Chapter 21. Cranial and Facial Pain Flashcards
Question 21-1:
Which of the following statements concerning activity-dependent headache are true?
1. Most exertional headaches are benign
2. Exertional headache is worrisome for posterior fossa lesion
3. Positional headache exacerbated by upright posture suggests low CSF pressure
4. Recurrent headache during sexual activity is most likely due to unruptured aneurysm
Select:A= 1,2,3. B= I, 3.C =2.4. D= 4 only. E=AII
Answer 21-1: A.
A single episode of headache developing
abruptly during sexual activity suggests
aneurysm, although these headaches are often
benign, especially if the headache is recurrent.
Most exertional headaches are benign, but
intracerebral lesions can produce this, so they
must be considered during evaluation.
Positional headache exacerbated by upright
posture. and relieved by recumbency are often
due to low CSF pressure, which may be
related to previous dural puncture or
development of a spontaneous leak
Question 21-2:
Which of the following are true regarding cluster headache?
1. Headache is usually bilateral but may be unilateral
2. Headache may change sides between clusters
3. Alcohol precipitates migraine but not cluster headache
4. Pain of cluster may be in the lower half of the face
Select: A = 1,2,3. B = 1,3. C = 2, 4. D = 4 only. E = All
Answer 21-2: C.
Headache of cluster is almost always
unilateral In a cluster, the headache is
typically on the same side, but the sides may
change between clusters. Cluster headache is
often precipitated by alcohol. Lower-half
headache can be a cluster variant, but the
same temporal features exist
Question 21-3:
Migraine aura can be difficult to differentiate from brain ischemia. Which of the following are differentiating features?
1. Aura symptoms spread over minutes whereas stroke symptoms have an abrupt onset
2. If more than one modality is affected by an aura, they have a staggered onset
3. Visual symptoms are the most common auras
4. Aura symptoms which develop during the headache phase are more likely to be due to migrainous infarction
Select: A = 1,2, 3. B = 1,3. C = 2,4.0=4 only. E = All
Answer 21-3: A.
Aura symptoms and infarction can be
differentiated in several ways. Aura symptoms
spread over several minutes, and often march
up an extremity or across the face or across
the visual field in a manner which corresponds
to the spread across the cerebral cortex. Visual
auras are most common, although we tend to
be concerned about stroke especially when
motor or sensory symptoms develop in the
face and extremities. Aura symptoms usually
develop 20-30 minutes prior to the headache
phase, but they may develop simultaneously
with the headache or even after the headache
has already begun.
Question 21-4:
Which of the following clinical features suggests temporomandibular joint dysfunction?
1. Clenching of the teeth
2. Tenderness in the temporal region
3. TMJ clicking
4. Increased range of motion of the TMJ
Select: A = 1,2,3. B = 1,3. C = 2, 4. D = 4 only. E = All
Answer 21-4: B.
TMJ dysfunction is suggested by pain and
tenderness in the region of the TMJ which is
exacerbated by movement of the jaw. The
diagnosis is supported by clicking of the TMJ,
clenching of the teeth, and decreased range of
motion of the TMJ.
Question 21-5:
Some headache syndromes are hereditary. Which of the following statements regarding hereditary are true?
1. Migraine is often inherited
2. Cluster is inherited in Iess than 10% Of cases
3. Familial hemiplegic migraine is inherited as an autosomal dominant trait
4. Tension headache has a familial tendency
Select; A = 1,2,3. B = 1,3. C = 2,4. D = 4 only. E= All
Answer 21-5: E.
All of these are true. Many headache
syndromes are familial including migraine,
cluster, and tension. However, the familial
tendency is about 7% for cluster headache -
greater than the normal prevalence of cluster,
but still relatively low. Familial hemiplegic
migraine is a rare disorder that often has
autosomal dominant inheritance
Question 21-6: Headache which is markedly worsened by upright posture, and relieved by lying down. Indicate the most likely diagnosis from the following list: A. Migraine B. Cluster headache C. Tension headache D. Increased intracranial pressure E. Decreased intracranial pressure F. Trigeminal neuralgia G. TMJ pain
Answer 21-6: E.
Decreased intracranial pressure from any
cause can produce positional headache. The
patient is relatively headache-free when down,
but develops a severe headache when upright,
either sitting or standing. Post-lumbar
puncture headache is the most classic example
of this.
Question 21-7:
Episodic unilateral throbbing headache without neurologic symptoms or signs. The patient has nausea and photophobia with the attacks, but no symptoms between attacks.
Indicate the most likely diagnosis from the following list: A. Migraine B. Cluster headache C. Tension headache D. Increased intracranial pressure E. Decreased intracranial pressure F. Trigeminal neuralgia G. TMJ pain
Answer 21-7: A. Common migraine is characterized by episodes of severe unilateral headache without other neurologic symptoms. Nausea and photophobia are particularly helpful in differentiating migraine from many other types of headache
Question 21-8:
Headache which is worse in the morning, is better when upright.
Indicate the most likely diagnosis from the following list: A. Migraine B. Cluster headache C. Tension headache D. Increased intracranial pressure E. Decreased intracranial pressure F. Trigeminal neuralgia G. TMJ pain
A.nswer 21-8: D.
Increased intracranial pressure produces
headache which is generally worsened by
recumbency
Question 21-9:
Episodes of unilateral lancinating pain lasting seconds to a minute. No neurologic deficit.
Indicate the most likely diagnosis from the following list: A. Migraine B. Cluster headache C. Tension headache D. Increased intracranial pressure E. Decreased intracranial pressure F. Trigeminal neuralgia G. TMJ pain
Answer 21-9: F.
Trigeminal neuralgia presents with episodes
oflancinating, electric-type pain which is in
the distribution of a portion of the trigeminal
nerve. There are no neurologic deficits
Question 21-10:
Episodes of severe but brief unilateral
periorbital headache.
Indicate the most likely diagnosis from the following list: A. Migraine B. Cluster headache C. Tension headache D. Increased intracranial pressure E. Decreased intracranial pressure F. Trigeminal neuralgia G. TMJ pain
Answer 21-10: B.
Cluster headache is characterized by relatively
brief episodes of unilateral headache with a
concentration around one eye. The side of the
headache may change between clusters.
