Headache 1

Question 1

Abortive tx of common migraines is best with which med?

Answer 1

Rizatriptan

Question 2

Young pt w/ new onset severe HAs associated w/ periods of visual obscuration. Neuro exam wnl except for papilledema.
MRI: normal, no mass effect.
Next test?

Answer 2

Lumbar puncture to show opening pressure

Question 3

Characteristic of post lumbar puncture HA?

Answer 3

HA worse with sitting upright

Question 4

Effective tx for acute migraine

Answer 4

Sumatriptan

Question 5

35 y/o w/ episodes of flashing lights traveling slowly from L to R in L visual field, persisting for about 30 mins, followed by difficulty expressing themselves and concentrating. After 30 mins, these sxs subside and pt develops a pounding HA associated w/ nausea.
Physical exam and MRI normal.
Dx?

Answer 5

Migraine w/ aura

Question 6

25 y/o w/ HA and vomiting.
Pain dull and occipital in region, worse when lying down.
Severe papilledema bilaterally.
LP shows OP of 80 w/ normal CSF and 120 RBCs in last tube.
D-dimer, FDP (fibrin degradation products) in blood are elevated.
CT Normal.

Answer 6

Sagital sinus thrombosis

Question 7

Most effective abortive treatment for cluster headaches?

Answer 7

Oxygen

Question 8

28 y/o F.
Episodes severe HA w/ N+V. HAs incapacitating, preceded by flames of light in R visual field.
Which med appropriate to prevent these (prophylaxis for migraines)?

Answer 8

Topiramate

Question 9

Triptans should not be given as abortive tx in migraines in pt’s with

Answer 9

CAD

Question 10

35 y/o with hx migraines has daily migraines for past 3 months no longer responding to sumatriptan which she now takes daily.
Hx MDD, reports ok mood.
Normal Physical exam.
Approach?

Answer 10

DC sumatriptan

Question 11

25 y/o w/ VHs (similar to wavy distortions of heat rising from asphalt) affecting whole of both visual fields.
+vertigo, dysarthria, tingling in BL hands, feet, and around both sides of mouth. Followed by occipital HA.
Dx?

Answer 11

Basilar migraine

Question 12

26 y/o obese pt presents to ER w/ severe HA. Pt otherwise healthy and on no meds.
Head CT and MRI wnl.
Blurred optic disc.
Dx?

Answer 12

Idiopathic intracranial hypertension

Question 13

26 y/o F w/ 3 day hx of severe, continuous, non-throbbing HA.
Not improved on NSAIDs.
Mild BL papilledema.

Answer 13

Sagittal sinus thrombosis

Question 14

Severe dull and constant HA. 
\+vision loss L eye. 
\+pain and stiffness of limbs. 
MRI - periventricular white matter hyperintensities on T2. 
Elevated sed rate. 
Next step?

Answer 14

High dose prednisone

Question 15

Which med most likely to give relief for cluster HAs?

Answer 15

Propranolol

Question 16

Pt recovering from surgery of intracranial hemorrhage secondary to arterial aneurysm.
Develops sudden onset HA, vomiting, and progressive decline of consciousness.
Pupils are miotic (constricted) and abducens muscles are weak BL.
Etiology?

Answer 16

Acute hydrocephalus

Question 17

68 y/o with dull, R-sided, non-throbbing HA. Worse at night and w/ prolonged chewing.
Best initial tx?

Answer 17

Prednisone

Question 18

Young adult w/ HA behind L ear.
2 days later - twisting of face, impaired taste sensation, paralysis of forehead and lower face on L, incomplete closure of L eye w/ blinking. No sensory deficits or other CNs deficits.
MRI shows?

Answer 18

Gadolinium enhancement of L facial nerve

Question 19

35 y/o w/ daily HAs over last several weeks lasting an hour.
Sharp, severe, boring pain into R eye. Another element of this HA?

Answer 19

Occurs during REM

Question 20

25 y/o pt with severe HA, visual loss, vomiting, BL babinski, and then becomes drowsy

Answer 20

Ependymoma of 4th ventricle