Headache

Question 1

Migraine features?

Answer 1

Unilateral
tends to have a throbbing or pulsatile quality.
May include nausea, vomiting, photophobia, or phonophobia
Usually lasts 4-72hrs

Question 2

Tx Migraine

Answer 2

Triptans
Ergotamines (in nonpregnant pt)
Simple Analgesics
Lasmiditan (serotonin f1 receptor agonist)
Antiemetics

Question 3

Cluster HA features?

Answer 3

Unilateral orbital, supraorbital, or temporal pain
Ptosis, miosis, lacrimation, conjunctival injection, Rhinorrhea/nasal congestion.
Attacks usually last 15 to 180 minutes

Question 4

Acute Tx Cluster HA?

Answer 4

SQ or Nasal Sumatriptan

O2

Question 5

Tension HA features?

Answer 5

Bilateral
Mild to moderate intensity, nonthrobbing headache without other associated features.
Descriptions of TTH: “dull,” “pressure,” “head fullness,” “head feels large,” or, “like a tight cap,” “band-like,” or a “heavy weight on my head or shoulders.”

Question 6

Tx Tension HA?

Answer 6

Simple Analgesics (eg, ASA, NSAIDs) especially when combined with caffeine
Acupuncture(?)

Question 7

DD HA?

Answer 7

Migraine
Tension HA
Cluster HA
Intracranial Lesion
Hemorrhage/Stroke
Meningitis
Trauma

Question 8

Preventive Tx?

Answer 8

Migraine: Beta blocker, Amitryptiline
Cluster: Verapamil
Tension: Amitryptiline (?)

Question 9

DD HA pregnancy?

Answer 9

Preeclampsia
Migraine
Tension HA
Cluster HA
Intracranial Lesion
Post dural puncture headache (Postpartum)
Hemorrhage/Stroke
Meningitis
Trauma

Question 10

How does pregnancy affect migraine?

Answer 10

Most women (60 to 70%) with migraines report improvement
5% describe worsening, and the remainder report no change 
Improvement most likely in women with menstrual migraine, migraine without aura