Headache

Question 1

Differentiate primary and secondary headaches.

Answer 1

Primary headaches: 90% of all headaches, no underlying pathology

Secondary headaches: 10%, underlying intracranial or systemic pathology, red flags, often constant

Question 2

What does TTH stand for?

Answer 2

Tension-type headache

Question 3

In evaluating patients, what things should make you consider secondary headaches?

Answer 3

Red flags or atypical presentation of primary headache

Question 4

What is the SNOOP mnemonic for headache red flags?

Answer 4

Systemic/secondary symptoms (fever, weight loss, HIV)

Neurologic symptoms

Onset (sudden/abrupt)

Older patients

Past history (is this headache different than past headaches)

Question 5

Migraine used to be thought of as a vascular headache, but now it’s thought to be ______________.

Answer 5

related to the trigeminal ganglion activation –it is not known where migraines start

Question 6

What phenomenon is thought to underlie spreading visual auras?

Answer 6

A wave of oligemia (hypovolemia) that radiates out from the occipital cortex

Question 7

What is the key difference between migraines and cluster headaches?

Answer 7

Cluster headaches have autonomic involvement, particularly with restlessness. The classic example is a man who paces around with throbbing head pain (cluster headache) vs a woman with throbbing head pain who lies down in a dark, quiet room (migraine).

Question 8

What triggers cluster headaches?

Answer 8

Alcohol

Vasodilators

Question 9

How many recurring headaches do you need to have to be considered migraines?

Answer 9

5 that last at least four hours

Question 10

What criteria determine migraine?

Answer 10

At least two of these: 
Pulsating
Unilateral 
Pain increase with activity
Moderate or severe discomfort

And one of these:
Nausea/vomiting
Photophobia/phonophobia

Question 11

True or false: most migraine sufferers have auras.

Answer 11

False. Only 30% do

Question 12

Tension-type headaches must have two of the following symptoms: _____________. Importantly, they must not have _______________.

Answer 12

Bilateral
Moderate/severe pain
Not aggravated by activity
Pressing/tension sensation

Nausea/vomiting

Also, they can only have either photophobia or phonophobia… not both.

Question 13

What are cluster headaches?

Answer 13

Headaches that have ipsilateral periorbital or temporal symptoms, such as the following: lacrimation, conjunctival injection, ptosis, rhinorrhea, eyelid edema, ear “fullness.”

Question 14

What is the typical duration of trigeminal neuralgia?

Answer 14

Short (less than 2 min)

Question 15

What is the most common risk factor for increased intracranial hypertension?

Answer 15

Obesity

Question 16

TTH and migraines are the ____ and _____ most prevalent diseases in the world.

Answer 16

2nd; 3rd

Question 17

TTH account for _____ percent of primary headaches.

Answer 17

90

Question 18

What neuroimaging advice was given in this presentation?

Answer 18

Don’t do neuroimaging when a primary headache meets migraine criteria.
Use MRI over CT except in emergencies.

Question 19

What med guidelines were given in this presentation?

Answer 19

Don’t prescribe opioids.

Don’t recommend frequent OTC med use.

Question 20

Explain Brudzinski’s sign.

Answer 20

If a person is lying down, raise their head. If they have meningismus, then their legs will likely rise, too.