Headache

Question 1

Headache is caused by ….
Pathophys

Answer 1

traction, displacement, inflammation, vascular spasm, or distention of
the pain sensitive structures in the head or neck.

Question 2

Chronic headaches tend to be ……. while new-onset headaches are usually …….

Answer 2

Primary … secondary

Question 3

Headaches from………. are commonly maximal on awakening

Answer 3

Mass lesion

Question 4

headaches frequently awaken patients from sleep; they often recur at the same time each day or night. And this headache headache (peak over ….. min while migraine over …. To …….

Answer 4

Cluster …. Over 3-5 min while of migraine over minutes to hours

Question 5

Unilateral headache is an invariable feature of

Answer 5

cluster headache and occurs in the majority of migraine attacks; many patients with tension headache report unilateral pain.

Question 6

Ocular or retroocular pain suggests a

Answer 6

primary ophthalmologic disorder such as acute iritis or glaucoma, optic (II) nerve disease (eg, optic neuritis). It is also common in migraine or cluster headache.

Question 7

Headache from intracranial mass lesions may be

Answer 7

focal, but even in such cases it is replaced by bioccipital and bifrontal pain when the intracranial pressure becomes elevated.

Question 8

Bandlike or occipital discomfort is commonly associated with

Answer 8

tension headaches. Occipital localization can also occur with meningeal irritation from infection or hemorrhage and with disorders of the upper cervical spine.

Question 9

Pulsating, throbbing pain support the diagnosis of

Answer 9

migraine, but it doesn’t exclude tension headache.

Question 10

steady sensation of tightness or pressure is also commonly seen with

Answer 10

tension headache.

Question 11

pain produced by intracranial mass lesions is typically

Answer 11

dull and steady.

Question 12

Prodromal symptoms such

Recent weight loss ……..

Fever………

Visual disturbances……….

Photophobia……….

Nausea and vomiting………….

Myalgias………

Ipsilateral rhinorrhea and lacrimation ……….

Painful transient monocular visual loss …….

Answer 12

cancer, giant cell arteritis, or depression.

CNS infection.

ocular disorder and migraine.

migraine and acute meningitis or subarachnoid hemorrhage.

migraine and posttraumatic headache syndromes and can be seen in the course of mass lesions.

tension headaches, viral infections, and giant cell arteritis.

cluster headache.

giant cell arteritis.

Question 13

Precipitation of headache by alcohol is especially typical

use of oral contraceptive agents or other drugs such as nitrates may precipitate or exacerbate

rapid changes in head position or by events that transiently raise intracranial pressure, such as coughing and sneezing, is often associated with an

Anger, excitement, or irritation

Chewing and eating

Answer 13

Cluster hd
Migraine
Intracranial mass or migraine
Tension or migraine jaw claudication of giant cell arteritis

Question 14

Headache symptoms that suggest serous underlying disease

Answer 14

Worst headache ever
Subacute worsening over days or weeks
Abnormal Neuro exam
Fever or systemic signs
Vomiting preceded headach
Pain induced by binding , lifting, cough
Pin disturb sleep
Onset after age of 55 local tenderness associated pain

Question 15

Hypertension per se rarely causes headache unless

Answer 15

the blood pressure elevation is acute, paroxysmal as with pheochromocytoma, or very high, as with early hypertensive encephalopathy.

Question 16

pheochromocytoma headache

Answer 16

brief. They last less than 15 minutes in one half of patients and are characteristically associated with perspiration and tachycardia.

Question 17

mental status examination, patients with acute headache may demonstrate disturbance of consciousness, as is commonly seen with

Answer 17

subarachnoid hemorrhage and meningitis.

Question 18

Physical examination of headach steps are …

Answer 18

1. Vital signs:
2. Complete systemic physical examination
3. Neck
4. Mental status examination
5. Cranial nerve examination
6. Complete the neurological examination to reveal any focal neurological signs

Question 19

History of headach steps

Answer 19

1. Temporal pattern of headache
2. Location
3. The pain character
4. Prodromal symptoms associated phenomena and the chronological evolution.
5. Precipitating and exacerbating factors.
6. Relieving factors.
7. History of headache.
8. Past medical history.
9. Drugs history.
10. Family history (migraine and seizures).

