headache pearls

Question 1

how to distinguish new from old headache/

what is more important ? Quality or severity?

Answer 1

Q_uality= dull; sharp etc>>> S_everity (mild moderate; severe)

Question 2

any patient who has recurrent headaches that

cause “disability” (can’t work, can’to do much)/

consider which dx?

Answer 2

mi^graine h_eadache

Question 3

morning headaches/

interview emphazises on what?

Answer 3

careful hx:

1. PMhx:D^M?
2. ROS:we_{ight ch}g
3. SHx:zZ;

Question 4

pt w. a new headache + a preexisting cancer/

possible dx?

Which imaging tests to perform?

Answer 4

Bra_{in tu}mor

Contra^st-enhance_{d C}T or M^RI

hint: non contrast x blood

Question 5

pt w morning headaches and

no readily apparent cause./

which test is reasonable to do?

Answer 5

sle^{ep st}udy

Question 6

headaches occur when
pts sleep later than usual or occur

mainly on weekends or vacations./consider

Answer 6

Ca^ffeine wi_thdrawal:

hint:something is diff in the daily routine

Question 7

SAH is suspected.next step?

Answer 7

no_ncontrast h^{ead C}T. If the CT is ^{nl=> L}P

Question 8

exertional headaches are clinically indistinguishable from SAH/

what to do then?

Answer 8

carefu_{lly evalu}ate pt to ru_{le ou}t SAH

Question 9

benign thunderclap headaches are clinically indistinguishable

from SAH/what to do then?

Answer 9

car_{efully eval}uate pt to r_{ule out} SA_H

Question 10

clinical suspicion ( even moderate) Of temporal arteritis/

what is next?

Answer 10

te_mporal arte_{ry bx}

Question 11

temporal arteritis suspected/

initiate tx?

Answer 11

yes!!

Question 12

negative temporal artery biopsy/

what to do w pt next?

Answer 12

monitor^{ed clos}el^{y or tre}ated.

Question 13

elderly pt w a hx of falls + subacute neurologic deficits./

what to suspect?

Answer 13

s_ubdural hem^atoma

Question 14

pt w abnormal neurologic exam/

what to do next

Answer 14

C_{NS i}maging=>nl=> LP

Question 15

**migraine headache/

POUNDing questions

Answer 15

a. HA P_ulsatile?
b. last [_{4 -72}] hOurs w/out rx? (3days)
c. Un^ilateral?
d. Na_usea?
e. Dis^abling?

Question 16

migraine headache/ POUNDing questions/

when to dx migraine?

Answer 16

4+ y^es to questions

Question 17

tension HA vs migraine/

one of the diff is ?

Answer 17

N_ausea is present in migraine;

not in tension HA

Question 18

most common type of HA

Answer 18

te_nsion HA

Question 19

old 1ary/

unilateral vs bilateral HA

Answer 19

Bilateral: te_nsion HA (squizzing=> u need to press on both sides)

unilateral: mig_raine + cl^uster HA

Question 20

SAH/etiology

Answer 20

rupture of a sa_{ccular aneu}rysm i^{n or ne}ar the circ^le of Willis ( 85%).

Question 21

Cough; exertional; and sexual headaches/

most common in ?

Answer 21

m_en