Headache

Question 1

indication for imaging (9)

Answer 1

• New HA in pt age >50, or new persistent daily HA
• unexplained change in HA character/frequency
• new cluster type HA
• HA awakening pt from sleep
• HA worse w/ valsalva or exertion
• trigeminal neuralgia w/ CNV deficit or b/l neuralgia
• atypical/new migraine aura (other than visual)
• new HA associated w/ vomiting
• abnormal neuro exam

Question 2

define migraine w/o aura

Answer 2

-recurrent HA lasting 4-72h w/ n/v or photo/phonophobia AND at least 2 of the following:

unilateral
throbbing
mod-severe intensity
aggravated by routine activity
progression to allodynia

Question 3

chronic migraine definition

Answer 3

migraine present for >= 15d/mo

Question 4

migraine with aura definition

Answer 4

• visual aura most common, scotomoas w/ colored edges, or zig zag lines
• carries an increased risk of stroke (2x): Ix smoking, OCP use

Question 5

complex migraine

Answer 5

• neuro deficits

- must r/o stroke prior to Dx

Question 6

abortive treatment for migraine

Answer 6

Triptans
-contraindication: complex migraine, known CAD/stroke, severe hepatic/renal disease, uncontrolled HTN, hx of coronary vasospasm, avoid in elderly

NSAIDs

Question 7

migraine prevention

Answer 7

for pts w/ >1-2 wpisodes/wk

OCPs–> for pt’s w/ menstrual trigger, CONTRA in pt’s w/ aura

propranalol

verapamil

topiramate

TCAs

Gabapentin

Question 8

tension headache definition

Answer 8

at least two of the following:

bilateral tightening quality
no change w/ movement
no n/v
either ONLY photo OR phono phobia

Question 9

medication overuse headache

Answer 9

• med use >10d/month or pain analgesics >15/month
• headache worse after starting med, better cessation

Mx:short course prednisone taper + w/ ppx med on day 1