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Flashcards in Headache Deck (11):
1

Key history in headache

OLD CARTS +

Intensity ("Is it the worst headache of your life?") Duration

Other neurological symptoms (visual stigmata, weakness, numbness, photophobia, neck stiffness)

Nausea or vomiting

Jaw claudication

History of trauma

Dental surgery

Sinusitis symptoms

Personal and family history of migraine

2

Key physical exam in headache

Inspect and palpate entire head

ENT inspection

Complete neurological exam, including fundoscopic exam

3

21 yo F with episodic, throbbing, L temporal pain lasting 2-3 hours

+ visual aura

+ unilateral weakness and numbness

+ N/V

+ FHx of migraine

Complicated migraine

Tension HA

Cluster HA

Pseudotumor cerebri

CBC, ESR, CT-head, MRI-brain, LP-CSF analysis

4

26 yo M with severe R temporal pain

+ ipsilateral rhinorrhea, eye tearing, redness

+ Occur nightly at same time over last week

Cluster HA

Migraine

Tension HA

CBC, CT-head, MRI-brain, LP-CSF analysis, ESR

5

65 yo F with severe, intermittent R temporal HA

+ blurred vision in R eye

+ pain in jaw when chewing

Temporal arteritis (giant cell arteritis)

Migraine

Cluster HA

ESR, CBC, CRP, temporal artery biopsy, Doppler US - carotid, MRI - brain, LP-CSF analysis

6

30 yo F with frontal HA

+ fever

+ nasal discharge

+ pain on palpation at frontal and maxillary sinuses

+ history of allergies

Sinusitis

Migraine

Tension HA

CBC, XR - sinus, CT - sinus, LP-CSF analysis

7

50 yo F with recurrent episodes of bilateral squeezing HA at end of work day

+ life stressors

+ decreased caffeine intake

Tension HA

Migraine

Depression

Caffeine withdrawal

CBC, electrolytes, ESR, CT - head, LP-CSF analysis

8

35 yo M with sudden, severe HA

+ vomiting

+ confusion

+ L hemiplegia

+ nugal rigidity

Subarachnoid hemorrhage

Migraine

Meningitis/encephalitis

Noncontrast CT-head, LP-CSF analysis, CBC, PT/PTT/INR, urine toxicology

9

25 yo M with severe HA

+ high fever

+ confusion

+ photophobia

+ nuchal rigidity

Meningitis

Migraine

Subarachnoid hemorrhage

CBC, CT-head, MRI-brain, LP-CSF analysis (cell count, protein, glucose, Gram stain, PCR for specific pathogens, culture)

10

18 yo obese F with pulsatile HA

+ vomiting

+ blurred vision

+ taking OCPs

Pseudotumor cerebri

Tension HA

Migraine

Urine hCG, CBC, CT-head, LP - opening pressure and CSF analysis

11

57 yo M with daily pain in R cheek over last month

+ "electric" and stabbing sensations

+ occurs while shaving

Trigeminal neuralgia

Tension HA

Migraine

CBC, ESR, MRI-brain