Headache

Question 1

if headache px, must rule out..?

Answer 1

• tumor (focal deficits, papilledma, n/v)
• SAH (sudden onset, stiff neck, photophobia, loss of consciousness)
• temporal arteritis (vision changes, scalp/ temporal tenderness)

Question 2

initial diagnostics for headache

Answer 2

CT

Question 3

pt px with visual changes & temporal tenderness. what do you do next?

Answer 3

give steroids while waiting for temporal artery biopsy

• steroids = best initial
• biopsy = most accurate
• not a CT

Question 4

blood in CSF causes?

what disease does this happen?

Answer 4

WBCs in CSF to inc

• 1:500-1000, WBC:RBC = normal CBC
• seen in SAH

Question 5

SAH dx, tx

Answer 5

• CT or LP
• angiogram –to find origin of bleed & determine surgical repain
• dexamethasone (dec inflammation)
• embolization, clipping (via angiogram)
• nimodipine = CCB; dec risk of stroke by preventing vasospasm
• shunt (to prevent hydrocephalus)

Question 6

primary headaches

Answer 6

• recurrent

- tension, cluster, migraine

Question 7

secondary headaches

Answer 7

• sudden, severe

- meningitis, SAH, tumor, temporal arteritis

Question 8

tension headaches px, tx

Answer 8

• bilateral
• band like*
• tightness of posterior neck muscles
• NO focal findings, stiffness, seizures, aura
• tx: NSAID

Question 9

migraine px

Answer 9

• unilateral
• aura
• pulsatile, throbbing
• aggravated by movement, light, sound
• visual problems, flashing lights, “spectra fortification”

-focal neurologic findings = complicated migraine (stroke from vasospasm)

Question 10

migraine tx

Answer 10

-beta blockers
-CCB
(prevent vasospasm)

Question 11

cluster headaches px

Answer 11

-excruciating*
(wakes pt from sleep)
-men > women
-unilateral
-ipsilateral tearing*, rhinorrhea, red eye, Horner's

Question 12

cluster headache tx

Answer 12

• 100% O2 –> abortive therapy
• triptan, ergotamine –> abortive (constrict cerebral blood vessels)
• steroids, lithium –> chronic suppressive therapy

Question 13

abortive therapy for migraines

Answer 13

• NSAIDS
• ASA
• acetaminophen
• triptans
• ergotamine

Question 14

prophylactic therapy for migraines

Answer 14

• beta blockers (propanolol = best initial)
• CCBs (verapamil, diltiazem)
• TCAs
• SSRIs
• valproic acid
• topiramate
• lithium & steroids
• seizure medications –> phenytoin, carbamazepine, topiramite, lamotragine,valproic acid