Headache

Question 1

Primary headache

Answer 1

Migraine
Tension type headache, CNPHA
Cluster headache - a trigeminal autonomic cephalalgia

Question 2

Secondary headache - causes

Answer 2

Acute febrile illness
Head trauma
Medication, overuse of headache medication
Potential life threatening conditions

Question 3

Potential life threatening conditions causing secondary headache:

Answer 3

Raised ICP
Hydrocephalus
Intracranial infection - meningitis, encephalitis
Severe HTN
Intra-cranial tumor
Intra-cranial hemorrhage

Question 4

Dx

Answer 4

History, SOCRATES
Physical exam
Labs, Imaging useful for ddx of possible secondary cause

Question 5

Management

Answer 5

Secondary headache - treat underlying cause
Patient education
Pharmacotherapy
Psychotherapy

Question 6

Patient education

Answer 6

Provide realistic expectations
Encourage return to school 
Avoid triggers
Daily exercise (at least 20-30min)
Headache calendar might be helpful - to identify triggers, follow Tx plan, etc..

Question 7

Migraine pharmacotherapy

Answer 7

1st line: NSAIDS
2nd line: Triptans or Dihydroergotamine
Triptans: 
- Sumatriptan
- Almotriptan
- Rizatriptan
For nausea/vomiting - antiemetics; promethazine preferred in children

Question 8

Migraine emergency Tx

Answer 8

IV prochloroperazine
IV ketorolac
IV metoclopramide
IV dihydroergotamine
SC sumatriptan

Question 9

Tension headache pharmacotherapy

Answer 9

NSAIDs

Preventative: Amitryptiline, Topiramate

Question 10

Cluster headache - acute Tx

Answer 10

1st line: 100% oxygen

If not available - give sumatriptan

Question 11

Cluster headache preventative drug

Answer 11

Verapamil

Question 12

Psychotherapy

Answer 12

CBT, relaxation techniques (deep breathing, etc..)