Headaches

Question 1

Trigeminal neuralgia is caused by compression of the trigeminal nerve by _________________. The secondary causes include
1.
2.
3.
It affects ________ more.

Answer 1

loop of a vessel

1. MS
2. Tumor
3. AV malformation

women

Question 2

The clinical presentation of trigeminal neurlagia:

1. recurrent episodes 0-50x/day
2. brief episodes 1-120 seconds
3. ___________ electric pain along ___________ branches (V2/3 most common)
4. triggered by harmless stimuli
5. Can see associated facial __________ spasms on PE aka ______________________
6. chronic patients may have continuous _____________ between episodes

often confused with dental pain

Answer 2

3. unilateral, CN5
4. spasms - tic douloreux
5. dull pain

Question 3

What is the workup for trigeminal neuralgia?

Answer 3

MRI with and without contrast to rule out lesion, vascular compression and MS

Question 4

What is the first line treatment for trigeminal neuralgia?

Answer 4

carbamezapine or oxcarbazepine (better tolerated)

Question 5

What are the two classification of headaches?

Answer 5

primary: occurs independently
secondary: related to another underlying condition

Question 6

What are red flags where it comes the headaches?

Answer 6

worst HA ever, sudden pattern change, over 50, positional, seizure, fever, head injury, pulsatile sound, focal signs, history of CA or HIV, related to exercise, sex, coughing, sneezing, urination, defecation, refractory (did all the things and not getting better), severe pt anxiety