B7-001 Headache

Question 1

4 characteristics of common migraines

Answer 1

1. unilateral location
2. pulsating quality
3. moderate or severe pain
4. aggravation by routine physical activity

must meet two of four

Question 2

common migraines must cause what symptoms during the headache [2]

Answer 2

nausea/vomiting
OR
photophobia/phonophobia

Question 3

migraine HA preceded/accompanied by visual, sensory, or other focal neurologic symptoms

Answer 3

migraine with aura

Question 4

a migraine lasting longer than 72 hours

Answer 4

status migrainosus

Question 5

4 characteristics of episodic tension-type headaches

Answer 5

1. bilateral location
2. pressing/tightening quality
3. mild or moderate intensity
4. not aggravated by physical activity

must meet 2 of 4 characteristics

Question 6

chronic daily headache is defined as greater than […] days in a month

Answer 6

15

can be chronic tension type or chronic migraines

Question 7

a headache must have [….] cause to be classified as a migraine

Answer 7

no identifiable cause

Question 8

most common theory about cause of migraines

Answer 8

Trigeminal-vascular theory

(release of CGRP by 5HT1R causes sensitization)

Question 9

5HT1 agonists used for headache [3]

Answer 9

ergotamines (dihydroergotamine)
triptans (sumatriptan)
Ditans (lasmiditan)

Question 10

5HT1 agonist that does not cause vasoconstriction

Answer 10

ditans (lamiditan)

**safe in patients with CVD history

Question 11

CGRP antagonists

Answer 11

-gepants (rimegepant)

Question 12

most common cause of migraines transforming to chronic migraine is

Answer 12

overuse of symptomatic migraine drugs and/or analgesics

Question 13

typically, if a patient has more than […] headaches a month you should offer prophylactic medications

Answer 13

4

Question 14

botulinum toxin is helpful as prophylaxis for […]

Answer 14

chronic migraine

does not help unless they have progressed to chronic headaches as defined by >15 a month

Question 15

medication classes used for migraine prophylaxis [7]

Answer 15

antiepileptics
beta blockers
antidepressants
NSAIDs
herbal therapies
botulinum toxin
CGRP receptor binding

Question 16

most common primary headache syndromes [2]

Answer 16

migraine
tension-type

Question 17

severe unilateral peri-orbital pain lasting 15-180 min

Answer 17

cluster headache (trigeminal autonomic cephalgia)

Question 18

autonomic features associated with cluster headache (trigeminal autonomic cephalgia)

Answer 18

conjunctival injection
lacrimation
rhinorrhea
miosis
ptosis
eyelid edema

Question 19

what signs make a patient unlikely to have a sinister cause of their headaches?

Answer 19

long history of similar headaches with a benign outcome and normal neuro exam

Question 20

red flags in chronic headache [4]

Answer 20

onset > 35 years old
neurologic findings, AMS
elevated ICP (papilledema)
inflammation, fever, stiff neck

Question 21

types of primary headaches [3]

Answer 21

tension type
migraine
cluster

Question 22

causes of secondary headaches

Answer 22

medication overuse
meningitis
subarachnoid hemorrhage
hydrocephalus
neoplasia
giant cell arteritis

Question 23

tension type headaches are [bilateral/unilateral]

Answer 23

bilateral

Question 24

migraine headaches are [bilateral/unilateral]

Answer 24

unilateral

Question 25

cluster headaches are [bilateral/unilateral]

Answer 25

unilateral

Question 26

last >30 min (typically 4-6 hours) are constant

Answer 26

tension-type

Question 27

last 4-72 hrs

Answer 27

migraine

Question 28

last 15min- 3 hrs repetitive

Answer 28

cluster

Question 29

steady, bandlike pain

Answer 29

tension-type

Question 30

symptoms of migraine

Answer 30

Pulsatile One-day duration Unilateral Nausea Disabling POUND (from FA p. 534)

Question 31

excruciating periorbital pain with autonomic symptoms

Answer 31

cluster

Question 32

may present with Horners syndrome more common in males

Answer 32

cluster

Question 33

treatment for hemicrania continua

Answer 33

indomethacin

Question 34

acute thunderclap headache

Answer 34

aneurysm

Question 35

an otherwise typical migraine lasting longer than 72 hours

Answer 35

status migrainosus

Question 36

most common cause of transformed migraine

Answer 36

medication overuse

Question 37

transformed migraines and continuous tension type headaches are diagnosed when a patient suffers headaches [...] day a month

Answer 37

15 or more days

Question 38

a B12 or toxin would cause [pattern] symptoms and signs

Answer 38

bilateral symmetric

Question 39

a midline structural process would cause [pattern] symptoms and signs

Answer 39

bilateral symmetric

Question 40

a focal structural process would cause [pattern] symptoms and signs

Answer 40

unilateral, non-symmetric

Question 41

unilateral <3 hours in duration ipsilateral rhinorrhea, eye injection, miosis, ptosis

Answer 41

cluster headache syndrome

Question 42

most common headache disorder for which patient seek help from physicians

Answer 42

migraine (tension type is most common overall)

Question 43

migraine therapy with no vasoconstrictive properties

Answer 43

-ditans (lasmiditan)

Question 44

migraines are caused by

Answer 44

centrally mediated pain sensitization