Headache

Question 1

common types of headache seen in outpatient

Answer 1

migraine
tension
med induced

Question 2

differentiate btwn migraine and tension headache and cluster headache in terms of pain level

Answer 2

migraine has moderate to severe
tension has mild to moderate
cluster: severe

Question 3

associated symptoms for migraine, tension and cluster headache

Answer 3

migraine: n/v, photophobia, phonophobia, aura
tension: may have photobia or phonophobia
cluster: rhinorrhea, lacrimation, facial sweating, miosis, eyelid edema, conjunctival injection, ptosis

Question 4

quality of pain for migraine, tension, cluster

Answer 4

migraine: pulsating, can be unilateral
tension: pressing, tightening, bilateral
cluster: severe unilateral orbital, periorbital, supraorbital, temporal pain

Question 5

aggravating factors for types of headaches

Answer 5

migraines-worsened by activity

tension-isn’t worsened by activity

Question 6

duration of symptoms for types of HAs

Answer 6

migraine-4-72 hrs
tension-30 min to 7 days
cluster-15-180 min

Question 7

episodes needed for diagnosis of the different types of HAs

Answer 7

migraine: 5
tension: 10
cluster: 5

Question 8

common causes of secondary HAs

Answer 8

anxiety or depression (features are similar to tension type headache)

medication overuse HA (after chronic use of analgesic)

Question 9

describe med overuse HA

Answer 9

mild to moderate
often present upon first awaking
often made worse w exertion

Question 10

diagnostic criteria for med overuse HA

Answer 10

15 times or more per month
used analgesic over 3 months
dvlmpt or worsening of HA during med overuse

Question 11

symptoms that increase odds of positive neuroimaging

Answer 11

rapidly increasing frequency of HAs
abrupt onset of severe HA
marked change in HA pattern
poor coordination, HA that awakens pt from sleep
worsened w/ use of Valsalva maneuver
persistent HA after head trauma
new onset of HA in a person 35 or older
hx of cancer or HIV

Question 12

important PE signs with HA

Answer 12

signs of increased ICP (papilledema, altered men. status)
signs of meningeal irritation (Kernigs, Bruzinski sign)
focal neurologic signs

Question 13

meds that can act as triggers for tension or migraine HAs

Answer 13

estrogen
tobacco, caffeine, alcohol
aspartame and phenylalanine (in diet soda)

Question 14

migraine meds

Answer 14

migraine specific:
triptans
ergot alkaloids

non-migraine specific (for any kind of pain disorder):
aspirin/butalbital (barbiturate)/caffeine, etc

don’t use butalbital or opioids if can be avoided

Question 15

migraine prophylaxis meds

Answer 15

beta blockers
neurostabilizers (topiramate, gabapentin, divalproex sodium)
TCAs (amytriptyline-also for tension HAs)
Ca ch blocker