Headaches Flashcards
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?
Cluster headache
Abortive tx of common migraines is best achieved with?
Rizatriptan
Young pt with new onset severe HA associated with periods of visual obscuration. Neuro exam shows papilledema. MRI normal. Next step?
LP to measure P
Which of the following is characteristic of post LP HA?
HA worse with sitting upright
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?
Migraine with aura
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
Sagittal sinus thrombosis
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?
Basilar migraine
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?
Cluster HA
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?
Oxygen
The effective tx for acute migraine:
Sumatriptan
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?
Topiramate
26 yo obese patient presents to ER with severe HA. PE show blurred optic disk. Dx?
Idiopathic intracranial hypertension
Monitor of distal digit T along with instructions on how to raise digit T reduced frequency of
Migraine
Cognitive deficits after head trauma correlate with
Duration of post-traumatic amnesia
Strongest risk factor for chronic daily headaches in adults
Medication overuse
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
D/C sumatriptan
Triptan drugs should not be given in abortive tx of migraine in pts with
CAD
76 yo pt complains of bilateral, severe, persistent HA with loss of vision and scalp tenderness, and stiffness of proximal musculature.
Biopsy
Sed rate 96mm/hr. Which dx procedure?
????
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
Sagital sinus thrombosis
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?
High dose prednisone.
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?
Propanolol
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
Acute hydrocephalus
68 y/o with dull R sided non throbbing HAs worse at night and with prolonged chewing. Best initial tx
Prednisone
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
Gadolinium enhancement of Left facial nerve
35 yo with daily HA over last several weeks lasting one hour. Sharp, severe, boring pain into right eye. Another element of this HA?
Occurs during REM
25 yo pt with severe HA, visual loss, vomiting, bilateral babinski, and then becomes drowsy
Ependymoma of the 4th ventricle
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?
Cluster HA
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
Intraocular P mearument
Tx of vertigo, HA, confusion, restricted eye movement on lateral gaze s/p bariatric surgery?
Thiamine
