Headache

Question 1

types of primary headaches

Answer 1

migraine, tension, cluster

Question 2

new headache, elderly patient, jaw claudication

Answer 2

temporal arteritisd

Question 3

name some indicators a HA may be secondary

Answer 3

weakness, exertional HA, nuchal rigidity, neurological deficits, age >50, “first or worst”

Question 4

Migraine without aura: how long, character, accompanying signs, how many

Answer 4

4-72hrs, unilateral, pulsing, moderate to severe intensity; during HA: nausea, vomiting, phobias; at least 5 attacks

Question 5

migraine with aura: describe aura, how many attacks?

Answer 5

develops over 4 minutes but lasts < 60 min. HA follows aura. At least 2 attacks

Question 6

criteria for episodic tension type. Chronic tension type

Answer 6

pressing quality, bilateral, not aggravated by exertion. No nausea. Fewer than 15 days/month. Last 30 min to 7 days.:::Chronic is at least 15 days/month

Question 7

cluster HA characteristics

Answer 7

strictly unilateral, lasts 15-180 mins. Lacrimation, congestion, sweating, miosis, ptosis. At least 5 attacks

Question 8

migraine triggers

Answer 8

hormones, fasting, alcohol

Question 9

Tx of migraines

Answer 9

Ergot preparations like DHE (take before attack, give antiemetic,potent vasoconstrictors). Sumatriptan (dont use with ergots),

Question 10

Migraine prophylaxis

Answer 10

Beta blcokers, CCBs, Antidepressants (amitriptyline), serotonin antagonist, anticonvulsants (depacon= depakote, valproate)

Question 11

contraindications for ergots

Answer 11

PVD, CAD, HTN, pregnant or breastfeeding, elderly

Question 12

contraindications for triptans

Answer 12

ischemic heart dz, HTN, Concomitant use of ergotamines, pregnancy, decrease dose if on MAOI

Question 13

Cluster HA tx

Answer 13

O2, ergotamine, triptans, stop smoking EtOH, CCBs, lithium, prednisone