Headache

Question 1

What is the difference between a primary and a secondary headache?

Answer 1

Primary - headache is primary problem (tension, cluster)

Secondary - headache is secondary to mass, etc

Question 2

What are the typical Sx of migraine headache?

Answer 2

Throbbing pain, associated nausea and vomiting; commonly an aura

Question 3

What is the pathophysiology of migraine headache?

Answer 3

Cortical spreading depression affects parts of cortex 2-3 mm/min, activates trigeminal afferents

Question 4

What is the mainstay abortive therapy for migraines?

Answer 4

Triptans

Question 5

What therapies should be offered for tension headaches?

Answer 5

Not many good ones, but avoid caffeine, NSAID overuse, etc to prevent rebound headaches

Question 6

Described typical cluster headaches

Answer 6

Unilateral, accompanied by autonomic symptoms like lacrimal ion, eyelid edema, rhinorrhea

Question 7

What treatments can be offered for cluster headache?

Answer 7

high flow oxygen, Triptans, steroids can shorten, avoid alcohol

Question 8

What is paroxysmal hemicrania? How does it differ from cluster headaches?

Answer 8

Similar to cluster headaches except shorter in duration and greater frequency

Question 9

Thunderclap headache is…

Answer 9

SAH

Question 10

Headaches that improve when lying down are..

Answer 10

Low pressure headaches, usually iatrogenic (LP) but can be due to rupture of a CSF pouch

Question 11

A patient has a headache worse in the morning with pulsatile tinnitus and visual obscurations (blurring of vision for a few seconds) this is…

Answer 11

Idiopathic intracranial hypertension

Question 12

What is a possible complication of IIH?

Answer 12

Loss of vision from compress e optic neuropathy

Question 13

What is the classic population of patients with IIH?

Answer 13

Young overweight women

Question 14

An older patient presents with tender scalp, headache and jaw claudication. Think…

Answer 14

Temporal arteritis- tx with high dose steroids

Question 15

What are the neurological causes of facial pain?

Answer 15

Trigeminal neuralgia, glossopharygeal neuralgia, post herpetic neuralgia

Question 16

What is the treatment of choice for trigeminal neuralgia?

Answer 16

Carbamazepine or another anticonvulsant

Question 17

What is the treatment of choice for post herpetic neuralgia?

Answer 17

Tricyclics, gabapentin

Question 18

What is an Important mimic of IIH?

Answer 18

Venous sinus thrombosis

Question 19

What tx options exist for IIH?

Answer 19

Carboni anhydrase inhibitors, optic nerve fenestration, repeated LP, limbo peritoneal shunting

Question 20

What are ideal screening questions for migraine?

Answer 20

have headaches bothered you for >1 day in last 3 months
associated with nausea/vomiting?
worsened with light?

Question 21

A patient presents with insomnia, lots of fatigue, emotionality etc. after a head trauma during driving. This is likely…

Answer 21

post concussive state

Question 22

In what population of patients should triptans not be used?

Answer 22

people with heart disease, elderly

Question 23

A patient presents with severe intermitten right sided cheek pain while brushing her teeth. This is..

Answer 23

trigeminal neuralgia

Question 24

A patient presents with headaches for severeal years - she was just involved in a car accident in whch she hit the front of her head. CT shows a hyperdense left frontal parasagittal mass that enhances with contrast. This is..

Answer 24

meningioma

Question 25

A 16 year old girl had wisdom tooth extraction and drainage of an abscess and presents with headache and fever with proptosis and erythema of the eyelid. This is..

Answer 25

cavernous sinus thrombosis