Question 20

Strong indications for imaging in headache include:

Answer 20

1. Abnormal neurologic examination. 2. When the neurologic examination is normal, the indications include:
   a) An element of the history suggests a specific diagnosis (e.g., epilepsy or brain tumor).
   b) The headaches have developed a new quality, are more severe, or have become
   Headaches according to the temporal profile
   Headaches of sudden onset Sudden onset of new headache may be a symptom of serious intracranial or systemic disease. 1. Subarachnoid hemorrhage 2. intracerebral hemorrhage
   Headaches of subacute onset Subacute headaches occur over a period of weeks to months.
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   intractable to treatment. c) History of systemic disease (e.g. malignancy or endocrine dysfunction). d) Headaches of sudden onset. e) Persistent or increased vomiting. f) Headache triggered by maneuvers that increase intracranial pressure, such as
   coughing, sneezing, and straining at stool. g) The headache is maximal on awakening from sleep.

Question 21

Headaches of sudden onset

Answer 21

Headaches of sudden onset

Question 22

Headaches of acute onset

Answer 22

1. Meningitis or encephalitis 2. Seizures 3. Hypertensive encephalopathy 4. Drugs and alcohol induce headache 5. Headache secondary to systemic illnesses

Question 23

Headaches of subacute onset

Answer 23

1. Intracranial mass 2. Pseudotumor cerebri 3. Giant cell arteritis

Question 24

Chronic headaches

Answer 24

1. Tension type headache 2. Migraine 3. Analgesic withdrawal headache 4. Cluster headache 5. Referred pain from upper cervical spines

Question 25

The secondary headaches:

Answer 25

1. Headache attributed to head and neck trauma 2. Headache attributed to cranial or cervical vascular disorder 3. Headache attributed to non-vascular intracranial disorder 4. Headache attributed to a substance or its withdrawal 5. Headache attributed to infection 6. Headache attributed to disturbance of homoeostasis 7. Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures 8. Headache attributed to psychiatric disorder

Question 26

Diagnostic criteria for secondary headaches:

Answer 26

1. Disorder known to be able to cause headache has been demonstrated 2. Headache occurs in close temporal relation to the other disorder and/or there is other evidence of a causal relationship 3. Headache is greatly reduced or resolves within 3 months (this may be shorter for some disorders) after successful treatment or spontaneous remission of the causative disorder

Question 27

temporal arteritis, is characterized by

Answer 27

subacute granulomatous inflammation that affects the medium and large-sized arteries, usually involving one or more branches of the carotid artery, may accompany polymyalgia rheumatica. Inflammation of the pain sensitive arterial wall produces the headache.

Question 28

Diagnosis and Therapy of temporal arteries

Answer 28

Diagnosis is made by biopsy of affected temporal arteries, the erythrocyte sedimentation rate (ESR) is almost invariably elevated. Therapy for giant cell arteritis is prednisone, 40–60 mg/d orally, with decreasing dosage usually after about 1-2 months, depending upon the response. Therapy generally has to be continued for 1–2 years. Although dramatic improvement in headache occurs within 2–3 days after institution of therapy, the blindness is usually irreversible.

Question 29

The main feature of a low CSF pressure headache

Answer 29

bitemporal pressure or heaviness that is completely or near-completely relieved by lying flat. Aural symptoms such as muted hearing or non-pulsatile tinnitus commonly accompany the low pressure state

Question 30

Pseudotumor cerebri is

Answer 30

syndrome characterized by a diffuse increase in intracranial pressure causing headache, and papilledema. Diplopia may also occur as a result of abducens nerve palsy. Pulse synchronous tinnitus can occur.

Question 31

Treatment of Pseudotumor cerebri

Answer 31

Treatment: The main goals of treatment are alleviation of symptoms, including headache, and preservation of vision. All overweight patients should reduce weight, along with a low- salt diet. Acetazolamide is the treatment of choice. In other instances, topiramate and repeated lumbar punctures may be necessary. Surgical intervention is required when other treatments have failed to prevent progressive vision loss or when the disease onset is fulminant.

Question 32

Medication overuse and medication withdrawal headache

Answer 32

triptans (1 to 2 years), longer for ergots (3 years), and longest for analgesics (5 years). When medication overuse is present (abortive anti-migraine drugs or opioids or combination analgesics taken on >10 days/month and simple analgesics on >15 days/month), it is likely cause of chronic headache. Treated by slow tapering with or without steroid

Question 33

Cervical spine disease

Answer 33

Injury or degenerative disease processes involving the upper neck can produce pain in the occiput and may referred to the orbital regions due to irritation of the second cervical nerve root. In the lower cervical spine pain refer to the ipsilateral arm or shoulder, not to the head. Acute pain of cervical origin is treated with immobilization of the neck (eg, using a soft collar) and analgesics or anti-inflammatory drugs.

