Headache - FITZ Flashcards
- A 40-year-old man presents with a 5-week history of recurrent headaches that awaken him during the night. The pain is severe, lasts about 1 hour, and is located behind his left eye. Additional symptoms include lacrimation and nasal discharge. His physical examination is within normal limits. This clinical presentation is
most consistent with:
A. migraine without aura.
B. migraine with aura.
C. cluster headache.
D. increased intracranial pressure (ICP).
C. cluster headache.
- A 22-year-old woman presents with a 3-year history
of recurrent, unilateral, pulsating headaches with
vomiting and photophobia. The headaches, which
generally last 3 hours, can be aborted by resting in a
dark room. She can usually tell that she is going to
get a headache. She explains, “I see little ‘squiggles’
before my eyes for about 15 minutes.” Her physical
examination is unremarkable. This presentation is
most consistent with:
A. tension-type headache.
B. migraine without aura.
C. migraine with aura.
D. cluster headache.
C. migraine with aura.
- Indicators that a headache can be the presenting symptom of a serious illness and may require neuroimaging
include all of the following except:
A. headaches that occur periodically in clusters.
B. increasing frequency and severity of
headaches.
C. headache causing confusion, dizziness, and/or lack
of coordination.
D. headache causing awakening from sleep.
A. headaches that occur periodically in clusters.
13. Prophylactic treatment for migraine headaches includes the use of: A. amitriptyline. B. ergot derivative. C. naproxen sodium. D. clonidine.
A. amitriptyline.
14. Among the following beta blockers, which is the least effective in preventing migraine headache? A. acebutolol B. metoprolol C. atenolol D. propranolol
A. acebutolol
- Antiepileptic drugs useful for preventing
migraine headaches include all of the following
except:
A. divalproex.
B. valproate.
C. lamotrigine.
D. topiramate.
C. lamotrigine.
- Evidence supports the use of all of the following
vitamins and supplements for migraine prevention
except:
A. butterbur.
B. riboflavin.
C. feverfew.
D. ginkgo biloba.
D. ginkgo biloba.
- You are examining a 65-year-old man who has a
history of acute coronary syndrome and migraine.
Which of the following agents represents the best
choice of acute headache (abortive) therapy for this
patient?
A. verapamil
B. ergotamine
C. acetaminophen
D. sumatriptan
C. acetaminophen
- A 45-year-old man experiences rapidly progressing
migraine headaches that are accompanied by significant gastrointestinal (GI) upset. Appropriate acute headache (abortive) treatment includes all of the following
except:
A. injectable sumatriptan.
B. dihydroergotamine nasal spray.
C. oral naproxen sodium.
D. zolmitriptan nasal spray.
C. oral naproxen sodium.
- With migraine, which of the following statements
is true?
A. Migraine with aura is the most common form.
B. Most migraineurs are in ongoing healthcare for
the condition.
C. The condition is equally common in both men
and women.
D. The pain is typically described as pulsating.
D. The pain is typically described as pulsating.
- In tension-type headache, which of the following
is true?
A. Photophobia is seldom reported.
B. The pain is typically described as “pressing” in
quality.
C. The headache is usually unilateral.
D. Physical activity usually makes the discomfort
worse.
B. The pain is typically described as “pressing” in
quality.
21. Risk factors for cluster headaches include all of the following except: A. being older than 65 years of age. B. heavy alcohol use. C. heavy tobacco use. D. male gender.
A. being older than 65 years of age.
- Treatment options in cluster headache include the
use of:
A. nonsteroidal anti-inflammatory drugs (NSAIDs).
B. oxygen.
C. the triptans.
D. all of the above therapies.
D. all of the above therapies.
- Which of the following oral agents has the most rapid analgesic onset?
A. naproxen (Naprosyn®)
B. liquid ibuprofen (Motrin®, Advil®)
C. diclofenac (Voltaren®)
D. enteric-coated naproxen (Naproxen EC®)
B. liquid ibuprofen (Motrin®, Advil®)
- The mechanism of action of triptans is as:
A. a selective serotonin receptor agonist.
B. a dopamine antagonist.
C. a vasoconstrictor.
D. an inhibitor of leukotriene synthesis.
A. a selective serotonin receptor agonist.
- Limitations of use of butalbital with acetaminophen
and caffeine (Fioricet®) include its:
A. energizing effect.
B. GI upset profile.
C. high rate of rebound headache if used frequently.
D. excessive cost.
C. high rate of rebound headache if used frequently.
- The use of neuroleptics such as prochlorperazine
(Compazine®) and promethazine (Phenergan®) in
migraine therapy should be limited to less than three
times per week because of their:
A. addictive potential.
B. extrapyramidal movement risk.
C. ability to cause rebound headache.
D. sedative effect.
B. extrapyramidal movement risk.
- Which of the following statements about ergotamines is false?
