Headache

Question 1

characteristics of migraine headache

Answer 1

episodic, with or without aura, variants (retinal, opthalmoplegic, hemiplegic), usually lateralized but can be global, dull and deep (throbbing and pulsatile), photophobia, phonophobia

Question 2

precipitating factors of migraine headache

Answer 2

stress, menstruation, OCPs ,fatigue, hunger, lack and sleep, nitrates, glutamate (processed foods), tyramine, EtOH, change of environment or habits

Question 3

diagnostic criteria of migraine

Answer 3

lasts 4-72 hours

at least 2: unilateral pulsating, moderate-severe intensity, aggravation by physical activity

1: N/V, photophobia, phonophobia

Question 4

treatment of migraines

Answer 4

abortive: treat nausea, treat pain
preventive: calcium channel blockers, beta blockers, tricyclic antidepressants, anti-seizure meds, vitamin B2

Question 5

cluster headache characteristics

Answer 5

repetitive headaches that occur for WEEKS TO MONTHS at a time, followed by periods of remission; M>F

Question 6

most widely accepted pathogenesis of cluster headache

Answer 6

hypothalamic activation w/ secondary activation of trigeminal autonomic reflex

Question 7

clinical manifestations of cluster headaches

Answer 7

pain is deep, excruciating, explosive; begins around eye or temple, ALWAYS UNILATERAL; stabbing ice pick pain around eye, most px prefer to stay ACTIVE, horner’s; lasts 30 mins-3 hrs

Question 8

treatment of cluster headaches

Answer 8

abortive: 100% O2, triptans
preventive: verapamil, indomethacin

Question 9

clinical manifestations of tension headache

Answer 9

pressure/tightness all around head; no N/V, phonophobia, phonophobia; usually occurs at the end of the day

Question 10

treatment of tension headaches

Answer 10

NSAIDs, psychotherapy, relaxation techniques

Question 11

what is a rebound headache?

Answer 11

in pxs that complain of daily headache, who overuse NSAIDs, APAP, narcotics

Question 12

how to treat rebound headaches?

Answer 12

tricycylic antidepressants; slowly withdraw from offending meds or detox the px

Question 13

suggestive findings of brain tumor headache

Answer 13

N/V, worsening of headaches with change in body positions, abnormal neuro exam, significant change in prior headache pattern

Question 14

signs of ruptured intracranial aneurysm

Answer 14

severe sudden onset of headache; “worst pain of my life”; decreased consciousness and stiff neck

Question 15

what causes temporal arteritis (TA)?

Answer 15

chronic vasculitis involving cranial branches from aortic arch

Question 16

clinical manifestations of temporal arteritis

Answer 16

ppl over 50; headache in 2/3 of pxs, haw and arm claudication, fever, fatigue, weight loss, visual loss (usually abrupt partial visual field defect)

Question 17

diagnostic tools/treatment of suspected TA

Answer 17

urgent temporal artery biopsy, steroids should be started once diagnosis is established

Question 18

type of imaging needed for suspected brain tumor

Answer 18

CT with and without contrast