Headache - birlea

Question 1

Most headaches are primary or secondary?

What are the most common types of primary headaches?

Answer 1

Primary. No underlying pathology.

1) Tension
2) Migraine
3) Cluster

Question 2

What are the criteria for migraine diagnosis?

Answer 2

A. 5 episodes
B. 4-72 hours
C. (2/4) unilateral, pulsing, moderate/severe, WORSEN with activity
D. Nausea or vomiting or photophobia/phonophobia
E. No other explanation

Question 3

What are the criteria for a tension type headache?

Answer 3

A. 10 episodes
B. 30 minutes-7days
C. (2/4) Mild/moderate, pressing/tightening, bilateral, not aggravated by physical activity
D. No nausea or vomiting, no photo/phonophobia (or only one of the two)

** “What migraine is not. People can work through it, typically don’t go to the doctor”

Question 4

Criteria for cluster headache?

Answer 4

A. 5 episodes
B. Severe, unilateral, periorbital and/or temporal,15-180 min
C. 1 every other day up to 8/day
D. 1 of the following:
	conjunctival injection
	lacrimation
	nasal congestion
	rhinorrhea
	eyelid edema
	ptosis             
	miosis	  
	facial swelling
        ear fullness
	restless/agitation

“Excruciating pain behind one eye. 4:1 Men:women, alcohol, vasodilators are triggers”

Question 5

What causes trigeminal neuralgia? In what populations is it most often seen? What is the cure?

Answer 5

Happens mostly in the elderly. “Lacerating, sharp pain in a trigeminal (v2/3) distribution”. Require an aggressive approach. Most times the cause isn’t found. When a cause is found, generally a blood vessel presses on the trigeminal nerve branch, causing this type of pain. Can correct surgery in that case (sponge between artery and nerve).

Question 6

Kernig’s sign:

Brudzinski’s sign:

Answer 6

Kernig: Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees. (KERNIG KAN’T STRAIGHTEN LEG)

Brudzinski: Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed. (BRUDZINSKI BEND KNEES)

Question 7

What are the signs/symptoms of giant cell arteritis?

What is the cause?

What populations are most at risk?

What are the possible bad outcomes?

What is the treatment?

Answer 7

Jaw claudication
Temporal artery tenderness
Vision loss (optic nerve infarct)
Joint pain
Constitutional symptoms (fever, malaise, wt loss)

Vision-threatening (vessel occlusion) can also cause stroke
Have to take seriously and not miss. Tx is steroid.

ELEVATED CRP and Sed rate

Inflammation of vessel wall

Risk Factor: Age >60 years (70-80 yrs)

Question 8

What are characteristic symptoms of someone with a headache due to increased ICP?

Answer 8

Doc, I’ve got a headache that is killing me. It’s worse in am. It feel like pain “behind the eyes” eyes, like my eyes are “pulsating with my heart”

Question 9

Obese woman presents with papilledema, elevated ICP, normal neuroimaging, normal spinal tap, normal neuro exam. wtf she have?

Answer 9

Might be pseudotumor cerebri.