Headache

Question 1

What is the most common decade for onset of migraines?

Answer 1

Early 20s

Question 2

What neurotransmitters are thought to be involved in migraines?

Answer 2

Serotonin and dopamine

Question 3

What medications are used for migraine prophylaxis?

Answer 3

Anticonvulsants (e.g. gabapentin, topiramate), TCAs, beta-blockers, and CCBs

Question 4

Who is most commonly affected by cluster headaches?

Answer 4

Men, age of onset most commonly is 25

Question 5

What are the associated symptoms of cluster headaches?

Answer 5

Ipsilateral lacrimation, conjunctival injection, Horner syndrome, and nasal stuffiness

Question 6

What are the main characteristics of cluster headaches?

Answer 6

Excruciating, unilateral periorbital headache that lasts 30 minutes to 3 hours. Occurs in clusters tending to affect the same side of the head at the same time of the day (typically during sleep) during the same time of the year

Question 7

What are common triggers for migraines?

Answer 7

Certain foods (e.g. red wine), fasting, stress, menses, OCPs, bright light, and disruptions in normal sleep pattern

Question 8

What are treatments for cluster headaches?

Answer 8

High-flow O2 or sumatriptan injection. Verapamil is first line for prophylactic therapy (alternatives include lithium, valproic acid, and topiramate)

Question 9

How do cluster headaches and paroxysmal hemicrania differ?

Answer 9

Similar, but paroxysmal hemicrania has shorter attacks (10-30 minutes) with many more attacks in a day (up to 40). They also respond very well to NSAIDs, whereas cluster headaches do not

Question 10

What is the hallmark of a low pressure headache?

Answer 10

Worse in the upright position and relieved by recumbency. Usually due to CSF leak following LP, but may also be due to a ruptured CSF cyst

Question 11

What are the hallmarks of idiopathic intracranial hypertension (aka pseudotumor cerebri)?

Answer 11

Headaches worse in the mornings and when lying down. Often precipitated by by activities such as the Valsalva maneuver. Exam may show papilledema as well as unilateral or bilateral 6th nerve palsies. Most commonly seen in young overweight women who report menstrual irregularities. Caused by elevated CSF pressure in the absence of an identifiable intracranial mass lesion (thought to be due to impaired resorption of CSF through damaged arachnoid granulations in the dural venous sinuses)

Question 12

Venous sinus thrombosis mimics what headache causing disorder?

Answer 12

Idiopathic intracranial hypertension

Question 13

What is the most feared complication of idiopathic intracranial hypertension?

Answer 13

Visual loss due to compressive optic neuropathy

Question 14

How is idiopathic intracranial hypertension treated?

Answer 14

Repeat LPs, diuretics, carbonic anhydrase inhibitors (e.g. acetazolamide, topiramate), optic nerve sheath fenestration, and lumboperitoneal shunting

Question 15

What is the difference between a classic and common migraine?

Answer 15

Classic migraines are preceded by an aura (usually visual) while common migraines are not

Question 16

What are features of a basilar migraine?

Answer 16

Usually preceded by an aura then patients often develop neurological deficits, such as complete blindness, irritability/psychosis, transient quadriplegia, stupor, syncope and even coma - can persist for hours. These deficits are followed by a headache

Question 17

What are causes of symptomatic trigeminal neuralgia (ie has an underlying cause)?

Answer 17

MS, basilar artery aneurysm, acoustic schwannomas, and posterior fossa meningiomas

Question 18

What is Tolosa-Hunt syndrome?

Answer 18

An inflammatory disorder that produces ophthalmoplegia associated with headache and loss of sensation over the forehead. Pupillary function is usually spared

Question 19

What is atypical facial pain?

Answer 19

Patients feel a constant, deep pain in their face that is often bilateral but can be unilateral. The cheek, nose and zygomatic regions are most often affected. Responds well to antidepressants (may be caused by depression)

Question 20

What are systemic signs of temporal arteritis?

Answer 20

Fever and weight loss