Headaches

Question 1

What are the red flags for headaches?

Answer 1

“new” or “worst” headache
thunderclap, increasing frequency or intensity
known or suspected medical condition
immune compromise
prior history of malignancy
morning or cough head ache (traction symptoms: head turning, sneezing, coughing, valsalva)
age >50
meningismus
localized neurological findings (meningismus, papilledema, focal deficits, vision loss, jaw claudication)

Question 2

Meningitis (infection headache):

Answer 2

acute onset
severe, constant
photophobia, phonophobia, siezure

Question 3

PE of meningitis:

Answer 3

fever

meningismus (kernig, brudzinski), altered mental status

Question 4

Labs for meningitis:

Answer 4

leukocytosis

LP

Question 5

Imagine for meningitis:

Answer 5

normal

Question 6

Causes of meningitis headaches:

Answer 6

viral, bacterial, fungal

Question 7

Tx for meningitis headaches:

Answer 7

3rd gen cephalosporins, and treat underlying cause

Question 8

Intracerebral Hemorrhage:

Answer 8

acute onset
variable
n/v

Question 9

PE for intracerebral hemorrhage:

Answer 9

HTN
focal deficit
lethargy
meningismus

Question 10

What are the most common locations for HTN hemorrhages?

Answer 10

pons, thalmus, putamen, and cerebellum

Question 11

What do we suspect if the hemorrhage occurred on or near the cortex?

Answer 11

amyloid angiopathy

Question 12

Tx for intracerebral hemorrhage:

Answer 12

correct coagulopathy
control BP
may need to evacuate the hemorrhage

Question 13

Subarachnoid Hemorrhage:

Answer 13

acute onset
severe photophobia, phonophobia, n/v
SENTINEL BLEED

Question 14

PE of SAH:

Answer 14

meningismus
altered mental status
possibly cranial nerve abnormalities

Question 15

Imaging for SAH:

Answer 15

blood with sulci and/or ventricles

Question 16

Diagnosis of a SAH:

Answer 16

LP:
cell count should show elevated RBC
xanthochromia (yellowish color of CSF)

Question 17

What causes a SAH:

Answer 17

aneurysmal rupture
arterio-venous malformation
trauma
coagulopathy

Question 18

What is a complication seen in SAH?

Answer 18

vasospasms- an abnormal, severe constriction of blood vessels as a result of the irritating effects of subarachnoid blood

Question 19

Tx of a SAH:

Answer 19

TRIPLE H: HTN, hypervolemia, hemodilution

Ca+ channel blocker (nimodipine)

Question 20

Temporal Arteritis:

Answer 20

>50
jaw claudication
vision loss
fever
weight loss
Polymyalgia Rh??
giant cell arteritis

Question 21

PE of Temporal arteritis:

Answer 21

vision loss

temporal tenderness

Question 22

DX of Temporal arteritis:

Answer 22

ESR>80

Temporal artery biopsy

Question 23

Tx for Temporal arteritis:

Answer 23

steriods (prednisone/methylprednisone)- presumptive therapy

Question 24

What is a complication of temporal arteritits?

Answer 24

permanent blindness

Question 25

What is the most common neurological condition a/w headaches?

Answer 25

migraine

Question 26

Migraine Dx:

Answer 26

``` gradual build up 4-72 hr headache visual aura (scotoma, flashing lights) unilateral localization pulsating moderate to sever intensity aggravated by routine activity n/v photophobia and phonophobia ```

Question 27

What are common triggers of a migraine?

Answer 27

``` sleep stress undernourished menstrual period exertion changes in weather, altitude, traveling lights and odors alcohol dietary ```

Question 28

T/F: migraine is under-diagnosed.

Answer 28

True

Question 29

How common is shoulder and neck pain with a migraine?

Answer 29

78%

Question 30

What are factors a/w migraine progression?

