Headache 2

Question 1

Severe HA, associated w/ nausea. HA began w/ severe eye pain.
PE = Eye is red with a fixed, moderately dilated pupil

Answer 1

Glaucoma

Question 2

Acute, severe HA w/ stiff neck but NO fever suggests

Answer 2

Subarachnoid hemorrhage

Question 3

Acute, severe HA w/ stiff neck AND fever suggests

Answer 3

Meningitis

Question 4

Acute tx for migraine

Answer 4

Metoclopramide (dopamine antagonist)

Question 5

Topiramate

Answer 5

Preventative tx for migraines

Question 6

Amitriptyline, Botulism toxin type A

Answer 6

Preventative tx for migraines

Question 7

Effexor

Answer 7

Preventative tx for migraines

Question 8

Cells in the trigeminal nucleus activated during a migraine attack release?

Answer 8

Calcitonin gene-related peptide (vasoactive)

Question 9

Half of pts w/ untreated temporal arteritis develop?

Answer 9

Blindness (d/t involvement of ophthalmic artery and its branches)

Question 10

Begins few hrs after sleep onset. HAs last from 15-30 mins, usually moderately severe and generalized. (But can be UL and throbbing). Pts can fall back asleep to be awakened few hrs later by another attack. Up to 3 repetitions occur through the night. Daytime naps precipitate head pain. Mostly females > 60 y/o. Major contributor poorly controlled HTN 24 hr blood pressure monitoring to detect treatable condition

Answer 10

Hypnic HA

Question 11

Sudden onset severe HA w/o any prior hx of HA. Next step?

Answer 11

Neuroimaging and LP

Question 12

Tx of choice for hemicrania continua

Answer 12

Indomethacin (100 mg IM)

Question 13

70 y/o F presents w/ severe HA, scalp tenderness, and mild fever. She has polymyalgia rheumatica and jaw claudication. Nxt step?

Answer 13

Biopsy and prendisone therapy

*Temporal arteritis

Question 14

Involves extracranial carotid circulation.
HA, polymyalgia rheumatica, jaw claudication, fever, and weight loss. HA is dominant sx and explosive in onset, dull and boring pain, with superimposed sharp (stabbing) pains. Pts can recognize origin of pain is superficial, external to skull. Scalp tenderness is present. HA worse at night. Aggravated by exposure to cold.

Answer 14

Temporal (giant) cell arteritis

Question 15

Cluster HA frequency

Answer 15

0.1%

Question 16

Deep pain, retro-ortbital. Excruciating, non-fluctuating, and explosive. At least one of the daily attacks recurs at about the same hr each day for the duration of a cluster bout. Usual pt has 1-2 attacks of short-duration UL pain for 8-10 wks per yr

Answer 16

Cluster HAs

Question 17

Gender in which cluster HAs are more common

Answer 17

men

Question 18

Associated with ipsilateral sxs of cranial parasympathetic autonomic activation

Answer 18

cluster HAs

Question 19

Severe pain behind her right eye w/ lacrimation and nasal congestion on same side lasting 3 mins. 6-8 attacks per day, resolves after 2 days. Excellent response to indomethacin. Dx?

Answer 19

Paroxysmal hemicrania

Question 20

Frequent, UL, severe, short episodes of HA. Pain tends to be retro-ortbital, but may also be experienced all over the head, and associated w/ autonomic phenomena (lacrimation and congestion). Short lasting attacks (2-45 mins). Very frequent (>5 daily attacks). Rapid course (<72 hrs). Excellent response to indomethacin

Answer 20

Paroxysmal hemicrania

Question 21

BL, tight, band-liek discomfort across forehead. Building slow pain, fluctuating in severity, persisting for several days

Answer 21

Tension HA

Question 22

BL, throbbing HAs lasting 30-45 mins, precipitated by jogging and worsened by exertion. Dx?

Answer 22

Exertional HA

Question 23

Features resembling both cough HA and migraine

Answer 23

Exertional HA

Question 24

Can be precipitated by any form of exercise. Pulsatile quality of migraine. Pain BL and throbbing at onset. Prevented by avoiding excessive exertion, esp. in hot weather or at high altitude

Answer 24

Exertional HA

Question 25

Dull, BL ache in head and neck that intensifies during sexual intercourse. Dx?

Answer 25

Primary sex HA

Question 26

Dull BL ache in head and neck that intensifies as sexual excitement increases; Sudden, severe, explosive HA occurring at orgasm; Postural HA developing after coitus that resembles HA of low CSF pressure

Answer 26

Types of primary sex HAs

Question 27

Can be precipitated by sexual intercourse. Suspect if HA starts at orgasm

Answer 27

Subarachnoid hemorrhage

Question 28

HAs that begin suddenly, lasts several mins - few hrs, and precipitated by coughing

Answer 28

Primary cough HA

Question 29

Generalized HA that begins suddenly, lasts for several mins up to few hrs, precipitated by coughing

Answer 29

Primary cough HA

Question 30

Serious etiologies must be excluded before coming to this dx

Answer 30

Primary cough HA

Question 31

Chiari malformation or any lesion causing obstruction of CSF pathways or displacing cerebral structures can cause

Answer 31

head pain

Question 32

Cerebral aneursysm, carotid stenosis, and vertebrobasilar disease can present with

Answer 32

Cough or exertional HA