Clinical Approach to Headache (Hon)

Question 1

What are signs which may indicate headache of pathological origin (Secondary HA)?

Answer 1

1) Worst HA of life
2) Onset of HA after age 50
3) HA with fever
4) Abrupt onset

Question 2

Any HA patient with a “worrisome history” or abnormal examination needs what urgent imaging study?

What should be done next if the above imaging is normal?

Answer 2

1) CT head with and w/o contrast or MRI of the head

2) Lumbar puncture

Question 3

1) How is the intensity of a common migraine characterized?
2) At what age does the prevalence peak?
3) Which sex is it more common in?
4) Where is the location?
5) How is it described?
6) What is the typical response associated?
7) Do common migraine patients experience an aura?

Answer 3

1) Moderate to severe
2) 35-40 years
3) Females
4) Unilateral or bilateral
5) Throbbing, sharp, pressure
6) Retreat to dark, quiet room
7) No

Question 4

What are the most common associated symptoms of a common migraine?

Answer 4

1) Nausea
2) Vomiting
3) Photophobia
4) Phonophobia

Question 5

An aura is associated with what type of migraine?

How long does it usually last?

What are the most common symptoms assocaited?

Answer 5

1) Classic migraine
2) 15-30 min
3) Visual symptoms

Question 6

How is a chronic migraine classified?

Answer 6

1) HA for 15 or more days per month
2) HA lasts 4 hours or longer
3) For a period of at least 3 months

Question 7

1) How is the intensity of a Tension-Type HA characterized?
2) Does it prohibit daily activities?
3) Where is the location?
4) How is it described?
5) Do Tension-Type HA patients experience an aura?

Answer 7

1) Mild to Moderate
2) No
3) Bifrontal, bioccipital
4) Dull, aching, squeezing, pressure
5) No

Question 8

1) How is the intensity of a Cluster HA characterized?
2) Which sex is it more common in?
3) What condition is it associated with?
4) Where is the location?
5) What is the typical response associated?

Answer 8

1) Severe, excruciating
2) Men
3) Obstructive sleep apnea
4) 100% unilateral; generally orbitotemporal
5) Frenetic, pacing, rocking

Question 9

What are associated symptoms of cluster HA?

Answer 9

1) Ipsilateral ptosis
2) Miosis
3) Conjunctival injection
4) Lacrimation
5) Stuffed or runny nose

Question 10

Triptans which can be used in the acute treatment of migraine are contraindicated in what scenarios?

Answer 10

1) Ischemic heart disease
2) Raynaud’s syndrome
3) Uncontrolled HTN
4) Severe renal or haptic impairment

Question 11

What is the only FDA approved treatment for chronic migraine?

Answer 11

BOTOX injections

Question 12

What can be used to treat cluster HA?

Answer 12

Oxygen 100% 8L/min by mask

Question 13

Paroxysmal Hemicrania which are very similar to cluster headaches but have a shorter duration and an increased frequency are responsive to?

Answer 13

Indomethacin