A. They are effective for tension-type headaches.
B. They act as 5-HT1A and 5-HT1D receptor
agonists.
C. They have a potential vasoconstrictor effect.
D. They should be avoided in the presence of coronary artery disease.
A. They are effective for tension-type headaches.
- With appropriately prescribed headache prophylactic therapy, the patient should be informed to expect:
A. virtual resolution of headaches.
B. no fewer but less severe headaches.
C. approximately 50% reduction in the number
of headaches.
D. that lifelong therapy is advised.
C. approximately 50% reduction in the number
of headaches.
- A 48-year-old woman presents with a monthly
4-day premenstrual migraine headache, poorly
responsive to triptans and analgesics, and
accompanied by vasomotor symptoms (hot flashes).
The clinician considers prescribing all of the following
except:
A. continuous monophasic combined oral contraceptive.
B. phasic combined oral contraceptive with a
7-day-per-month withdrawal period.
C. low-dose estrogen patch use during the
premenstrual week.
D. triptan prophylaxis.
B. phasic combined oral contraceptive with a
7-day-per-month withdrawal period.
30. A first-line prophylactic treatment option for the prevention of tension-type headache is: A. nortriptyline. B. verapamil. C. carbamazepine. D. valproate.
A. nortriptyline.
- A 47-year-old woman experiences occasional migraine with aura and reports partial relief with zolmitriptan.
You decide to add which of the following to augment
the pain control by the triptan?
A. lamotrigine
B. gabapentin
C. naproxen sodium
D. magnesium
C. naproxen sodium
- A 68-year-old man presents with new onset of
headaches. He describes the pain as bilateral frontal
to occipital and most severe when he arises in the
morning and when coughing. He feels much better
by midafternoon. The history is most consistent with
headache caused by:
A. vascular compromise.
B. increased intracranial pressure (ICP).
C. brain tumor.
D. tension-type with atypical geriatric presentation
B. increased intracranial pressure (ICP).
- Systemic corticosteroid therapy would be most
appropriate in treating:
A. tension-type headache.
B. migraines occurring on a weekly basis.
C. intractable or severe migraines and cluster
headaches.
D. migraines occurring during pregnancy.
C. intractable or severe migraines and cluster
headaches.
- When evaluating a patient with acute headache, all of the following observations would indicate the absence of a more serious underlying condition except:
A. onset of headache with exertion, coughing, or
sneezing.
B. history of previous identical headache.
C. supple neck.
D. normal neurological examination results.
A. onset of headache with exertion, coughing, or
sneezing.
35. Common secondary headache causes include all of the following except: A. brain tumor. B. intracranial bleeding. C. intracranial inflammation. D. cluster headache.
D. cluster headache.
36 to 38. Match the female:male ratio for each type
of primary headache listed:
A. 1:3 to 1:8
B. 3:1
C. 5:4
- Tension-type headache
C. 5:4
36 to 38. Match the female:male ratio for each type
of primary headache listed:
A. 1:3 to 1:8
B. 3:1
C. 5:4
- Migraine without aura
B. 3:1
36 to 38. Match the female:male ratio for each type
of primary headache listed:
A. 1:3 to 1:8
B. 3:1
C. 5:4
- Cluster headache
A. 1:3 to 1:8
39 to 43. Indicate the appropriate course of action (head CT scan, head magnetic resonance imaging [MRI], or neither) for each of the following patients:
- A 45-year-old man who presents with a sudden,
abrupt headache. Upon questioning, he appears
somewhat confused with decreased alertness to
his surroundings.
CT scan
39 to 43. Indicate the appropriate course of action (head CT scan, head magnetic resonance imaging [MRI], or neither) for each of the following patients:
- A 48-year-old woman with a history of breast cancer who presents with 3-month history of progressively severe headache, and bulging optic disk.
MRI
39 to 43. Indicate the appropriate course of action (head CT scan, head magnetic resonance imaging [MRI], or neither) for each of the following patients:
- A 24-year-old man who presents in the emergency
department (ED) following a motor vehicle accident.
He exhibits confusion and falls in and out
of consciousness.
