Final Exam -- Headaches--Part II

Question 1

True or false: tension-type headaches are the most common type of headache worldwide.

Answer 1

True.

Question 2

Tension-type headaches are ___________ (bilateral/unilateral) and ___________ (throbbing/non-throbbing).

Answer 2

Bilateral*, non-throbbing

Question 3

Comparing tension headaches to migraines, which does worsen with exercise?

Answer 3

Migraine

Question 4

Comparing tension headaches to migraines, which does not worsen with exercise?

Answer 4

Tension

Question 5

Comparing tension headaches to migraines, which is not typically associated with nausea or vomiting?

Answer 5

Tension

Question 6

Comparing tension headaches to migraines, which is typically associated with nausea or vomiting?

Answer 6

Migraine

Question 7

In order to diagnose a tension headache, there must be at least 10 episodes of headaches fulfilling four other criteria. One of those four criteria is that the headache must last how long?

Answer 7

30 minutes to seven days

Question 8

In order to diagnose a tension headache, there must be at least 10 episodes of headaches fulfilling four other criteria. One of those four criteria is there must be at least two of which four characteristics?

Answer 8

Bilateral*
Pressing/tightning* (nonpulsating)
Mild/moderate intensity*
Not aggravated by routine physical activity*

Question 9

In order to diagnose a tension headache, there must be at least 10 episodes of headaches fulfilling four other criteria. One of those four criteria is there must be no nausea or vomiting* AND no more than one of photophobia or phonophobia*.

Answer 9

Free card.

Question 10

In order to diagnose a tension headache, there must be at least 10 episodes of headaches fulfilling four other criteria. The last of those four criteria is that the headache is not better accounted for by another diagnosis.

Answer 10

Free card.

Question 11

What is the most common trigger for a tension headache?

Answer 11

Stress*

Question 12

Tension headaches are divided into infrequent/episodic, frequent, and chronic. On average, how often do infrequent/episodic headaches occur?

Answer 12

Less than 1 day per month on average

Question 13

Tension headaches are divided into infrequent/episodic, frequent, and chronic. On average, how often do frequent headaches occur?

Answer 13

Between 1-14 days per month on average

Question 14

Tension headaches are divided into infrequent/episodic, frequent, and chronic. On average, how often do chronic headaches occur?

Answer 14

More than 15 days per month on average

Question 15

Tension headaches are divided into infrequent/episodic, frequent, and chronic. Which is most common?

Answer 15

Infrequent/episodic*

Question 16

Treatment for tension headaches can include analgesics (ibuprofen, naproxen, aspirin) and acetaminophen. Which of these (analgesics vs acetaminophen) is less effective and should be limited in use to 9 days/month and limited to 2 doses/day?

Answer 16

Acetaminophen

Question 17

Treatment for tension headaches can include analgesics (ibuprofen, naproxen, aspirin) and acetaminophen. Which of these (analgesics vs acetaminophen) is more effective and should be limited to 15 days/month?

Answer 17

Analgesics

Question 18

Prophylaxis of tension headaches is done through stress avoidance. Use of which antidepressant can also be considered?

Answer 18

Amitriptyline*

Question 19

Chronic daily headaches (aka “chronic migraines”) are characterized by headaches occurring at least _____ days per month for at least _______ months.

Answer 19

At least 15 days/month for at least 3 months*

Question 20

Which migraine subtype involves the brainstem or bilateral occipital hemispheres?

Answer 20

Migraine with brainstem aura (aka basilar migraine)

Question 21

Basilar migraines need two or more of what symptoms for diagnosis? (FYI: these symptoms last 5-60 minutes)

Answer 21

Dysarthria
Vertigo/difficulty walking
Tinnitus and/or hearing impairment
Diplopia
Bilateral visual symptoms*
Bilateral paresthesia
Decreased consciousness

Question 22

True or false: when asked to localize the pain, a patient with a basilar migraine will point to their entire forehead, just above the eyes.

Answer 22

False; they will more likely point to the back of their head (occipital area).

Question 23

True or false: with basilar migraine, it is possible for a patient to have weakness

Answer 23

False; there should be no evidence of weakness.

Question 24

Typically avoid beta blockers and triptans in basilar, hemiplegic, and retinal migraines.

Answer 24

Free card.

Question 25

What type of migraine subtype is associated with unilateral weakness during the headache?

Answer 25

Hemiplegic migraine

Question 26

True or false: the unilateral weakness of hemiplegic migraines can switch sides during an attack.

Answer 26

True.

Question 27

The motor aura that occurs in hemiplegic migraines contrasts with the aura of basilar migraines in that the hemiplegic migraine auras last how long?

Answer 27

1 to 24 hours

Question 28

Retinal migraine (aka ocular or ophthalmic migraine*) is thought to involve which arteries?

Answer 28

Central retinal and ophthalmic

Question 29

What visual symptom occurs with a retinal migraine, and how long does it typically last?

Answer 29

Monocular scotoma or blindness*

Lasts from minutes to less than an hour

Question 30

True or false: a retinal migraine is associated with a severe headache and can lead to permanent vision loss.

Answer 30

False; it can indeed lead to permanent vision loss, but the associated headache is mild*

Question 31

Recurrent painful ophthalmoplegic neuropathy is characterized by paralysis of the ocular cranial nerves and ipsilateral headache*. Which cranial nerve is most often affected?

Answer 31

CN III*

Question 32

The headaches that occur in recurrent painful ophthalmoplegic neuropathy can develop up to how many weeks prior to the eye muscle weakness? Does the eye muscle weakness ever resolve?

Answer 32

2 weeks; the muscle weakness does recover completely between attacks.

Question 33

Trigeminal neuralgia involves extreme pain. Does it occur bilaterally or unilaterally?

Answer 33

Unilaterally*

Question 34

True or false: hypotension is a risk factor for trigeminal neuralgia.

Answer 34

False; hypertension is a risk factor for trigeminal neuralgia. (Thought to be due to compression on the nerve by an artery or a vein.)

Question 35

Trigeminal neuralgia episodes last how long? Which branches of the trigeminal nerve are most commonly affected?

Answer 35

Episodes last a few seconds to 2 minutes*

V2 and/or V3 are most commonly affected*

Question 36

What drug can be used to treat trigeminal neuralgia?

Answer 36

Carbamazepine*

Question 37

What surgical options are available for trigeminal neuralgia?

Answer 37

Microvascular decompression (move the artery or vein away from the nerve), or lesion the trigeminal nerve.