Headaches

Question 1

DDx for sudden onset of “thunderclap” HA

Answer 1

Subarachnoid Headache

Question 2

DDX for prior headaches similar to present one

Answer 2

CNS infection

Question 3

DDx for focal neurological signs other than Aura?

Answer 3

(Think facial droop)

Stroke / Tumor

Question 4

DDx for symptoms such as fever?

Answer 4

Meningitis

Question 5

DDx for rapid onset of exercise?

Answer 5

intercranial hemorrhage due to brain annuerysm

Question 6

DDx for nasal congestion?

Answer 6

Sinusistis

Question 7

DDx for papilledema?

Answer 7

ICP

Question 8

Reasons for imaging (HA):

Answer 8

• Changes - frequency, severity
• Changes - vision, auras, orbital bruits
• Focal neurological deficits
• Scalp tenderness
• Exertion, cough, sex induced
• Headache after 40
• Trauma, fever, htn
• Therapy not working

Question 9

What is the most prevalent type of headache?

Answer 9

Tension HA

Question 10

Common complaints of tension HA?

Answer 10

• Bilat
• Daily
• “Vice-like”
• Caused by stress, fatigue, noise, glare

Question 11

MSK involvement with tension HA?

Answer 11

Hypertonicity of neck muscles

Question 12

Hallmarks for Tension Headache?

Answer 12

• Bilateral HA
• Women more effected
• Waxes and wanes (no throbbing)
• Neck or back of head
• No focal neuro

Question 13

Treatment for tension headaches?

Answer 13

• NSAIDS max 2.4 g

* Acetaminophen max 4g

Question 14

Cluster HA Hallmarks?

Answer 14

• Unilateral Pain
• Middle aged men
• 15min to 3 hr
• Allergies Like symptoms;
• Ipsilateral nasal congestion/rhinorrhea
• lacrimation
• Horner syndrome

Question 15

Treatment of Cluster HA

Answer 15

• O2
• Sumatriptan (unless heart conditions)
• Zolmitriptan

Question 16

Migraine Hallmarks

Answer 16

• Unilateral and buildup
• Hours or more
• Aura possible
• Positive family history
• Aphasia, numbness

Question 17

Treatment of Migraine pain

Answer 17

• Quite darkened room
• Analgesics/NSAIDS
• Sumatriptan

Question 18

Prophylaxis for Migraines?

Answer 18

• Antihypertensive (Beta Blocker)
• Anticonvulsant
• Antidepressant (TCA)
• Botox?

Question 19

Post Traumatic HA Hallmarks

Answer 19

• Common after trauma
• 1-2 days and last 7-10 days
• Impaired memory, poor concentration, emotionally unstable

Question 20

Treatment for Post Traumatic HA

Answer 20

Simple analgesics

Question 21

Medication Overuse HA hallmarks

Answer 21

• 50% of most chronic daily headaches
• Chronic pain or unresponsive to meds
• Heavy use Mhx of analgesics

Question 22

Treatment for Medication overuse ha?

Answer 22

• Withdraw from analgesics (improvements will be in months not days)