CT scan
39 to 43. Indicate the appropriate course of action (head CT scan, head magnetic resonance imaging [MRI], or neither) for each of the following patients:
- A 57-year-old woman with a prior history of a
brain tumor that was removed 8 years ago.
She complains of headaches that have been
increasing in frequency and intensity over the
past month.
MRI
39 to 43. Indicate the appropriate course of action (head CT scan, head magnetic resonance imaging [MRI], or neither) for each of the following patients:
- A 37-year-old man diagnosed with cluster-type
headache that is alleviated with high-dose
NSAIDs.
Neither
- In counseling a patient who experiences migraines, you recommend all of the following lifestyle changes to minimize the risk of triggering a headache except:
A. avoiding eating within 1–2 hours of a.m. awakening.
B. limiting exposure to cigarette smoke.
C. avoiding trigger physical activities.
D. implementing strategies to reduce stress.
A. avoiding eating within 1–2 hours of a.m. awakening.
45. A 37-year-old woman complains of migraine headaches that typically occur after eating in restaurants. Potential triggers that can influence the onset and severity of migraine symptoms include all of the following except: A. cheese pizza. B. pickled or fermented foods. C. freshly baked yeast products. D. baked whitefish.
D. baked whitefish.
Headache “Red Flags” (SNOOP Mnemonic)
- Systemic symptoms
* Fever, weight loss, or secondary headache risk factors such as HIV, malignancy, pregnancy, anticoagulation
Headache “Red Flags” (SNOOP Mnemonic)
- Neurological signs, symptoms
- Any newly acquired neurological finding including confusion, impaired alertness or consciousness, nuchal rigidity, hypertension, papilledema, cranial nerve dysfunction, abnormal motor function
Headache “Red Flags” (SNOOP Mnemonic)
- Onset
- Sudden, abrupt, or split-second; the “thunderclap” headache
- Onset of headache with exertion, sexual activity, coughing, sneezing
- Suggests subarachnoid hemorrhage, sudden-onset increased intracranial pressure
Headache “Red Flags” (SNOOP Mnemonic)
- Onset (age at onset of headache)
* Older (>50 years) and younger (<5 years)
Headache “Red Flags” (SNOOP Mnemonic)
- Previous headache history
- First headache in adult ≥30 years
- Primary headache pattern usually established in youth/young adult years
- New onset of different headache
- Change in attack frequency, severity, or clinical features including progressive headache without headache-free period
Potential Lifestyle, Health Status, or Medication Triggers Influencing the Onset or Severity of Migraine Symptoms: A Comprehensive Headache Treatment Plan Includes Minimizing or Eliminating These Triggers Whenever Possible
Menses, ovulation, or pregnancy Birth control/hormone replacement (progesterone) therapy Illness of virtually any kind, whether acute or chronic Intense or strenuous activity/exercise Sleeping too much/too little/jet lag Fasting/missing meals Bright or flickering lights Excessive or repetitive noises Odors/fragrances/tobacco smoke Weather/seasonal changes High altitudes Medications Stress/stress letdown
Potential Dietary Triggers Influencing the Onset or Severity of Migraine Symptoms: A Comprehensive Headache Treatment Plan Includes Minimizing or Eliminating These Triggers Whenever Possible
Sour cream
Ripened cheeses (cheddar, Stilton, Brie, Camembert)
Sausage (bologna, salami, pepperoni, summer sausage,
hot dogs)
Pizza
Chicken liver pâté
Herring (pickled or dried)
Any pickled, fermented, or marinated food
Monosodium glutamate (MSG) (soy sauce, meat
tenderizers, seasoned salt)
Freshly baked yeast products, sourdough bread
Chocolate
Nuts or nut butters
Broad beans, lima beans, fava beans, snow peas
Onions
Figs, raisins, papayas, avocados, red plums
Citrus fruits
Bananas
Caffeinated beverages (tea, coffee, cola)
Alcoholic beverages (wine, beer, whiskey)
Aspartame/phenylalanine-containing foods or
beverages
Cluster headaches
are most common in middle-aged men, particularly men with heavy alcohol and tobacco use
Cluster headaches
Sometimes called the “suicide
headache” because of the severity of the associated pain, cluster headache occurs periodically in clusters (hence its name) of several weeks, with associated lacrimation and rhinorrhea.
Cluster headache treatment
reduction of triggers, such as tobacco and
alcohol use, and initiation of prophylactic therapy and appropriate abortive therapy (triptans, high-dose NSAIDs, and high-flow oxygen)
