CLINICAL CARE OF THE NERVOUS SYSTEM

Question 1

Tension Headaches are presented with

Answer 1

1) Most prevalent headache
2) Bilateral headaches
3) Often occurs daily
4) Characterized as “vice-like” in nature
5) Often exacerbated by emotional stress, fatigue, noise, glare
6) It May be associated with the hypertonicity of neck muscles.

Question 2

Diagonsis for Tension Headaches

Answer 2

No diagnostic tests are required

Question 3

Treatment for tension headaches

Answer 3

NSAIDS

Question 4

Cluster Headache presentation with

Answer 4

1) Usually affects middle-aged men but can also affect women
2) Intense unilateral pain that starts around the temple or eye
3) Patients is often restless and agitated due to the pain
4) Episodes often occur 15 minutes to 3 hours
5) Usually occur seasonally, and attacks are grouped together
6) Other associated symptoms
a) Ipsilateral congestion or rhinorrhea
b) Lacrimation and redness of the eye
c) Horner syndrome (Ptosis, miosis, anhidrosis)
7) After the resolution of attacks there is a hiatus of several months

Question 5

Cluster Headache Treatment

Answer 5

1) Oral treatment during an attack is generally unsatisfactory
2) Inhaled 100% oxygen for 15 minutes is the initial treatment of choice
3) Subcutaneous Sumatriptan (Imitrex) - Anti-migraine medication
4) Oral Zolmitirptan (Zomig) – Oral anti-migraine medication if they are able to
tolerate.

Question 6

Migraines presentation

Answer 6

1) Gradual build-up of a throbbing headache that may be unilateral or bilateral
2) several hours
3) Aura may or may not be present
a) Visual disturbances such as visual field deficits or visual hallucinations
(stars, light slashes, zigzags, etc)
b) Other focal disturbances such as aphasia or numbness, tingling,
clumsiness or weakness in a circumscribed distribution
4) Family history often positive for headaches
5) May have associated nausea and vomiting

Question 7

Migraines Diagnosis

Answer 7

Made clinically by HPI

Question 8

Migraine Management

Answer 8

Rest in a quiet, darkened room during acute attacks until symptoms subside.

Migraine Abortive Treatment- Simple analgesics/NSAIDS: Ibuprofen, Naprosyn, Aspirin, Acetaminophen, Ketorolac (Toradol) 30mg IV/IM once or every 6 hours
or 60mg IM once (max 120mg/day)

Sumatriptan (Imitrex)

Zolmitriptan (Zomig)

Question 9

Migraine Prophylaxis

Answer 9

Preventative treatment indicated when migraines occur more than 2-3 times
per month or associated significant disability