Headache

Question 1

To help you remember the red flags, The mnemonic SNOOP is used for the presence of serious underlying disorders that can cause acute or subacute headache. What does the mnemonic stand for?

Answer 1

●Systemic symptoms, illness, or condition (eg, fever, weight loss, cancer, pregnancy, immunocompromised state including HIV)
●Neurologic symptoms or abnormal signs (eg, confusion, impaired alertness or consciousness, papilledema, focal neurologic symptoms or signs, meningismus, or seizures)
●Onset is new (particularly for age >40 years) or sudden (eg, “thunderclap”)
●Other associated conditions or features (eg, head trauma, illicit drug use, or toxic exposure; headache awakens from sleep, is worse with Valsalva maneuvers, or is precipitated by cough, exertion, or sexual activity)
●Previous headache history with headache progression or change in attack frequency, severity, o

Question 2

How would u examine a pt with c/o headache?

Answer 2

●Obtain blood pressure and pulse
●Listen for bruit at neck, eyes, and head for clinical signs of arteriovenous malformation
●Palpate the head, neck, and shoulder regions
●Check temporal and neck arteries
●Examine the spine and neck muscles

Question 3

pt c/o bilateral headache with pressure or tightness which waxes and wanes. h/a in non-throbbing. pt may remain active or may need to rest. this particular h/a may last for 30 minutes - 7 days. pt denies any associated symptoms.

Answer 3

dx- tension-type headache

Question 4

adult pt c/o unilateral headache. (b/l with adolescents) headache started gradually with throbbing/ pulsating pain; moderate or severe intensity; aggravated by routine physical activity; pt prefers to rest in a dark, quiet room. h/a lasts for 4-72 hours. pt also complains of Nausea, vomiting, photophobia, phonophobia; may have aura (usually visual, but can involve other senses or cause speech or motor deficits.

Answer 4

dx. migraine headache

Question 5

pt c/o severe unilateral h/a that began around the eye or temple. h/a started quickly and reaches a crescendo within minutes. pt states pain is deep, continuous, excruciating, and explosive in quality. Leading to significant disability [Despite pain, pt remains active.] h/a ONLY lasts for 15 mins-3 hours/ short period. Associated s/s include Ipsilateral lacrimation and redness of the eye; stuffy nose; rhinorrhea; pallor; sweating; Horner syndrome; restlessness or agitation; focal neurologic symptoms rare; sensitivity to alcohol.

Answer 5

dx: cluster headache

Question 6

Name a few triggers of migraine headaches

Answer 6

stress, menstruation, visual stimuli, weather changes, nitrates, fasting, wine, sleep disturbances, and aspartame, among others.

Question 7

What are the specific abnormalities with tension-type headaches?

Answer 7

pericranial muscle tenderness

Question 8

What are the specific abnormalities with migraine?

Answer 8

manifestations related to sensitization of primary nociceptors and central trigeminovascular neurons, such as hyperalgesia and allodynia (i.e. facial pain)

Question 9

questions asked in ID migraine screen

Answer 9

During the last three months, did you have the following with your headaches?

●You felt nauseated or sick to your stomach
●Light bothered you (a lot more than when you don’t have headaches)
●Your headaches limited your ability to work, study, or do what you needed to do for at least one day

Question 10

what is a thunderclap headache

Answer 10

sudden h/a with explosive and unexpected nature

• medical emergency!
• STAT CT of head

Question 11

what is the primary symptom of aneurysmal subarachnoid hemorrhage?

Answer 11

sudden, severe headache

• “worst headache of my life”
• associated s/s : brief loss of consciousness, seizures, nausea or vomiting or meningismus. ——While not invariable, symptom onset may occur in the setting of physical exertion
• STAT CT head

Question 12

What is Meningism

Answer 12

triad of nuchal rigidity (neck stiffness), photophobia (intolerance of bright light) and headache

Question 13

women who have migraine with aura are»»

Answer 13

• at Increased risk of stroke associated with migraine
• should NOT smoke or use oral birth control
• SHOULD control their blood pressure

Question 14

is have high bp (vascular disease) and migraines, the NP should avoid which medications to tx migranes

Answer 14

Vasoconstrictive medications including triptans, serotonin agonists, and ergot alkaloids= CONTRAINDICATED

Question 15

t/f: There appears to be an increased risk of stroke associated with migraine, particularly in women who have migraine with aura. However, the absolute increase in the risk of stroke is small

Answer 15

TRUE

Question 16

T/F: Women who have migraine WITHOUT aura and no other risk factors for stroke may use a contraceptive pill with low-dose estrogen (less than 50 mcg).

Answer 16

TRUE