10. Headache & Other Craniofacial Pains

Question 0

Ushered in by a disturbance of nervous function, most often visual, followed in a few minutes by hemicranial headache, nausea & sometimes vomiting, all of which lasts for hours or as long as a day or more

Answer 0

Migraine with aura/ classic or neurologic migraine

Question 1

Unheralded onset over minutes or longer of hemicranial headache with or without nausea or vomiting, lasting for hours or as long as a day or more

Answer 1

Migraine without aura/ common migraine

Question 2

A less common form of migraine syndrome with prominent brainstem symptoms

Answer 2

Basilar migraine

Question 3

Recurrent unilateral headache associated with weakness of the extraocular muscles

Answer 3

Ophthalmoplegic migraine

Question 4

Migraine type wherein neurologic symptoms, instead of being transitory, leave a prolonged or even permanent deficit, indicative of an ischemic stroke

Answer 4

Complicated migraine

Question 5

Daily or virtually severe continuous headache

Answer 5

Status migrainosus

Question 6

Treatment for migraine if headaches are mild

Answer 6

NSAIDs

Question 7

Treatment for severe attacks of migraine headache

Answer 7

Triptans/ ergot alkaloids

Question 8

Treatment for severely ill patients, having failed to obtain relief from prolonged headache with NSAIDs, ergots, or triptans; also used for ongoing status migrainosus

Answer 8

Metoclopromide 10 mg IV + dihydroergotamine 0.5 to 1 mg IV every 8 hours for 2 days

Question 9

Used for refractory cases of migraine & for terminating migraine status

Answer 9

Corticosteroids

Question 10

Most effective agents for prevention of migraine

Answer 10

Beta blockers
Anti-epileptics
TCAs

Question 11

Characterized by consistent unilateral orbital localization with a nightly occurrence, between 1 & 2 hours after the onset of sleep

Answer 11

Cluster headache

Question 12

Characterized by infraorbital radiation of pain, ipsilateral partial Horner syndrome, & ipsilateral hyperhydrosis; important because of high frequency of underlying intracranial lesions

Answer 12

Trigeminal autonomic cephalalgia

Question 13

Resembles cluster headache but is of shorter duration, the paroxysms occur many times each day, recur daily for longer periods, & most important, respond dramatically to the administration of indomethacin 25-50 mg TID

Answer 13

Chronic paroxysmal hemicrania

Question 14

Attacks are even briefer & more frequent & does not usually respond to indomethacin

Answer 14

SUNCT (short-lasting unilateral neuralgiform attacks with conjunctival injection & tearing)

Question 15

Treatment to terminate a cycle of cluster

Answer 15

100% O2 via 10-15 min at the onset of headache

Verapamil

Question 16

Treatment for nocturnal attacks

Answer 16

Ergotamine at bedtime

Question 17

Most common type of headache; usually bilateral; absence of persistent throbbing quality, nausea, photophobia, phonophobia, & clear lateralization of migraine

Answer 17

Tension headache

Question 18

The only type of headache that exhibits the peculiarity of being present throughout the day, day after day, for long periods of time

Answer 18

Chronic tension-type headache

Question 19

Treatment of tension headache

Answer 19

Simple analgesics

Anti-depressants (amitriptyline)

Question 20

Headache syndrome in older patients with a nocturnal occurrence; bilateral & unaccompanied by lacrimation & rhinorrhea

Answer 20

Hypnic headache

Question 21

Steps to take at the earliest suspicion of cranial arteritis

Answer 21

1) immediate administration of corrticosteroids

2) biopsy

Question 22

A common disorder of middle age & later life, consisting of paroxysms of intense stabbing pain in the distribution of the mandibular & maxillary divisions of the trigeminal nerve; another characteristic feature is initiation of a jab or series of jabs of pain by stimulation of certain areas of the face, lips, or gums

Answer 22

Trigeminal neuralgia/ tic douloureux

Question 23

Treatment for trigeminal neuralgia

Answer 23

Carbamazepine/ anti-epileptics