Dolor en mi Cabeza!

Question 1

Tic douloureux

Answer 1

Trigeminal neuralgia (v1, v2, or v3 distribution), severe pain in cheek or jaw precipitated by touching it (brushing teeth)
Give carbamazepine!
If new in a young person, worry abt MS

Question 2

Temporal arteritis

Answer 2

Giant cell arteritis, systemic disease w/ anemia + jaw claudication (weight loss, headaches, jaw pain)
Dx: temporal artery biopsy

Question 3

Meningioma

Answer 3

Lesion in parasigittal region, hyperdense (calcified) on unenhanced CT, enhancing UNIFORMLY on contrast CT = extra-axial!

Meanwhile, glioblastoma would enhance heterogenously, intra-axial

Question 4

Tension headaches

Answer 4

More frequent but less severe individually than migraines, no therapy :( Dull and worsesn with the day, maybe you can make ergonomic adjustments at work?

Question 5

Migraine w/out aura tx?

Answer 5

Infrequent? Then just use abortive agent like sumatriptan (serotonin 1b/1d agonist)
If you have HTN or CAD uncontrolled, no triptans!

Question 6

Cavernous Sinus thrombosis

Answer 6

Proptosis and eyelid erythema, able to abduct eye, but no other eye movements (so oculomotor is out!)