Headache

Question 1

What gender is at greater risk of migraines?

Answer 1

Females

Question 2

What gender is at greater risk of cluster headaches?

Answer 2

Males

Question 3

A 24 year old female presents for the sudden onset of the “worst headache of her life.” Her neurologic examination is notable for an enlarged and poorly reactive right pupil. What is the most likely diagnosis?
– A. Migraine Headache
– B. Aneurysmal subarachnoid hemorrhage
– C. Cluster headache
– D. Secondary pain related to acute angle closure glaucoma
– E. Tension headache

Answer 3

– B. Aneurysmal subarachnoid hemorrhage

Question 4

A 28 year old male presents for complaint of visual problems and headaches. He reports the development of a shimmering light in his left visual field that gets bigger over the course of about 30 minutes, followed by a pounding left sided headache lasting several hours, associated with an upset stomach, light and sound sensitivity. What is the treatment of choice?
– A. Lorazepam 1.0 mg
– B. Inhaled oxygen 10 mL/min
– C. Sumatriptan 100 mg
– D. Methylprednisolone 1g
– E. Butalbital-acetaminophen combination therapy

Answer 4

– C. Sumatriptan 100 mg

Question 5

What are some clinical features of migraines?

Answer 5

• nausea
• aura
• photophobia and phonophobia

Question 6

What is the area of effect of migraines?

Answer 6

Usually unilateral

Question 7

What is prodrome of a migraine?

Answer 7

A set of symptoms that occurs hours to days before onset of headaches

Question 8

What is aura in migraines?

Answer 8

Most commonly visual lights that develop minutes before migraines occur

Question 9

What is the cause of migraines?

Answer 9

Associated with release of neuropeptides including CGRP, Substance P, and Neurokinin A
– May lead to “neurogenic inflammation”
– Evoke vasodilation of pain-producing structures
– Creates a feedback loop with the trigeminal
pathway

Question 10

What is the treatment for migraines?

Answer 10

Treat early with EFFECTIVE doses of NSAIDs

Question 11

What are patients treated with if NSAIDs are not effective for their migraines?

Answer 11

Triptans

Question 12

What is the function of triptans?

Answer 12

5HT1B/D agonists that lead to vasoconstriction

Question 13

Triptan Contraindication

Answer 13

Avoid in those with vascular risk factors

Question 14

What is the action of DHE and ergotamine for migraine treatment?

Answer 14

Arterial and venous vasoconstrictor with DHE having less prominent SE

Question 15

DHE and Ergotamine Contraindications

Answer 15

Ischemic cardiac, cerebrovascular, or peripheral vascular disease and pregnancy

Question 16

A 48 year old male presents for a severe boring pain in the left eye. What duration of symptoms is most consistent with cluster headaches?
– A. 0-60 seconds
– B. 60 seconds – 180 seconds 
– C. 180 seconds – 10 minutes 
– D. 10 minutes – 15 minutes 
– E. >30 minutes

Answer 16

– E. >30 minutes

Question 17

What are some of the features of cluster headaches?

Answer 17

– Severe pain retro-orbitally
– 1-4 attacks/day lasting 20m to 3hrs
– Rapid onset over usually 15-30 minutes (not seconds)
– Invariably unilateral

Question 18

What are cluster headaches associated with?

Answer 18

• Males
• Smokers
• Heavy Alcohol Use

Question 19

What are some of the treatments for cluster headaches?

Answer 19

– Inhaled oxygen 100% by rebreather at 10-15 L/min
– Injectable sumatriptan
– Nasal spray triptans

Question 20

What is the most common form of headache?

Answer 20

Tension Headache

Question 21

What are the features of tension headache?

Answer 21

• Bilateral is not worsened by activity
• Phonophobia or photophobia but NOT both
• No nausea

Question 22

What is the treatment of tension headache?

Answer 22

Treated largely with sleep

Question 23

Trigeminal Neuralgia

Answer 23

Paroxysmalattacksofpain lasting from a fraction of a second to two minutes, affecting one or more divisions of CN V

Question 24

What is the treatment for trigeminal neuralgia?

Answer 24

Carbamazepine is established as effective for controlling pain

Question 25

Pseudotumor Cerebri

Answer 25

Headache with papilledema and no mass or lesion with normal CSF - EMERGENCY

Question 26

What is the typical patient of pseudo tumor cerebri?

Answer 26

Typically an overweight female - increased
intracranial pressure from increased abdominal
pressure leads to papilledema in eye

Question 27

Primary Exertional Headache

Answer 27

Pulsating HA lasting from 5 min to 48 hours, and occurring only during or after physical activity