Headache and Facial Pain

Question 1

Migraines

Answer 1

Usually unilateral
Autosomal Dominant
Rebound headaches with tx with pain reliever

Question 2

Cluster HA

Answer 2

A trigeminal autonomic cephaligia (TAC)
unilateral trigeminal n distribution pain with ipsilateral autonomic symptoms.
Strictly unilateral
Tx: Triptans, steroids

Question 3

Paroxysmal Hemicrania

Answer 3

short duration (10-30min) with greater frequency. 
Responsibe to NSAID: indomethacin

Question 4

Low pressure headaches

Answer 4

positional: upright position is worse

Question 5

Idiopathic Intracranial Hypertension (IIH)

Answer 5

pulsatile tinnitus, transient visual obscurations, esp on valsalva. Paipilledema, 6th n palsies,
DDX: Venous sinus thrombosis
Complication: Visual loss due to compressive optic neuropathy.

Question 6

Temporal arteritis

Answer 6

Medium to Large caliber arteries.
Tenderness of scalp, claudication of the jaw with chewing and systemic symptoms: fever, weight loss, fatigue, anemia.
Visual loss from anterior ischemic optic neuropathy.
Dx: ESR, CRP levels, Temporal Artery biopsy.

Question 7

Chronic daily headache

Answer 7

every day. 15 days per mo.
exclude secondary causes, taper meds if uverused.
Start Botox A.

Question 8

Trigeminal neuralgia

Answer 8

paroxysm of severe neuropathic pain in distribution of one or more branches of fifth cranial n.
MRI to exclude compressive lesions.
Tx: Carbamazepine

Question 9

Post-herpetic neuralgia

Answer 9

varicella zoster
herpetic rash. with burning itching hypersensitivity.
Prevention: acyclovir
Management: TCA, Gabapentin

Question 10

Treatment of migraines

Answer 10

Abortive medications: Serotonin 1B/1D (Suitriptan) unless uncontrolled HTN.
Can also tx with NSAIDS, excedrine, sudaphed, barbituates.
Prophylaxis: Topamax, VPA, CCBs, TCAs, Beta blockers

Question 11

16 yo after wisdom tooth extraction and drainage of abscess. Headache fever proptosis erythema. slight abduction of eye but no other eye movements

Answer 11

Cavernous sinus thrombosis:

Question 12

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing, or SUNCT

Answer 12

Shorter attacks, responsive to lamotrigine

Question 13

Spontaneous intracranial hypotension

Answer 13

positional headache (3 mo of daily dull bioccipital headache). 
Tinnitus, blurred vision or horizontal diplopia. 
MRI: pachymeningeal enhancement and downard displacement of tonsils (can be misdiagnosed as chiari type 1). Pituitary enlargement.

Question 14

Migraine prophylaxis recommended by American Academy of Neurology

Answer 14

Level A: metoprolol, timolol, topiramate

Level B: amitriptyline, other b blockers, and venlafaxine

Question 15

headache with nausea and vomiting. respond to ibuprofen and rectal prochlorperazine. occur 2-3 x week. BP: 99/62 P64. Best option for migraine prophylaxis

Answer 15

Topiramate.

Question 16

Chronic daily migraine and medicine overuse.

Answer 16

Wean off analgesics and start onabotulinumtoxin A injections. (>15 migraines x mo with more than 4 hours of headache x week).