Headache

Question 1

T/F: CT is best used for acute bleeding

Answer 1

True. Fast, easy, usually available

Question 2

Best imaging format for tumors

Answer 2

MRI
Slow, not always available
More definition

Question 3

Likely diagnosis:
“Worst headache of my life”
Sudden onset

Answer 3

Subarachnoid hemorrhage

Question 4

T/F: A lumbar puncture is the 1st diagnostic procedure to do when evaluating a subarachnoid hemorrhage.

Answer 4

False. Must do CT to evaluate ICP first. If ICP, taking CSF will cause hemorrhage.

Question 5

Likely diagnosis for:
Morning headache, indolent
Progression over months
No response to medication
No PMH of HA

Answer 5

Brain tumor

Question 6

Likely diagnosis for:
LP show elevated opening pressure
Contrast enhancement of optic nerves on MRI

Answer 6

Idiopathic Intracranial Hypertension

Question 7

Diagnosis of exclusion

Answer 7

Tension type headache

Question 8

Has HIGH ESR

Answer 8

Temporal artheritis

Question 9

Unilaterality and severe, throbbing nature
Similar headache for years
Episodic weakness consistent with aura

Answer 9

Migraine

Question 10

Which of the following is FALSE about migraines?
A. Involves CN V, brain nuclei, biochemical transmitters and vasculature
B. Dilation and contraction of vessels are key to symptoms
C. Brain can’t feel pain
D. The test to confirm diagnosis is head CT

Answer 10

D. No need for any kind of imaging or tests. Diagnosis based on clinical symptoms and history.

Question 11

Which of the following is TRUE about tension type headaches?
A. Last month to years
B. Aggravated by routine physical activity
C. Characterized by pulsations
D. Unilateral
E. Experiences nausea or vomiting
F. Always associated pericranial tenderness
G. Photophobia OR phonophobia

Answer 11

G.

A. 30 min - 7 days
B. NOT aggravated by routine physical activity
C. Characterized by pressure/tightness
D. Bilateral
E. NO nausea or vomiting
F. Can be w/ or w/o pericranial tenderness

Question 12

Which of the following is not a characteristic of cluster headaches?
A. Severe
B. Bilateral
C. Temporal, orbital or supraorbital pain
D. Lasts 15-30 mins
E. Frequency 1 every other day - 8/day

Answer 12

B. Unilateral

Question 13

What type of headache must have at least one of the following:
Injection/lacrimation
Nasal congestion/rhinorrhea
Eyelid edema
Forehead and facial sweating
Miosis/ptosis
Restlessness or agitation

Answer 13

Cluster headache

Question 14

AM headaches are concerning for

Answer 14

tumor

Question 15

Which of the following is NOT a primary headache?
A. Migraine
B. Tumor
C. Tension
D. Cluster
E. Neuralgia

Answer 15

B. Tumor is secondary headache

Sub-arachnoid hemorrhage and CNS infection are also secondary headache