Approach to patient with a headache

Question 1

Sudden onset of severe headaches should make you think about

Answer 1

• subarachnoid hemorrhage

- meningitis

Question 2

to check for an UMN lesion what exams should you perform

Answer 2

• pronator drift
• pyramidal weakness
• plantar response?
• reflexes
• cerebellar tests

Question 3

Headache that is ubiquitous, often not severe

Answer 3

tension-type

Question 4

Migraine criteria

Answer 4

5 or more attacks lasting 4-72 hours
- unilateral 
-pulsating-
moderate-severe intensity
- aggravation by routine activity 
(either N/V or Photo/phonophobia)

Question 5

Which headache subtype has NO family history associated?

Answer 5

tension-type

Question 6

Which headache type has a male predominance?

Answer 6

Cluster

Question 7

Bilateral headaches point to which 2 types

Answer 7

Migraine

Tension-type

Question 8

Headache with NO associated symptoms

Answer 8

Tension-type

Question 9

Headache associated with sweating, flushing, autonomic symptoms

Answer 9

Cluster type

Question 10

How long does sensory aura need to progress?

Answer 10

usually 15 mins

Question 11

which meds are NOT recommended for routine use

Answer 11

Ergot-based meds

Question 12

What are triptans?

Answer 12

Agonists of 5HT serotonin receptor

Question 13

3 ways in which triptans act:

Answer 13

1) vasoconstrict
2) inhibit transmission of nociceptive impulse
3) inhibit vasoactive neuropeptides, inhibit pro inflammatory petides

Question 14

Contraindications to triptans

Answer 14

anything ischemic - htn
- worry about serotonin syndrome
concurrent use with SSRIs
concurrent use with MAO inhibitors

Question 15

S/E of triptans

Answer 15

• chest and neck tightness
• Tingling in limbs and face
• sensation of warmth
• flushing
• dizziness

Question 16

What dose should you not exceed with triptans

Answer 16

• 2 doses in 24 hours

Question 17

3 common prophylactic treatments for migraine

Answer 17

beta blockers
tricylics
anti-epileptics

Question 18

In pregnancy - key treatment C/I

Answer 18

NSAIDS in third trim
ergot-based meds
Topiramate- 
avoid prophylaxis
no butterbur

Question 19

S/E of tricyclics

Answer 19

Dry mouth

Question 20

visual aura in a migraine arises from

Answer 20

Cortical spreading depression

Question 21

Treatment of migraine
mild-moderate:
Moderate-severe
Ergot-based meds

Answer 21

AS EARLY AS POSSIBLE
NSAID
Triptan
dont use