Headache

Question 1

The primary headache syndromes include :

Answer 1

1. Cluster
2. Migraine
3. Tension

Question 2

Secondary causes of headache include:

Answer 2

▪️Meningitis
▪️Intracranial bleeding (SAH)
▪️Neoplasia
▪️Hydrocephalus / IIH
▪️Acute sinusitis
▪️ Giant cell (Temporal) arteritis
▪️Medication overuse

Question 3

Headache with fever & stiff neck

Answer 3

CNS infection “Meningitis”

Question 4

“The worst headache of my life”

Answer 4

Subarachnoid hemorrhage

Question 5

Headache with pain/fullness behind the eyes or over the cheeks or forehead + Tenderness + worse with straining / coughing / leaning forward

Answer 5

Sinusitis

Question 6

Headache Pain over the occiput + neck stiffness

Answer 6

Cervical spondylosis

Question 7

Generalized headache in obese female,
worse in the morning ☀️+ papilledema + drowsiness & vomiting + worse with coughing

Answer 7

Idiopathic intracranial hypertension

Question 8

Headache unilateral lancinating pain over V2/V3 triggered by light touch

Answer 8

Trigeminal neuralgia

Question 9

What are the features of Migraine headache ?

Answer 9

Pulsitile
One day (4-72 hr)
Unilateral
Nausea / vomiting
Disabling (photophobia/phonophobia)
“Aura” - before headach

Question 10

What are the features of cluster headache ?

Answer 10

Unilateral
15 min - 3 hr [repetitive]
Excruciating periorbital pain
Awaken patient from sleep
+ autonomic symptoms (lacrimation, rhinorrhea..)
+ Horner syndrome

Question 11

What are the features of Tension headache ?

Answer 11

Bilateral
Steady “band-like”
Stress
+ Neck / shoulder tenderness
عادي يكتب في السؤال throbbing

Question 12

Acute treatment of Cluster headache […]

Answer 12

100% Oxygen
Triptans

Question 13

Acute treatment of Migraine headache […]

Answer 13

1st (mild): NSAIDs
2nd (N/V): Triptans (N/V » nasal / SC Triptan)
3rd: Ergotamine
Antiemetics

Question 14

Acute treatment of Tension headache […]

Answer 14

NSAIDs
Acetaminophen

Question 15

Prophylactic treatment of Cluster headache […]

Answer 15

Verapamil (CCB)

Question 16

Prophylactic treatment of Migraine headache […]

Answer 16

ß-blockers
TCA (amitriptaline)
Topiramate / Valproate
Botulinum toxin
anti-CGRP monoclonal antibody

Question 17

Prophylactic treatment of Tension headache […]

Answer 17

«TCA for Tension»
Behavioral therapy

Question 18

First line treatment of Trigeminal neuralgia

Answer 18

Carbamazepine

Question 19

The first step for diagnosis of patient presenting with headache

Answer 19

Full history and examination

Question 20

If you suspect SAH what is the first diagnostic test ?

Answer 20

CT head

Question 21

What diagnostic test confirm SAH if CT was negative?

Answer 21

LP .. “xanthochromia”

Question 22

What diagnostic test confirms sinusitis ?

Answer 22

CT paranasal sinuses

Question 23

Elderly with Unilateral headache at temporal area + visual changes + “jaw claudication” + 🔺ESR
Jaw pain during eating & weight loss

Answer 23

Temporal arteritis

Question 24

Headache + 🔺 ESR
What is your next step

Answer 24

High dose steroids
(Dont wait for biopsy!)

Question 25

How to confirm diagnosis of Temporal arteritis ?

Answer 25

Biopsy

Question 26

Which primary headache syndrome present with autonomic symptoms ?

Answer 26

Cluster *sweating, facial flushing, nasal congastion, lacrimation*

Question 27

Which primary headache syndrome associated with trigger ?

Answer 27

Migraine *certain food, hunger, sleep disruption*

Question 28

Use of over the counter pain medication for 10-15 days

Answer 28

Medication overuse headache