HEADACHE

Question 1

21 yo F presents with several episodes of
throbbing left temporal pain that lasts
for 2–3 hours. Prior to its onset, she sees
fl ashes of light in her right visual field
and feels weakness and numbness on the
right side of her body for a few minutes.
Headaches are often associated with
nausea and vomiting. She has a family
history of migraine.

Answer 1

Migraine (complicated)              CBC
Tension headache                     ESR
Cluster headache                     CT—head
Pseudotumor cerebri                MRI—brain
Trigeminal neuralgia                 LP 
CNS vasculitis
Partial seizure
Intracranial neoplasm

Question 2

26 yo M presents with severe right
temporal headaches associated with
ipsilateral rhinorrhea, eye tearing, and
redness. Episodes have occurred at the
same time every night for the past week
and last for 45 minutes.

Answer 2

Cluster headache CBC
Migraine ESR
Tension headache CT—head
Sinusitis MRI—brain
Pseudotumor cerebri LP
Trigeminal neuralgia
Intracranial neoplasm

Question 3

65 yo F presents with severe, intermittent
right temporal headache, fever, blurred
vision in her right eye, and pain in her
jaw when chewing.

Answer 3

Temporal arteritis (giant cell arteritis) CBC
Migraine ESR
Cluster headache CRP
Tension headache Temporal artery biopsy
Meningitis Doppler U/S—carotid
Carotid artery dissection MRI—brain
Pseudotumor cerebri
Trigeminal neuralgia
Intracranial neoplasm

Question 4

30 yo F presents with frontal headache,
fever, and nasal discharge. There is pain
on palpation of the frontal and maxillary
sinuses. She has a history of sinusitis.

Answer 4

Sinusitis CBC
Migraine XR—sinus
Tension headache CT—sinus
Meningitis LP
Intracranial neoplasm

Question 5

50 yo F presents with recurrent episodes
of bilateral squeezing headaches that
occur 3–4 times a week, typically
toward the end of her work day. She is
experiencing significant stress in her life.

Answer 5

Tension headache CBC
Migraine Electrolytes
Depression ESR
Caffeine or analgesic withdrawal CT—head
Hypertension LP
Cluster headache
Pseudotumor cerebri
Intracranial neoplasm

Question 6

35 yo M presents with sudden severe
headache, vomiting, confusion, left
hemiplegia, and nuchal rigidity.

Answer 6

Subarachnoid hemorrhage CT without contrast-head
Migraine LP
Meningitis/encephalitis CBC
Intracranial hemorrhage PT/PTT
Vertebral artery dissection MRI/MRA—brain
Intracranial venous thrombosis
Acute hypertension
Intracranial neoplasm

Question 7

25 yo M presents with high fever, severe
headache, confusion, photophobia, and
nuchal rigidity. Kernig’s and Brudzinski’s
signs are positive.

Answer 7

Meningitis CBC
Migraine CT—head
Subarachnoid hemorrhage MRI—brain
Sinusitis/encephalitis LP—CSFanalysis
Intracranial or epidural abscess (cell count,protein,
glucose,Gramstain
PCR for antigens, culture)

Question 8

18 yo obese F presents with a pulsatile
headache, vomiting, and blurred vision
for the past 2–3 weeks. She is taking
OCPs.

Answer 8

Pseudo tumor cerebri urine hCG
Tension headache CBC
Migraine CT—head
Cluster headache LP—opening pressure and CSF-
Meningitis analysis
Intracranial venous thrombosis
Intracranial neoplasm

Question 9

57 yo M c/o daily pain in the right cheek
over the past month. The pain is electric
and stabbing in character and occurs
while he is shaving. Each episode lasts
2–4 minutes.

Answer 9

Differential Workup

Trigeminal neuralgia CBC
Tension headache ESR
Migraine MRI—brain
Cluster headache
TMJ dysfunction
Intracranial neoplasm