Headache

Question 1

Examples of PRIMARY Headaches (3 total)

Answer 1

Migraine
Tension
Cluster (Trigeminal Autonomic Cephalgias)

Question 2

Examples of SECONDARY Headaches (4 total)

Answer 2

Trauma
Vascular
Substance use/overuse/withdrawal
Infection

Question 3

Symptoms of migraine that are diagnostic criteria

POUND

Answer 3

Pulsatile
hOurs (at least 30 mins)
Unilateral (either side)
Nausea (+/- vomiting)
Disabling

Question 4

True or False: Most migraines are preceded by an aura (flashing lights)

Answer 4

False; 75% are without an aura

Question 5

These are examples of

Visual (scintillation or loss)*
Tinnitus
Paresthesias
Inability to move

*visual most common

Answer 5

“Auras” for migraines

Question 6

Noise, Exercise, Diets, Stress, Hormones (women), Alcohol, Smells, Changes in altitude, and Caffeine are triggers for

Answer 6

migraines

Question 7

Treatments for Migraines (Abortive)

Answer 7

• Triptans (affect the serotonin system)

- NSAIDs

Question 8

Treatments for Migraine (PROPHYLAXIS)

Answer 8

Cardio: Beta and Ca Channel Blockers
Epilepsy: Valproic acid and Topiramate
Psych: TCAs and Venlafaxine

Botox (botulinum)
- mab (monoclonal antibodies)

Question 9

Migraine treatment; 5HT agonist (potential for serotonin syndrome); CONTRAINDICATED in history of MIs and Stroke

Answer 9

Triptans

Question 10

You would want to avoid prescribing a patient with Triptans who also takes what classes of drug

Answer 10

MAOi (cause Serotonin Syndrome)

Question 11

Triptans can cause what life-threatening condition

Answer 11

Serotonin Syndrome

*also want to avoid in pts with MIs and Strokes

Question 12

PRIMARY Headache; MOST COMMON; diffuse, circumferential, mild to moderate pain like there is a “tight band around their head”; due to the Trigemino-Vascular system

Answer 12

Tension

Question 13

Treatment for Tension Headaches

Answer 13

NSAIDs
Behavioral adjustments (avoid triggers)

Question 14

PRIMARY Headache; UNILATERAL; occur everyday at the same time with symptom-free periods in between; exacerbated by ANY amount of alcohol; NOT relieved by rest;

Answer 14

Cluster

Question 15

Which type of Primary Headache is NOT relieved by rest

Answer 15

Cluster

Question 16

Which type of Primary Headache is exacerbated by ANY amount of alcohol

Answer 16

Cluster

Question 17

Treatments for Cluster Headaches

Answer 17

Oxygen
Triptans
Prednisone
Avoid Alcohol
Prophylaxis: -mab (monoclonal antibody)

Question 18

The red flag symptoms for headaches

SNOOP

Answer 18

Systemic symptoms
Neurological signs
Onset abrupt
Older
Positional/Papilledema

Question 19

Signs/Symptoms of Intracranial HTN

Answer 19

Headache
Papilledema
Tinnitis
Visual obscurations

Question 20

Intracranial HTN is usually in (young/old) (males/females)

Answer 20

Young Females

*usually also obese

Question 21

Treatments for Intracranial HTN

Answer 21

topiramate (also aid with weight loss)
Shunts
Weight loss

Question 22

Secondary Headache; caused by low CSF pressure; worse when sitting and standing but BETTER when lying flat

Answer 22

Intracranial HYPOtension (“Spinal Headaches”)

Question 23

Intracranial Hypotension, or “Spinal Headaches”, are worse with __________ and better with ___________

Answer 23

Worse:sitting/standing
Better: lying flat

Question 24

Treatment for Intracranial Hypotension (“Spinal Headaches”)

Answer 24

Lie flat
Analgesics
Caffeine

Question 25

Secondary Headache; due to the daily use of pain relievers for headaches; need more and more medication to achieve relief

Answer 25

Analgesic Rebound Headaches

Question 26

Excruciating UNILATERAL pain in the Trigeminal nerve distribution; intense, stabbing, and electric shock-like; caused by blood vessel pressing on the trigeminal nerve

Answer 26

Trigeminal Neuralgia (Tic Doloureux)

Question 27

Treatment for Trigeminal Neuralgia

Answer 27

Carbamazepine (anticonvulsant)

Surgery