Headache

Question 1

What are the three main HA classifications?

Answer 1

Primary HA/secondary HA/ cranial neuralgias and facial pain

Question 2

What is a secondary HA?

Answer 2

A HA with an underlying cause

Question 3

What is a primary HA?

Answer 3

A HA with no underlying cause

Question 4

What are the three types of primary HA?

Answer 4

Tension, migraine and cluster

Question 5

Does giant cell arteritis usually cause a unilateral or b/l HA?

Answer 5

Unilateral

Question 6

What is Cushing’s triad suggestive of?

Answer 6

Herniation

Question 7

Subhyaloid hemorrhage is seen with what?

Answer 7

Subarachnoid hemorrhage

Question 8

When should you order a sed rate/CRP?

Answer 8

For suspected giant cell arteritis

Question 9

CTA is good to identify what?

Answer 9

Subarachnoid hemorrhage

Question 10

CTV is good for identifying what?

Answer 10

Changes in the venous system

Question 11

Should HIV+ pt w/new HA get emergent imaging?

Answer 11

Yes

Question 12

In what two cases should a pt w/HA get emergent imaging?

Answer 12

New onset with neuro changes OR sudden onset severe HA

Question 13

If you suspect a pt has a subarachnoid but has a normal CT, what is the next step?

Answer 13

Do an LP

Question 14

When should you image prior to getting an LP?

Answer 14

If you suspect a space occupying lesion

Question 15

What is an absolute contraindication for an LP?

Answer 15

Cellulitis near puncture site

Question 16

What type of meds is recommended for treatment of acute primary HA in the ED?

Answer 16

Nonopioid

Question 17

What is another name for cluster HA?

Answer 17

Trigeminal autonomic neuralgia

Question 18

When do migraines usually develop?

Answer 18

Adolescence or early adulthood

Question 19

What is first line tx for migraines?

Answer 19

NSAIDs

Question 20

What is the best NSAID for migraines?

Answer 20

Ibuprofen

Question 21

Haldol and compazine are abortive meds for what?

Answer 21

Migraines

Question 22

Serotonin agonists may cause what?

Answer 22

Cardiac ischemia

Question 23

Serotonin agonists may not be combined with what?

Answer 23

SSRIs or MAOIs

Question 24

Botox can be used as a tx for what?

Answer 24

Frequent migraines

Question 25

Are cluster HAs usually unilateral or b/l?

Answer 25

Unilateral

Question 26

What is the tx for cluster HA?

Answer 26

100% O2 via mask for 15 mins

Question 27

What is the tx for tension HA?

Answer 27

Nonopioid therapy

Question 28

What will you see on fundoscopic exam with giant cell arterities?

Answer 28

Papilledema

Question 29

Can fever occur with giant cell arteritis?

Answer 29

Yes

Question 30

Is impaired vision an early or late sign in giant cell arteritis?

Answer 30

Early

Question 31

What is the giant cell arteritis diagnostic criteria?

Answer 31

ACR classification

Question 32

What type of anemia is common in giant cell arteritis?

Answer 32

Normocytic anemia

Question 33

Are LFTs elevated in giant cell arteritis?

Answer 33

Yes

Question 34

What is the tx for giant cell arteritis?

Answer 34

Emergent steroids

Question 35

What dose of steroids should someone w/giant cell arteritis be started on?

Answer 35

60mg prednisone daily

Question 36

Syncope w/HA is suspicious for what?

Answer 36

Subarachnoid hemorrhage

Question 37

Sentinel HA can start how long before subarachnoid hemorrhage?

Answer 37

10-20 days

Question 38

Ottawa SAH rule is used when?

Answer 38

When pt has normal neuro exam

Question 39

Serial EKG and trop should be done if suspicious for what type of HA?

Answer 39

SAH

Question 40

When can a normal CT be used to r/o a SAH?

Answer 40

When CT is done within 6 hours of HA onset and pt has normal neuro exam

Question 41

Maintain BP at what for SAH?

Answer 41

130-140 systolic

Question 42

What is the tx for SAH if 2/2 AV malformation?

Answer 42

Surgical clipping

Question 43

What will be in CSF if pt has SAH?

Answer 43

Blood

Question 44

WBC will be less than what in LP for SAH?

Answer 44

5

Question 45

What three labs should be drawn to diagnose CVST?

Answer 45

CBC, ESR, D-dimer

Question 46

What imaging modality is used to diagnose CVST?

Answer 46

MRV

Question 47

How to treat CVST?

Answer 47

Anticoagulation

Question 48

Xanthocromia in the CSF indicates what?

Answer 48

SAH