Headaches Flashcards
A 55-year-old woman presents with new-onset headaches localized to the temporal region. She describes the pain as dull and throbbing, worse in the morning. She also reports jaw pain while chewing and scalp tenderness. Physical examination reveals reduced pulses over the temporal region. What is the most likely diagnosis?
A. Giant cell arteritis
B. Migraine
C. Cluster headache
D. Medication overuse headache
E. Tension-type headache
A
A. Giant cell arteritis
The combination of jaw claudication, temporal headache, and scalp tenderness suggests temporal arteritis (giant cell arteritis).
Key test: ESR and temporal artery biopsy.
Complication: Can lead to blindness due to ischemic optic neuropathy.
Treatment: High-dose corticosteroids immediately!
Secondary headache in subarachnoid haemorrhage ?
Medication overuse headache (due to chronic analgesic use)
Meningitis (headache with fever and neck stiffness)
Subarachnoid hemorrhage (sudden severe “thunderclap” headache)
Hydrocephalus (increased intracranial pressure, papilledema)
Neoplasia (tumor pressing on pain-sensitive structures)
Giant cell arteritis (elderly patients with temporal headache and jaw claudication)
Headache in meningitis?
Medication overuse headache (due to chronic analgesic use)
Meningitis (headache with fever and neck stiffness)
Subarachnoid hemorrhage (sudden severe “thunderclap” headache)
Hydrocephalus (increased intracranial pressure, papilledema)
Neoplasia (tumor pressing on pain-sensitive structures)
Giant cell arteritis (elderly patients with temporal headache and jaw claudication)
Headache in medication overuse.
Medication overuse headache (due to chronic analgesic use)
Meningitis (headache with fever and neck stiffness)
Subarachnoid hemorrhage (sudden severe “thunderclap” headache)
Hydrocephalus (increased intracranial pressure, papilledema)
Neoplasia (tumor pressing on pain-sensitive structures)
Giant cell arteritis (elderly patients with temporal headache and jaw claudication)
A 30-year-old woman presents with a bilateral headache that feels like a tight band around her head. She denies nausea, vomiting, photophobia, or phonophobia. Her symptoms are not worsened by physical activity. The pain typically lasts for several hours and occurs more frequently during stressful periods. Neurological examination is normal. What is the most likely diagnosis?
A. Tension-type headache
B. Migraine
C. Cluster headache
D. Trigeminal neuralgia
E. Medication overuse headache
A
A 25-year-old woman presents with recurrent headaches that last for several hours and are preceded by visual disturbances described as flashing lights. The headache is unilateral, throbbing, and associated with nausea and photophobia. She has a family history of similar headaches. What is the most likely diagnosis?
A. Migraine with aura
B. Cluster headache
C. Tension-type headache
D. Trigeminal neuralgia
E. Idiopathic intracranial hypertension
A
A 35-year-old man presents with severe right-sided periorbital pain that occurs at the same time each day for the past 2 weeks. The pain lasts 45 minutes and is accompanied by lacrimation and rhinorrhea. On examination, mild ptosis and miosis are noted on the affected side. What is the most appropriate acute treatment?
A. Sumatriptan and 100% oxygen
B. NSAIDs and acetaminophen
C. Amitriptyline
D. β-blockers
E. Topiramate
A
A 40-year-old woman with a history of stress-related headaches presents with bilateral, non-throbbing headache that lasts several hours. She denies visual disturbances or nausea. No triggers are identified, and neurological exam is unremarkable.
Which of the following is the best acute treatment?
A. Sumatriptan
B. NSAIDs or acetaminophen
C. Verapamil
D. Ergotamine
E. β-blockers
B
A 35-year-old woman presents with chronic tension-type headaches occurring 4–5 times per week. She has no photophobia, nausea, or vomiting. She has been using NSAIDs daily for the past 3 months.
Which of the following is the most appropriate next step?
