Headaches

Question 1

35 yo M awakens frequently in the middle of the night with severe HA which sometimes occurs nightly and lasts approximately 1-2 hrs, so severe that the pt is afraid to go to sleep. Located around L eye and ss with lacrimation, ptosis, and miosis. Dx?

Answer 1

Cluster headache

Question 2

Abortive tx of common migraines is best achieved with?

Answer 2

Rizatriptan

Question 3

Young pt with new onset severe HA associated with periods of visual obscuration. Neuro exam shows papilledema. MRI normal. Next step?

Answer 3

LP to measure P

Question 4

Which of the following is characteristic of post LP HA?

Answer 4

HA worse with sitting upright

Question 5

35 yo reports episodes of flashing lights traveling slowly from L to R in the L visual field, symptoms persisting for about 30 min, followed by difficulty expressing self and concentrating. After about 30 minutes, these neurologic sx subside, and pt develops a pounding HA with nausea. PE normal. Dx?

Answer 5

Migraine with aura

Question 6

25 yo has HA and vomiting. Pain is dull and in the occipital region, worse when lying down. Severe papilledema b/l. LP= OP=80 w/ normal CSF, and 120 RBCs in last tube. D-dimer, FDP elevated. CT normal. Dx

Answer 6

Sagittal sinus thrombosis

Question 7

25 yo w VH similar to the wavy distortions produced by heat rising from asphalt- affecting the whole of both visual fields, + vertigo, dysarthria, tingling in both hands and feet and around both sides of mouth followed by occipital HA. Most likely dx?

Answer 7

Basilar migraine

Question 8

24 yo M with nocturnal HA resulting in early AM waking. ROS + rhinorrhea, nostril blocking, and ipsilateral eye tearing and facial swelling. HA persists 45-60 min. Dx?

Answer 8

Cluster HA

Question 9

30 yo with intermittent HA, each attack lasting 1 hr. Attacks with sharp, stabbing pain around eye, tearing, and nasal congestion. Most effective abortive tx?

Answer 9

Oxygen

Question 10

The effective tx for acute migraine:

Answer 10

Sumatriptan

Question 11

28 yo F reports episodes of severe HA with nausea/vomiting, incapacitating, often preceded by flash of light in the right visual field. During headache, pt sometimes have difficulty expressing herself. Which med would be the appropriate to prevent these episodes?

Answer 11

Topiramate

Question 12

26 yo obese patient presents to ER with severe HA. PE show blurred optic disk. Dx?

Answer 12

Idiopathic intracranial hypertension

Question 13

Monitor of distal digit T along with instructions on how to raise digit T reduced frequency of

Answer 13

Migraine

Question 14

Cognitive deficits after head trauma correlate with

Answer 14

Duration of post-traumatic amnesia

Question 15

Strongest risk factor for chronic daily headaches in adults

Answer 15

Medication overuse

Question 16

35 yo with hx of migraines has daily migraines for past 3 months no longer responding to sumatriptan which she now takes daily. Hx of MDD but reports ok mood. Preferred initial approach

Answer 16

D/C sumatriptan

Question 17

Triptan drugs should not be given in abortive tx of migraine in pts with

Answer 17

CAD

Question 18

76 yo pt complains of bilateral, severe, persistent HA with loss of vision and scalp tenderness, and stiffness of proximal musculature.

Answer 18

Biopsy

Question 19

Sed rate 96mm/hr. Which dx procedure?

Answer 19

????

Question 20

26 yo F with 3 day hx of severe continuous non-throbbing headache, has not improved on NSAID, has mild bilateral papilledema. A head CT w and w/o contrast is shown

Answer 20

Sagital sinus thrombosis

Question 21

Pt complains of dull and constant HA not associated with n&v + vision loss in L eye. Pain and stiffness of limbs. MRI= periventricular white matter hyper intensities on T2. Elevated sed rate. Next step?

Answer 21

High dose prednisone.

Question 22

35 yo pt is evaluated for headache syndrome characterized by paroxysms of sharp pain around the eyes and side of the head lasting 5 minutes and happening 10x/day. HA are accompanied by rhinorrhea and conjunctival erythema. Which med is most likely to give relief?

Answer 22

Propanolol

Question 23

Pt recovering from surgery of an intracranial hemorrhage 2/2 arterial aneurysm, develops a sudden onset of headache, vomiting, and progressive decline of consciousness. Pupils are semiotic, and abducens muscles are weak bilaterally. Etiology

Answer 23

Acute hydrocephalus

Question 24

68 y/o with dull R sided non throbbing HAs worse at night and with prolonged chewing. Best initial tx

Answer 24

Prednisone

Question 25

Young adult w headache behind left ear. 2 days later twisting of face. Impaired taste sensation. Paralysis of forehead, lower face on L, incomplete closure of L eye with blinking. MRI shows

Answer 25

Gadolinium enhancement of Left facial nerve

Question 26

35 yo with daily HA over last several weeks lasting one hour. Sharp, severe, boring pain into right eye. Another element of this HA?

Answer 26

Occurs during REM

Question 27

25 yo pt with severe HA, visual loss, vomiting, bilateral babinski, and then becomes drowsy

Answer 27

Ependymoma of the 4th ventricle

Question 28

32 y/o has a new onset HA with unilateral stabbing eye pain, also experiences runny nose and conjunctival injection on the same side and last 2 hours. Dx?

Answer 28

Cluster HA

Question 29

71 yo patient with thunderclap HA, unilateral eye pain, blurred vision, dilated pupils, conjunctival injection. Which dx test is best to reveal cause of patient’s HA

Answer 29

Intraocular P mearument

Question 30

Tx of vertigo, HA, confusion, restricted eye movement on lateral gaze s/p bariatric surgery?

Answer 30

Thiamine