Headache and Facial Pain

Question 1

vInDIcATEs

Answer 1

Vascular
Infectious / Inflammatory
Neoplasm
Developmental / Degenerative
Idiopathic / Iatrogenic
Congenital
Allergic / Auto-immune
Trauma / Toxins
Environment / Endocrine
pSychiatric

Question 2

how do you diagnose a HA?

Answer 2

By EXLUSION…have to see them twice at least

Question 3

most important question?

Answer 3

HAVE YOU EVER HAD THIS HA BEFORE?

Question 4

Likely to be primary if:

Answer 4

slow onset and typical for the pt.

Question 5

time couse for migraine, cluster, tension, brain tumor?

Answer 5

migraine random, tension freqent daily, cluster many days separated by symptoms free, tumor is progressive HA

Question 6

unilateral throbbing often behind eye

Answer 6

migraine

Question 7

describe a migraine

Answer 7

prodromal, slow onset with aura, unilateral throbbing pain often behind the eye, N/V, photo and phonopobia. Women > men

Question 8

Prevention of migraine?

Answer 8

Reduce triggers and daily prophylactic meds (bb, naproxen, amitripyline all level A evidence)

Question 9

whole head pain that is not throbbing

Answer 9

tension HA

Question 10

describe a tension HA

Answer 10

slow onset, whole head, may attribute to stress or nerves

-Usually no N/V, photo or phonopobia

Question 11

treatment of tension HA

Answer 11

NSAIDS, tylenol, excedrin. Stress management, stretching neck, sleep hygiene, good food and same MIGRAINE prophylaxis possible

Question 12

quick onset with severe pain HA

Answer 12

Cluster HA while ruling out SAH

Question 13

describe a cluster HA

Answer 13

quick onset, severe, periorbital, temporal, or supraorbital with unilateral lacrimation, rhinnorhea, conjuctival injection, miosis, ptosis. Men > Women

Question 14

tx of cluster

Answer 14

12-15 L O2 with non-rebreather for 15 minutes then opiates. Can use triptans and Migraine prophylaxis too.

Question 15

describe a SAH

Answer 15

worst HA of my life OR altered mental status.

N/V and possible nuchal rigidity

Question 16

fever and nuchal rigidity

Answer 16

menigitis

Question 17

negative scan for SAH but high suspicion?

Answer 17

LP…xantochromia (RBC breakdown product)

Question 18

progressively worsening HA and worse in morning? What else might you see?

Answer 18

Brain Tumor. N/V. now focal neurologic deficit and new onset seizures

Question 19

First drug to try for trigeminal neuralgia?

Answer 19

anti-convulsants. Carbamazepine then phenytonin. Possibly gabapentin.

Question 20

obses woman of childbearing age gets HA worsening over time. Also visual disturbance.

Answer 20

Pseudotumor cerebri (IIP idiopathic intracranial hypertension)

Question 21

PE for psudotumor?

Answer 21

papilledema, obesity, decreased visual acuity

Question 22

diagnosis of pseudotumor?

Answer 22

Clincial suspicion: CT for tumor (quick scan) and then LP

Question 23

tx of pseudotumor cerebri?

Answer 23

aggressive weight loss, Na restriction, acetazolamide

Question 24

Other causes of HA

Answer 24

sinusitis, dehydration, hangover, rebound HA, hypoglycemia, TMJ, lupus, temporal arteritis, venous sinus thrombosis