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CS Minicases > Headache > Flashcards

Headache Flashcards

1
Q

Key history for headaches

A 
Onset: acute vs. chronic
Location: unilateral vs. bilateral 
Quality: dull vs. stabbing 
Intensity: worst headache of my life
Duration
Timing: disturbs sleep
Assoc. neuro. Symptoms: paresthesias, weakness, numbness, ataxia, photophobia, dizziness, aura, neck stiffness
Nausea, vomiting, jaw claudication, recent trauma, dental surgery , sinusitis symptoms
Exacerbating factors: stress, fatigue, menses, exercise, foods
Alleviating factors: rest, medications
Pt. and family history of headaches
History of trauma
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2
Q

Key physical exam for headache

A
  1. Vital signs
  2. Inspection/ palpation of entire head
  3. ENT inspection
  4. Complete neurological exam
    * **Including fundoscopic exam
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4
Q

21 y.o. F presents with several episodes of throbbing left temporal pain that lasts for 2-3 hours. Before onset, she sees flashes of light in her right visual field and feels weakness and numbness on the right side of her body for a few minutes. Her headaches are often associated with nausea and vomiting. She has a family history of migraine.

A

Dx

  1. Migraine (complicated)
  2. Tension headache
  3. Cluster headache
  4. Pseudo tumor cerebri
  5. CNS vasculitis
  6. Partial seizure
  7. Intracranial neoplasm
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5
Q

Work up for a complicated migraine

A
  1. CBC
  2. ESR
  3. CT - head
  4. MRI - brain
  5. LP - CSF analysis
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6
Q

26 y.o. M presents with severe right temporal headache 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.

A

Dx

  1. Cluster headache
  2. Migraine
  3. Tension headache
  4. Intracranial neoplasm
  5. Pseudo tumor cerebri
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7
Q

Work up for cluster headache

A
  1. CBC
  2. CT- head
  3. MRI- brain
  4. LP- CSF analysis
  5. ESR
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8
Q

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

A

Dx

  1. Temporal arteritis
  2. Migraine
  3. Cluster headache
  4. Tension headache
  5. Meningitis
  6. Carotid artery dissection
  7. Trigeminal neuralgia
  8. TMJ disorder
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9
Q

30 y.o. 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 allergies.

A

Dx

  1. Sinusitis
  2. Migraine
  3. Tension headache
  4. Meningitis
  5. Intracranial neoplasm
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10
Q

Work up for sinusitis

A
  1. CBC
  2. X-RAY- sinus
  3. CT - sinus
  4. LP- CSF analysis
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11
Q

50 y.o. 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 and recently decreased her intake of caffeine.

A

Dx

  1. Tension headache
  2. Migraine
  3. Depression
  4. Caffeine withdrawal
  5. Hypertension
  6. Cluster headache
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12
Q

Work up for tension headache

A
  1. CBC
  2. Electrolytes
  3. ESR
  4. CT- head
  5. LP- CSF analysis analysis
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13
Q

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

A

Dx

  1. Subarachnoid hemorrhage
  2. Migraine
  3. Meningitis/encephalitis
  4. Intracranial hemorrhage
  5. Vertebral artery dissection
  6. Intracranial venous thrombosis
  7. Acute hypertension
  8. Intracranial neoplasm
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14
Q

Work up for subarachnoid hemorrhage

A
  1. No contrast CT- head
  2. LP- CSF analysis
  3. CBC
  4. PT/ PTT/ INR
  5. Urine toxicology
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15
Q

25 y.o. M presents with high fever, severe headache, confusion, photophobia and nuchal rigidity

A

Dx

  1. Meningitis
  2. Migraine
  3. Subarachnoid hemorrhage
  4. Sinusitis
  5. Intracranial or epidural abscess
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16
Q

Work up for meningitis

A
  1. CBC
  2. CT- head
  3. MRI- brain
  4. LP- CSF analysis (cell count, protein, glucose, gram stain, PCR for specific pathogens, culture)
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17
Q

18 y.o. Obese F presents with pulsitile headache, vomiting, and blurred vision for the past 2-3 weeks. She is taking OCPs.

A

Dx

  1. pseudo tumor cerebri
  2. Tension headache
  3. Migraine
  4. Cluster headache
  5. Meningitis
  6. Intracranial venous thrombosis
  7. Intracranial neoplasm
18
Q

Work up for pseudo tumor cerebri

A
  1. Urine hCG
  2. CBC
  3. CT- head
  4. LP- opening pressure and CSF analysis
19
Q

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

A

Dx.

  1. Trigeminal neuralgia
  2. Tension headache
  3. Migraine
  4. Cluster headache
  5. TMJ disorder
  6. intracranial neoplasm
20
Q

Work up for trigemnial neuralgia

A
  1. CBC
  2. ESR
  3. MRI- brain
21
Q

Work up for temporal arteritis

A
  1. ESR
  2. CBC
  3. CRP
  4. Temporal artery biopsy
  5. Doppler u/s : carotid
  6. MRI- brain
  7. LP- CSF analysis analysis

CS Minicases (2 decks)

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