Headaches

Question 1

What condition would you be concerned about in a pt who presents with visual loss?

Answer 1

Giant cell arteritis, acute angle closure glaucoma

Question 2

What condition would you be concerned about in a pt with prolonged visual aura?

Answer 2

Arteriovenous malformation (AVM)

Question 3

What condition would you be concerned about in someone with disequilibrium?

Answer 3

CVA, brain tumor

Question 4

Confusion or lethargy?

Answer 4

Meningitis, encephalitis, brain tumor, brain abscess

Question 5

New-onset seizure?

Answer 5

infection, brain tumor

Question 6

Fever?

Answer 6

Meningitis, encephalitis, brain abscess

Question 7

Speech changes?

Answer 7

Expressive or receptive aphasia (brain tumor)

Question 8

History of malignancy?

Answer 8

Brain tumor, metastasis

Question 9

History of HIV?

Answer 9

CNS lymphoma, toxoplasmosis, cryptococcal meningitis

Question 10

History of neurosurgery or CNS shunt?

Answer 10

Hydrocephalus, meningitis

Question 11

Eye pain?

Answer 11

Acute angle closure glaucoma

Question 12

Thunderclap headache?

Answer 12

Subarachnoid hemorrhage

Question 13

New onset after age 50?

Answer 13

brain tumor, CVA, giant cell arteritis

Question 14

Progressive headache over weeks to months?

Answer 14

Brain tumor

Question 15

Diplopia?

Answer 15

Brain tumor, CVA, AVM

Question 16

Hemiparesis?

Answer 16

CVA, brain tumor, brain abscess

Question 17

Aphasia?

Answer 17

CVA, brain tumor, brain abscess

Question 18

Headache worse at work?

Answer 18

Carbon monoxide poisoning

Question 19

Nausea?

Answer 19

Brain tumor, hydrocephalus, carbon monoxide poisoning

Question 20

Neck stiffness?

Answer 20

Meningitis

Question 21

Onset of headache with exertion, cough, or sexual activity?

Answer 21

Subarachnoid hemorrhage (SAH)

Question 22

Unilateral in 60 to 70 percent, bifrontal or global in 30 percent

Answer 22

Migraine

Question 23

Bilateral location

Answer 23

Tension

Question 24

Always unilateral

Answer 24

Cluster headache (usually begins around eye or temple)

Question 25

Gradual or abrupt onset, crescendo pattern, pulsating, aggravated by physical activity

Answer 25

migraine

Question 26

pressure or tightness that waxes and wanes

Answer 26

tension

Question 27

pain begins quickly. Deep, continuous, excruciating pain. Described as "hot poker" through the eye

Answer 27

Cluster

Question 28

Patient may remain active or need to rest

Answer 28

Tension

Question 29

Patient remains active, pacing around

Answer 29

Cluster

Question 30

Duration is 4-72 hours

Answer 30

Migraine

Question 31

Duration is 30 minutes to 3 hours

Answer 31

Cluster

Question 32

Associated symptoms: N/V, photo/phonophobia, may have aura

Answer 32

migraine

Question 33

Associated symptoms: Ipsilateral lacrimation and redness of the eye, stuffy/runny nose, sweating, pallor, Horner's symptoms, sensitivity to alcohol.

Answer 33

Cluster headache

Question 34

Focal neurologic symptoms are rare

Answer 34

Cluster headache

Question 35

Women > men

Answer 35

migraines

Question 36

Women = men

Answer 36

Tension

Question 37

Men > women

Answer 37

Cluster

Question 38

More common in smokers

Answer 38

Cluster

Question 39

POUND: P

Answer 39

pulsatile quality

Question 40

POUND: O

Answer 40

4-72 hOurs

Question 41

POUND: U

Answer 41

Unilateral location

Question 42

POUND: N

Answer 42

Nausea or vomiting

Question 43

POUND: D

Answer 43

Disabling intensity

Question 44

What should you consider if your patient is pregnant?

Answer 44

Benign intracranial hypertension (Pseudotumor cerebri), venous sinus thrombosis, and new-onset migraine

Question 45

Chronic nasal stuffiness or chronic URI with headache suggests what?

Answer 45

Sinusitis (but can also be s/s of migraine)

Question 46

Impaired vision or seeing "holes" around light suggests what?

Answer 46

Glaucoma (present within one hour with unilateral pain suspect sub acute angle closure glaucoma)

Question 47

Visual field defects suggests what?

Answer 47

Presence of lesions in the optic chiasm

Question 48

Bitemporal hemianopsia suggests what?

Answer 48

pituitary mass

Question 49

Blurring of vision on forward bending of the head, and headaches with early morning awakening that improve with sitting up and double vision suggests what?

Answer 49

Increased intracranial pressure

Question 50

Headaches that are relieved by recumbency and exacerbated with upright position suggests what?

Answer 50

Low CSF pressure or CSF leak. Recent lumbar puncture?

Question 51

Sudden, severe, unilateral vision loss suggests what?

Answer 51

Presence of optic neurosis

Question 52

Headache, fatigue, generalized aches and pains, and night sweats, blurred vision, jaw claudication in patients older than 55 suggests what?

Answer 52

Temporal arteritis! Check SED rate/ESR STAT!!!

Question 53

Intermittant headaches with high blood pressure and symptoms of palpitations are suggestive of what?

Answer 53

Pheochromocytoma (Adrenal tumor)

Question 54

Important things to check on PE:

Answer 54

Vitals, auscultate for bruits in neck and temporal arteries, assess spine and neck muscles, FULL neurologic exam (especially pt's ability to get up from a seated position w/o support, walking on tiptoes and heels, cranial nerve exam, fundoscopy and otoscopy, tandem gait, romberg test, assess symmetry on motor, sensory, reflexes, cerebellar tests), and Mental status exam

Question 55

Neck stiffness and resistance to passive neck flexion (meningismus) suggests what?

Answer 55

Meningitis

Question 56

Papilledema suggests what?

Answer 56

Presence of mass in the brain, intracranial HTN, encephalitis, or meningitis

Question 57

Focal neurologic signs suggests what?

Answer 57

Intracranial mass, AV malformation, or collagen vascular disease

Question 58

If a bleed is suspected, what imaging study is done?

Answer 58

CT

Question 59

In emergency situations, what imaging study is done?

Answer 59

CT (Fast!)

Question 60

What imaging study is done if a mass is suspected?

Answer 60

MRI

Question 61

What imagine study is done if suspect a stroke?

Answer 61

MRI

Question 62

When is a lumbar puncture indicated?

Answer 62

1. Clinical suspicion of subarachnoid headache with normal CT 2. Suspicion for infection or inflammatory etiology