

Subarachnoid hemorrhage

Question 2

What red flag condition(s) are you worried about with a new onset headache in an adult over 50?

Answer 2

Subarachnoid hemorrhage

Question 3

What red flag condition(s) are you worried about with a headache on exertion or progressive in nature?

Answer 3

Mass lesion

Question 4

What red flag condition(s) are you worried about with a headache accompanied by fever?

Answer 4

Systemic infection
CNS infection
Collagen vascular disease

Question 5

What red flag condition(s) are you worried about with a headache with new neurologic signs?

Answer 5

Infection
Mass lesion
Subdural hematoma
Metabolic imbalance
CV disease
Inc intracranial pressure
MS
Lyme
Glaucoma
Arthritis
Focal brain disease
Subarachnoid hemorrhage

Question 6

Tx for tension headaches

Answer 6

Stress reduction
Peppermint oil
NSAIDs
Caffeine

Question 7

Tx for migraines

Answer 7

Triptans
Feverfew/butterbur tincture for prevention
Hormonal: chaste tree, seed cycling

Question 8

Cluster headache tx

Answer 8

Triptans
CCBs
Melatonin
Stress reduction
Avoiding smoking/alcohol

Question 9

Name the headache ddx:

Bilateral
Bandlike
Hx anxiety, stress, depression
Neck tightness

Answer 9

Tension-type headache

Question 10

Name the headache ddx:

Progressive
Unilateral
Nausea/vomiting
Can be visual changes
Photophobia
Phonophobia

Answer 10

Migraine

Question 11

Name the headache ddx:

Throbbing
Constant pain
Muscle tightness
FHx of migraine

Answer 11

mixed headache

Question 12

Name the headache ddx:

Abrupt
Unilateral
Periorbital pain
Nighttime onset
Rhinorrhea
Nasal stuffiness
Sweating
Ptosis
Conjunctival injection

Answer 12

Cluster headaches

Question 13

Name the headache ddx:

Sudden onset
Related to physical exertion, valsalva, or coitus

Answer 13

Benign exertional headache

Question 14

Benign exertional headache work up

Answer 14

CT to differentiate from subarachnoid hemorrhage

Question 15

Name the headache ddx:

Frontal, upper molar, or periorbital pain
Cough
Rhinorrhea
No fever/low fever
Pain on palpation of sinuses
Purulent nasal/postnasal dc

Answer 15

Sinusitis

Question 16

work up sinusitis

Answer 16

Radiographs (waters view)

Question 17

Name the headache ddx:

Ear pain
Pain with swallowing

Answer 17

Otitis media

Question 18

Name the headache ddx:

Severe headache
Chills
Myalgias
Stiff neck
Fever
Photophobia
Petechial rash
Pos Kernig/Brudzinski

Answer 18

Meningitis

Question 19

Meningitis work up

Answer 19

Lumbar puncture

Question 20

Name the headache ddx:

> 55
Bursts of sharp pain over face

Answer 20

Trigeminal neuralgia

Question 21

Name the headache ddx:

Acute onset pain with EOM
Followed by blurred vision
Dec visual acuity
Dec papillary reflex
Hypermedia of optic disc
Pain with EOMs

Answer 21

Optic neuritis

Question 22

Name the headache ddx:

Hx of trauma
Occipital pain
Muscle stiffness
Pain with neck motion

Answer 22

Cervical spine disorders

Question 23

Name the headache ddx:

> 50
Sharp, localized temporal pain
Malaise
Anorexia
Hx poly myalgia rheumatica
Fever
Wt loss

Answer 23

Temporal arteritis

Question 24

Temporal arteritis work up

Answer 24

ESR - immediate referral

Question 25

Name the headache ddx: Throbbing headache Mild dyspnea Nausea Vomiting Change in mental status Lethargy LOC

Answer 25

Carbon monoxide poisoning

Question 26

Name the headache ddx: Hx diabetes/meds/etoh Generalized headache Dizziness General sense of unwell Pallor, sweating, weak

Answer 26

Severe hypoglycemia

Question 27

Name the headache ddx: Sudden onset Progressive Worse by coughing or exercise Worse in morning Hx trauma (possible) Papilledema Vomiting Asymmetrical reflexes Sensory/Neuro deficit

Answer 27

Intracranial tumor

Question 28

Intracranial tumor workup

Answer 28

CT scan

Question 29

Name the headache ddx: Progressive headache Vomiting Irritability Rapid enlargement of head

Answer 29

Hydrocephalis

Question 30

Hydrocephalis workup

Answer 30

CT and referral

Question 31

Name the headache ddx: Hx head trauma, bleeding disorders, child abuse Adult >35 Sudden onset “Worst headache ever” Often over eye Transient LOC Unequal pupils Photophobia Neuro changes Seizure

Answer 31

Subdural hematoma

Question 32

Subdural hematoma workup

Answer 32

CT scan and neuro surgeon referral

Question 33

Name the headache ddx: Teens, menopausal women Hx Vit A or tetracycline ingestion Progressive headache Papilledema

Answer 33

Pseudotumor cerebri

Question 34

Pseudotumor cerebri workup

Answer 34

CT and referral

Question 35

Name the headache ddx: Hx chronic ear infection or cyanotic heart disease Fever Seizures Focal neuro deficits

Answer 35

Brain abscess

Question 36

Brain abscess workup

Answer 36

MRI

Question 37

Name the headache ddx: >50 AIDS Anticoagulation meds HTN Abnormal neuro findings

Answer 37

Intracranial hemorrhage

Question 38

Intracranial hemorrhage workup

Answer 38

ER for CT, MRI, possibly surgery

Question 39

what PEs would you do for headache?

Answer 39

General observation (A&Ox3) Vitals Palpate and percuss scalp, face, neck, temporal arteries, sinuses EENT exam (eyes regardless, ears/nose/throat only if sx align) CN exam Neck ROM Brudsinski/kernig MRS Balance/Gait