Headache 2

Question 1

What are some causes of secondary headache disorders

Answer 1

1. trauma/injury to the head/neck
2. cranial/cervical vascular disorders (blood vessels)
3. non vascular intracranial disorders (intracranial masses)
4. substance abuse/withdrawal
5. disorder of eyes (uveitis), sinuses, teeth, mouth or other facial/cranial structures (TMJ).

Question 2

Secondary headache occurs in association with a definable abnormality:

Answer 2

1. structural
2. vascular
3. toxic
4. inflammatory
5. infectious
   - may mimic a primary headache disorder. Requires prompt work up.

Question 3

Headache caused by trauma is one of the most common causes of secondary headache. Presents within ____ months of injury and can persist. Usually resembles tension or migraine headaches. It is never due to intracranial bleed from trauma

Answer 3

3

Question 4

What are some additional symptoms of headaches that are caused by trauma to head/neck

Answer 4

1. dizziness
2. fatigue
3. reduced ability to concentrate
4. mild memory problems
5. insomnia
6. irritabilty

Question 5

What is the pathogenesis of headaches caused by trauma?

Answer 5

unclear, may be due to:

1. axonal injury
2. alteration in cerebral metabolism
3. psychopathology: patient expectation of dev headache after injury
4. malingering: uncommon cause

Question 6

how do you manage headache caused by trauma

Answer 6

1. neuroimaging to rule out structural abnormality
   - carotid artery dissection: med ER
   - intracranial hematoma: med ER

Question 7

What is an optometrists role in managing headaches due to trauma

Answer 7

1. rule out ocular sequelae of trauma (retinal tear, RD, etc)
2. refer to neurology for management

Question 8

What types of disorders cause headaches due to cranial/cervical vascular disorders

Answer 8

1. ischemic stroke
2. hemorrhagic stroke
3. arterio-venous malformation
4. cerebral venous sinus thrombosis
5. arterial dissection
6. giant cell arteritis

Question 9

Headache in ischemic stroke is a self limited course. Dev’s in close temporal relation to other symptoms and signs of ischemic stroke. Neurologic symptoms predominate:

Answer 9

1. loss of consciousness
2. motor weakness
3. altered mental status

Question 10

Headache in hemorrhagic stroke is usually due to _____hemorrhage. it involves an abrupt and severe thunderclap headache. mortality is 40-50%. 50% of survivors are left disabled. Requires STAT non contrast CT: neuro surgical ER to identify site of ruptured aneurysm, and repair aneurysm.

Answer 10

subarachnoid

Question 11

______space is not a real space but it can fill with blood. acute but not as severe as subarachnoid hemorrhage. in elderly its usually associated with history of falling. may lead to permanent neurologic deficits if left untreated. Occurs as a tear of a bridging veiln.

Answer 11

subdural

Question 12

Headache secondary to arteriovenous malformation may present as ____ HA, chronic paroxysmal hemicrania, or migraine. Other features present include seizure disorder, and focal neurologic deficits. Requires neuroimaging to diagnose.

Answer 12

cluster

Question 13

How do you differentiate headaches secondary to arteriorvenous malformation from primary HA disorders?

Answer 13

1. abrupt onset
2. falls out of patient demographic for particular primary HA
3. associated neurologic symptoms
4. associated retinal findings.

Question 14

Headache is the most common symptom of ____ sinus thrombosis. associated with other signs of elevated ICP. Requires MRI and ____ for diagnosis. Treatment requires ____ followed by 6+ month course of oral anticoagulation

Answer 14

venous; MRV; heparin

Question 15

Headache secondary to artery dissection is sudden and severe, ipsilateral to artery dissection. HA is usually persistent and can last up to 4 days in duration. If suspected requires, STAT MRI and ____ of head and neck and prompt surgical intervention. If cervical arteries involved, may present with ______

Answer 15

MRA; horners

Question 16

Headache secondary to GCA includes inflammation of your cervical, cranial, or brain arteries. Other symptoms usually present include:

Answer 16

1. jaw claudication
2. polymyalgia rheumatica; muscle pain and stiffness
3. fever
4. anorexia
5. amarosis fugax

Question 17

Headache secondary to GCA includes:

Answer 17

1. STAT IV steroids if optic nerve is involved.
2. ESR, CRP, platelets
3. Temporal artery biopsy

Question 18

Non vascular intracranial causes of HA include:

Answer 18

1. intracranial mass
2. intracranilal pressure alteraions: elevated or decreased ICP
3. intracranial infections: meningitis

Question 19

intracranial mass usually doesn’t present with headaches. Usually ____ signs will predominate.

Answer 19

neurologic

Question 20

Increase ICP will present with papilledema, transient vision loss and ____ palsy. Manage these patients with MRI, _____ and treat underlying disorder

Answer 20

CN VI; lumbar puncture

Question 21

what can DECREASED ICP cause

Answer 21

ICP below 90 mmH20, usually due after LP, epidural, or shunting due to persistent CSF leak. Usually occurs 48 hours after procedure, but may be delayed up to 14 days. worsens with standing, improves on laying down.

Question 22

what are associated symptoms of decreased ICP

Answer 22

1. nausea/vomiting
2. tinnitus
3. photophobia
4. diplopia: bilateral CN VI palsy due to traction from the brain as it sinks down
5. management: stop CSF leak

Question 23

______ is pain accompanied by photophobia, stiff neck and fever. Etiology is usually _____, inflammatory, or neoplastic. If bacterial its very aggressive and can cause rapid deterioration if not treated promptly. IT viral it is usually self resolving. Neoplastic is usually due to history of prior cancer treatment.

Answer 23

Meningitis; infectious

Question 24

main symptoms of meningitis include headache, fever, and stiff neck. what are additional symptoms?

Answer 24

1. pain in back, muscles or neck
2. chills, lethargy, loss of appetite
3. nausea or vomiting
4. mental confusion
5. sluggish
6. elevated heart rate

Question 25

Postherpetic neuralgia occurs days to months after acute ____ dermatitis. It presents with constant burning mixed with sharp stabs that may be triggered by light touch. More frequent in elderly, diabetic or immunocompromised patients. Difficult to treat and may subside within ___ years. Best treatment is prompt oral antivirals and corticosteroids during acute HZV attack

Answer 25

HZV

Question 26

Jaw origin of head pain is usually due to dental pain, exacerbated by chewing/hot/cold temps. You can also get it from ____ pain which is exacerbated by jaw movement, a clicking sound is often heard.

Answer 26

TMJ

Question 27

Paranasal sinus disease usually presents with headaches thats worse in the morning and is accompanied by _____. Requires CT scan of head and orbits for diagnosis. If you transilluminate the sinuses, and they’re clear they should light up, if theres a sinusitis it doesn’t light up

Answer 27

congestion

Question 28

what are ocular causes of head pain

Answer 28

1. corneal disease: dryness inflammation abrasion. may be associated with collagen vascular disorders.
2. inflammatory disease:
   uveitis, scleritis, episcleritis, optic neuritis
3. elevated IOP: sudden elevation in IOP; acute angle closure, Possner Schlossmsan syndrome (acute elevation of IOP)
4. uncorrected RE
5. ischemia: ocular ischemic syndrome; significant ICA stenosis, dull pain
6. Accommodative spasm: excessive accusation leads to ciliary muscle cramps. typically binocular and is associated with near work. distance vision blur is a common symptom
7. binocular dysfunction: DI, DE, CI, CE
8. Orbital disease: proptosis, vascular congestion