1: Adult Headache

Question 1

This type of headache has no specific cause.

Answer 1

Primary

Question 2

T/F Eye strain is a common cause of headaches.

Answer 2

False

Question 3

Temporal _____ can cause severe headaches.

Answer 3

Temporal arteritis can cause severe headaches.

Question 4

When is imaging indicated in headaches?

Answer 4

Worst or first headache ever
Unexplained abnormal exam finding
Recent change in pattern, frequency, or severity
Progressive worsening despite appropriate treatment
Onset with exertion, cough, or sexual activity (mass lesion)
Onset after age 40

Question 5

What conditions that cause vasodilation can cause headaches (4)?

Answer 5

Pheochromocytoma
Malignant HTN
Sexual activity
MAOIs

Question 6

T/F The brain parenchyma produces part of the headache pain.

Answer 6

False. Brain parenchyma itself does not produce pain.

Question 7

T/F If there has been no change in headaches recently, this likely negates a serious underlying cause.

Answer 7

True

Question 8

Headache pain is thought to arise from what 3 things?

Answer 8

Large intracranial vessels
Dura mater
Trigeminovascular system

Question 9

What are common headache triggers (3)?

Answer 9

Alcohol
Nitroglycerin
Nitrites in food

Question 10

T/F Only severe HTN causes headaches.

Answer 10

True. Mild to moderate HTN does not cause headaches.

Question 11

_____ is likely the cause of headache pain.

Answer 11

Vasodilation of arteries or other vessels is likely the cause of headache pain.

Question 12

Labwork is usually not necessary with headaches. However, if you’re worried, what could you order?

Answer 12

CBC
CMP
Toxicology panel if suspect toxic-metabolic etiology
ESR or CRP test if suspect inflammation
Infectious etiologies (e.g., Lyme or HIV)
Endocrine studies

Question 13

T/F Use of OTC meds frequently can cause medication overuse headaches.

Answer 13

True

Question 14

What is the physical exam for headaches (10)?

Answer 14

Blood pressure/pulse
Carotid bruit check
Palpate head, neck, shoulders
Check temporal/neck arteries
Examine spine/neck muscles
Cranial nerves
Fundoscopic exam
Tandem gait
Romberg test
Symmetry of motor, sensory, reflex skills

Question 15

What does a lumbar puncture measure?

Answer 15

Opening pressure
Cell counts
Protein
Glucose
Gram stain

Question 16

What is the imaging of choice for worst headache ever?

Answer 16

Head CT

Lumbar puncture indicated if concerned for bleed or meningitis

Question 17

This type of headache has an underlying structural or metabolic cause.

Answer 17

Secondary

Question 18

What are the 2 types of headache?

Answer 18

Primary

Secondary

Question 19

What patient hx is important with headaches (15)?

Answer 19

Age at onset
Aura/prodrome
Number/month
Time/mode of onset
Quality, site, and radiation of pain
Family hx (esp with migraines in women)
Changes in vision
Recent trauma
Precipitating/relieving factors
Effect of activity on pain
Response to previous treatment
Changes in sleep, diet, weight, exercise
Birth control
Effects of menses
Changes in work/lifestyle

Question 20

What are red flags for headaches (10)?

Answer 20

Sudden onset that reaches max intensity within a few seconds to minutes.
Worsening pattern
Focal neuro signs (other than typical aura)
Fever
First or worst headache ever
Head pain that spreads to lower neck and between shoulders
New headache in patients younger than 5 or older than 50
Changes in mental status, personality, or fluctation of LOC
Neck stiffness
Papilledema