Question 34

The main pain features of tension headache

Answer 34

begins after age 20. Women are more commonly bilateral location, squeezing non- pulsating quality, mild to moderate intensity, and lack of aggravation by routine physical activity. bilateral occipital head pain that is not associated with vomiting or prodromal visual disturbance.

Question 35

There are three subtypes of tension headache

Answer 35

1. Infrequent episodic tension headache (headache episodes on <1 day per month) 2. Frequent episodic tension headache (headache episodes on 1 to 14 days per month) 3. Chronic tension headache (headache on >15 days per month, perhaps without recognizable episodes).

Question 36

treatment tension headache:

Answer 36

Acute attacks may respond to acetaminophen, or nonsteroidal anti-inflammatory drugs. For prophylactic treatment, amitriptyline is the only proven treatment.

Question 37

Migraine

Answer 37

episodic recurrent disabling headache disorder manifesting in attacks lasting 4–72 hours which can be classified into common and classic migraine. Intracranial vasoconstriction and extracranial vasodilatation have long been held to be the respective causes of the aura and headache phases of migraine.

Question 38

Migraine attacks can be precipitated by

Answer 38

certain foods (chocolate and cheese). Fasting, emotion, menses, drugs (especially oral contraceptive agents and vasodilators such as nitroglycerin), and bright lights may also trigger attacks.

Question 39

The most common cause of transient binocular visual loss

Answer 39

the visual aura that occurs with migraine.

Question 40

Migraine without aura (common migraine).

Answer 40

usually bilateral and periorbital, and is seen more frequently in clinical practice Vomiting may occasionally terminate the headache.

Question 41

Migraine with aura (classic migraine):

Answer 41

auras are visual alterations, particularly scotomas and scintillations that enlarge and spread peripherally last for about 20 minutes followed by throbbing unilateral headache. no more than one attack per week.

Question 42

Migraine Remissions are common during

Answer 42

second and third trimesters of pregnancy and after menopause.

Question 43

During the migraine headache, prominent associated symptoms include ……. And released by

Answer 43

nausea, vomiting, photophobia, phonophobia, irritability and lassitude. Migraine headaches are frequently relieved by darkness, sleep, vomiting, or pressing on the ipsilateral temporal artery.

Question 44

Treatment of migraine

Answer 44

Acute migraine attacks may respond to simple analgesics (acetaminophen, or NSAIDs). If not, they usually respond to triptans or narcotic analgesics or ergot preparations.

Question 45

Prophylactic treatment is indicated for:

Answer 45

Four or more headache episodes per month  Acute medications ineffective, contraindicated, or overused  Adverse effects from acute medications

Question 46

Classes of Migraine Preventives:

Answer 46

Antiepileptic drugs  Antidepressants  Beta-adrenergic blockers  Calcium channel antagonists  Nonsteroidal anti-inflammatory drugs

Question 47

Migraine during pregnancy should be treated only with

Answer 47

opiates as all other pharmacologic agents raise concerns regarding teratogenicity or complications of pregnancy.

Question 48

Cluster headache:

Answer 48

Cluster headache is much more frequently in men than in women. Cluster headaches characteristically the mean age at onset of 25 years.

Question 49

The Cluster headache: syndrome presents as

Answer 49

brief, very severe, unilateral, constant nonthrobbing headaches that last from a few minutes to less than 2 hours. Unlike migraine headaches, cluster headaches are always unilateral, and usually recur on the same side in any given patient.

Question 50

are commonly associated with the attack of clustered headache

Answer 50

Ipsilateral conjunctival injection, lacrimation, nasal stuffiness, and Horner's syndrome

Question 51

Acute relief of pain in cluster headach within minutes may be achieved by

Answer 51

triptan and 100% oxygen. Dramatic improvement is typically seen with administration of prednisone, 40–80 mg/d orally for 1 week, discontinued by tapering the dose over the following week. Pain may resolve within hours, and most patients who respond do so within 2 days.

Question 52

Prophylactic drugs for cluster headach are

Answer 52

Verapamil , lithium