Head Pain

Question 1

what are some causes of eye pain that can cause a headache?

Answer 1

corneal (FB, abrasion, erosion, EKC, dryness, trichiasis), scleritis, light sensitivity/photophobia

Question 2

what are some causes of periocular pain that may cause a headache?

Answer 2

near point stress, orbital mass or eyelid mass, sinusitis, neuralgia, and herpes zoster

Question 3

what are the two causes for light sensitivity/photophobia?

Answer 3

light scattering within the eye or true photophobia

Question 4

what can cause light scattering in the eye?

Answer 4

dirty glasses, dry eye, ocular media (cataract, ocular dystrophy), rule out iritis, low RPE pigment, idiopathic

Question 5

what can cause true photophobia?

Answer 5

iritis (anterior uveitis) until proven otherwise or other iris pathology

Question 6

what is strong evidence for near point stress diagnosis?

Answer 6

if the patient answers yes to the question = does cessation of the activity alleviate the symptoms

Question 7

what are the signs and symptoms of near point stress?

Answer 7

both eyes, frontal headaches, worse at the end of the day, gritty/burning eyes, some redness, general fatigue, tiredness, need frequent breaks

Question 8

what is the treatment for near point stress?

Answer 8

functional disorders = vision therapy

computer users = computer glasses

Question 9

how do you test for an orbital mass or eyelid mass?

Answer 9

seeing it or by touch - use retropulsion and compare both eyes
could also be a chalazion or hordeloum
any orbital mass needs imaging

Question 10

how do patients with sinusitis present?

Answer 10

pain at/over sinus, associated with rhinorrhea, nasal congestion, recent cold, failure to transilluminate sinus

Question 11

what are the 4 types of primary headaches?

Answer 11

migraine, tension, TAC, and chronic daily

Question 12

what are TAC primary headaches?

Answer 12

TAC = trigeminal autonomic cephalalgias
cluster, paroxysmal hemicrania and SUNCT types
pain is neuralgiform and accompanied by autonomic hyper- or hypo-activity

Question 13

what is a cluster headache?

Answer 13

comes every 8-16 months (2 per year), lasts for 2-12 weeks, headaches occur 2-3 times per day and last for 1 hour
do not occur between cluster periods (remission is 6-24 months)

Question 14

what type of pain occurs with cluster headaches?

Answer 14

highly excruciating, hot poker
always unilateral (around/behind eye)
may awaken during the night

Question 15

who typically gets cluster headaches?

Answer 15

males > females (larger men), 20-40 years old

Question 16

what do people with cluster headaches do?

Answer 16

they often pace the floor - being still makes the pain worse

Question 17

what are some associations with cluster headaches?

Answer 17

trigeminal and parasympathetic pain, conjunctival injection/tearing, post-ganglionic horners, nasal stuffiness, cigarette smoking

Question 18

what is paroxysmal hemicranial?

Answer 18

parasympathetic activation ipsilateral to the pain
> 5 attacks per day, 2-30 minutes long, unilateral, neuralgiform, periocular pain
may be chronic or episodic

Question 19

what is SUNCT?

Answer 19

short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing

Question 20

what is the pattern/frequency for migraine headaches?

Answer 20

recurrent (1 per year - 5 per week), lasts 24 hours, unilateral pain, pulsating/throbbing, exacerbated by exercise

Question 21

who typically gets migraines?

Answer 21

often run in families, females > males, starts in childhood

Question 22

what are some migraine triggers?

Answer 22

stress, alcohol, red wine, cheese, chocolate, activities

Question 23

what are some associations with a migraine?

Answer 23

gastrointestinal upset, nausea, photophobia, phonophobia, +/- aura

Question 24

how is an aura different from a TIA or retinal detachment?

Answer 24

an aura is usually the hour before the migraine
a TIA = lasts 3-10 minutes (doesn’t move/dark)
RD = 5-30 seconds

Question 25

is it possible to have a migraine without an aura?

Answer 25

yes = aura without headache, ophthalmic migraine or cephalic migraine

Question 26

what tests should you do if a patient reports having an aura with or without a headache?

Answer 26

conduct VF to rule out = permanent damage to the visual system and etiology other than primary migraine

Question 27

what is a tension headache?

Answer 27

lasts 0.5 hours to 7 days, steady pressing or vice-like pain, worse at the end of the day, bilateral and wide spread, negative for migraine signs

Question 28

what are the triggers for tension headache?

Answer 28

stress, fatigue, not eating (physical activity doesn’t make pain worse/better)

Question 29

what can tension headaches lead to?

Answer 29

depression due to its relentlessness

Question 30

what are daily persistent headaches?

Answer 30

present upon waking up or begin in morning, 1 hour - all day (usually 4-6 hours), gradually gets worse or better, dull/steady bilateral pain

Question 31

what are medication overuse or rebound headaches?

Answer 31

due to frequency of analgesic use for treatment of chronic headaches

Question 32

what is a “kid headache”?

Answer 32

rule out migraines and near point stress

conduct a thorough exam

Question 33

what are the 8 types of secondary headaches?

Answer 33

pseudotumor cerebri, mass (tumor, aneurysm), subdural hematoma, chemical, trauma/illness/infection, menstrual, ice cream, myopia/uncorrected refractive error, medications

Question 34

describe the headache pain in pseudotumor cerebri patients

Answer 34

gradual onset, generalized and bilateral, dull and steady

accompanied by blurry vision, visual obstructions (papilledema) and diplopia (CN6)

Question 35

what are the signs and symptoms of a brain tumor?

Answer 35

focal neurological signs or seizures, nausea, vomiting, impaired mental status

Question 36

what are the signs and symptoms for a subdural hematoma?

Answer 36

slow onset (after blunt trauma or fall), headache starts mild, neurological signs, change in mental status, usually no papilledema and elevated ICP