A. Increase NSAID dose
B. Prescribe triptans
C. Discontinue NSAIDs and start sumatriptan
D. Consider tricyclic antidepressants (TCAs) for prophylaxis
E. Order MRI brain
D
A 26-year-old woman presents with unilateral, throbbing headache that lasts 12 hours and is associated with nausea and photophobia. Prior to the headache, she experiences flashing lights in her vision.
Which of the following is the best initial treatment?
A. NSAIDs
B. β-blockers
C. Triptans
D. Amitriptyline
E. Verapamil
C
A 28-year-old woman presents with recurrent migraines that occur twice per week. The attacks are disabling and require triptans.
Which of the following is the most appropriate prophylactic therapy?
A. NSAIDs
B. Sumatriptan
C. Dihydroergotamine
D. β-blockers or topiramate
E. Ibuprofen
D
A 25-year-old woman with migraines presents with worsening frequency of headaches. She has been using triptans >10 days per month.
Which of the following is the best next step?
A. Increase triptan dose
B. Prescribe opioids
C. Discontinue triptans and manage medication overuse headache
D. Prescribe CGRP monoclonal antibodies
E. Add NSAIDs
C
A 30-year-old woman with migraines and aura seeks contraception.
Which of the following should be avoided?
A. Copper IUD
B. Progestin-only pill
C. Combined estrogen-progestin oral contraceptives
D. Barrier contraception
E. Levonorgestrel IUD
✅ Answer: C. Combined estrogen-progestin oral contraceptives (↑ risk of stroke)
A 27-year-old woman presents with unilateral pulsating headache that lasts 24 hours, accompanied by nausea, photophobia, and phonophobia.
Which neurotransmitter is primarily involved in this condition?
A. Dopamine
B. Glutamate
C. Serotonin (5-HT)
D. GABA
E. Norepinephrine
C
A 40-year-old man presents with severe periorbital pain lasting 45 minutes, associated with lacrimation, rhinorrhea, and ptosis. Episodes occur daily at the same time for the past 2 weeks.
What is the best acute treatment?
A. 100% oxygen and sumatriptan
B. NSAIDs
C. Amitriptyline
D. β-blockers
E. Topiramate
A
A 38-year-old man has recurrent unilateral headaches occurring every evening for 3 weeks. He describes the pain as sharp and excruciating in the right periorbital region. He has nasal congestion, lacrimation, and ptosis on the same side.
What is the best long-term prophylaxis?
A. Triptans
B. Verapamil
C. Amitriptyline
D. NSAIDs
E. β-blockers
B
A 45-year-old man presents with excruciating left-sided periorbital pain, occurring at night for the past 10 days. He describes the pain as intense and stabbing. Neurological exam shows miosis and ptosis.
Which of the following is a classic feature of this condition?
A. Photophobia
B. Nausea
C. Jaw claudication
D. Autonomic symptoms (lacrimation, rhinorrhea)
E. Pulsatile quality
D
Unilateral headache + jaw claudication in elderly ?
Giant cell arteritis
Unilateral headache + ptosis + miosis → ?
Cluster
Bilateral bandlike headache + stress →
Tension
Thunderclap headache + worst headache of life →
SH
Papilledema + morning headache + obese female →
Idiopathic intracranial hypertension
Sudden headache after exertion + neck stiffness →
SH
Headache + visual aura + photophobia →
Migraine + aura
Repetitive headaches + worse with analgesic overuse →
Medication overuse headache
New daily persistent headache + HIV + focal neuro signs →
Cryptococcal meningitis or CNS lymphoma
Headache + sinus tenderness →
Sinusitis
Headache worsened by leaning forward + pulsatile tinnitus →
Idiopathic intracranial hypertension
Trigeminal nerve irritation + brief electric shock-like pain
Trigeminal neuralgia
Headache + nausea + worsens when lying down →
Intracranial hypertension (brain tumor?)
Trigeminal neuralgia Tx ?
Carbamazepine
Ox-carbamazepine
