Fall 2014: Lecture 7: Headaches

Question 1

Neuroimaging

1. CT Method of choice for what?
2. MRI Method of Choice for what?
3. MRA
4. CTA
5. Gold Standard?
6. MRV or CTV

Answer 1

1. Acute Intracranial Hemorrhage and Post-Trauma. (Highly sensitive to bony lesions and Acute Hemorrhage)
2. Soft tissues to look for Parenchymal Lesions or Hydrocephalus (Fat suppression technique is valuable when obtaining orbital views to improve the resolution of the optic nerve and EOMs)
   a. Higher Sensitivity for SELLA TURCICA, Cavernous Sinus and Posterior Fossa Lesions
3. R/o Carotid Artery Dissection, Aneurysm, Arteriovenous Malformation (AVM)
4. Alternative to the MRA
5. Catheter Angiogram to assess for small aneurysms but significantly more invasive than MRA and CTA studies.
6. Evaluate for Cerebral Venous Sinus Thrombosis (CVST) or Stenosis

Question 2

Indications for Neuroimaging

1. What?

Answer 2

1. 1st or Wrost HA of Pt’s Life, esp if Acute onset
2. Change in freq, severity, clinical features
3. Neurologic Symptoms that don’t meet migraine w/aura criteria
4. Hemicrania that’s ALWAYS on the SAME side and is associated w/Contralateral Neurological Symptoms
5. Positional HA
6. HA exacerbated by Valsalva maneuver
7. Poor response to conventional therapy

New HAs in Pt w/CA or immunosuppression or >50 years old.

HA w/Fever, Nuchal Rigidity, change in mental status, or change in behavior

HA PRECEDES AURA

Atypical Aura (more than 1 aura happening in a SINGLE DAY, lack of Expansion of or change in aura)

Question 3

LP Indications?

Answer 3

1. Meningitis suspect, Infectious etiologies, Idiopathic Intracranial HTN, Cerebral Venous Thrombosis

Question 4

Primary Vs. Secondary HAs

1. Primary:

Answer 4

1. No known etiology; can be severe but don’t cause death or permanent neuro deficits.
   a. Migraine
   b. Tension (Scalp Muscle Contraction)
   c. Cluster and other Trigeminal Autonomic Cephalgias
   d. Primary Stabbing
   e. Hemicrania Continua