Answer 30

smoking caffeine overuse obesity frequent use of abortive/analgesic meds

Question 31

Orthostatic headache:

Answer 31

pain starts with in a minute from rising resolves promptly on laying down seen often after an LP

Question 32

Tx for othostatic headache:

Answer 32

epidural injection of autologus blood patch

Question 33

Pseutdotumor/Itracranial HTN:

Answer 33

Daily headache for months worsens when laying down, pulsatile graying of vision PAPILLEDEMA

Question 34

Tx of Pseutdotumor/Itracranial HTN:

Answer 34

``` LP Acetazolamide weight loss lumbar peritoneal shunt optic nerve sheath fenestration ```

Question 35

Tx for dural sinus thrombosis:

Answer 35

heparin or coumadin

Question 36

Tx for a SAH:

Answer 36

embolization or clippin of aneurysm

Question 37

Tx for a intracerebral hemorrhage:

Answer 37

correct coagulopathy permissive HTN neurosurgical consolidation

Question 38

Pediatric migraine:

Answer 38

``` recurrent belly pain vomit once pain goes away episodic vertigo motion sickness icecream headache ```

Question 39

Tx of a pediatric migraine:

Answer 39

periactin gabapentin domperidone

Question 40

Cluster headache:

Answer 40

``` middle aged men severe unilateral periorbital pain jack hammer headache daily 90 min attacks of unilateral icepick pain w/ tearing and injection, a/w horners syndrome early every morning alcohol triggers the attacks ```

Question 41

Tx of a Cluster headache:

Answer 41

sumatriptan, 100% o2 verapamil melatonin

Question 42

Hemicrania continua:

Answer 42

left sided headache continuous aching pain, no pain-free periods w/ brief 30 min spells of worsening a/w gritty sensation in left eye and nasal congestion

Question 43

Tx of hemicrania continua:

Answer 43

indomethacin

Question 44

Hypnic Headache:

Answer 44

awakened every morning at 2am 30 min of aching throbbing frontal pain then returns to sleep sometimes reoccurs at 5am

Question 45

Tx of Hypnic Headache:

Answer 45

lithium carbonate

Question 46

What type of headache is the most common?

Answer 46

primary

Question 47

Tension Headache:

Answer 47

``` pericranial tenderness poor concentration vise-like tight grip not pulsatile exacerbated by stress or glare generalized( neck and shoulders) ```

Question 48

Tension headache tx:

Answer 48

rest in a quiet dark room, simple analgesic right away is effective ergotamines (cafergot- contains caffeine)

Question 49

What is a cough induced headache a/w?

Answer 49

structural lesions of the posterior fossa

Question 50

When are tension headaches worst?

Answer 50

at the end of the day

Question 51

basilar artery migraine:

Answer 51

blindness/visual disturbance (bilateral) tinnitus impairment/loss of consciousness followed by throbbing headache

Question 52

Migraine Tx:

Answer 52

rest in a quiet dark room, simple analgesic right away is effective ergotamines (cafergot- contains caffeine) triptans: sumatriptan (5-HT1 receptors)

Question 53

What is the most common type of primary headache disorder?

Answer 53

tension headaches

Question 54

post traumatic headache:

Answer 54

after trauma dull ache with superimposed throbbing n/v scotomas

Question 55

Tx of post traumatic headache:

Answer 55

supportive | simple analgesic may be helpful

Question 56

Primary cough headache:

Answer 56

lasts only minutes | may clear after an LP

Question 57

T/F: in approximately half of all patients with chronic daily headaches, medication over use is responsible.

Answer 57

true

Question 58

What is the single most common chief complaint that brings a pt to medical care?

Answer 58

headache

Question 59

What is SNOOP4?

Answer 59

``` red flags for headaches: S- systemic symptoms N- neurological symptoms O- onset (sudden) O- onset after 50 P - pattern change (progression, precipitated (cough), postural, papilledema) ```

Question 60

Who is more likely to get a migraine?

Answer 60

women, after puberty hits

Question 61

who is more likely to get a cluster headache?

Answer 61

men

Question 62

What is a characteristic of a person with a cluster headhache?

Answer 62

restless, hypothamlic involvement

Question 63

Who is most likely to get a tension headache?

Answer 63

women

Question 64

Trigeminal Neuralgia:

Answer 64

``` not a headache disorder episodic facial pain severe middle aged men excruciating unilateral pain, shock-like most common in 2nd max division ```

Question 65

What triggers trigeminal neuralgia?

Answer 65

shaving, applying make-up | jackhammer like pain

Question 66

PE for trigeminal neuralgia:

Answer 66

loss of corneal reflex facial sensory loss weakness in mastication muscles

Question 67

Tx for trigeminal neuralgia:

Answer 67

carbamazepine