Headaches

Question 1

PE manuever where patient is placed in supine position, their leg is flexed at hip and knee. The leg is then extended while you keep the hip flexed

Answer 1

Kernig’s Sign, indicates meningeal irritation if pain occurs

Question 2

PE manuever that is positive when flexing the patient’s neck causes flexion of the patient’s hips and knees

Answer 2

Brudzinski’s Sign, indicates meningeal irritation

Question 3

Most common type of headache

Answer 3

tension headache (“muscle contraction headaches”)

Question 4

Type of headache that usually starts in the back of the head and is characterized by a feeling of a tight band around the head that lasts for a long period of time

Answer 4

tension headache (“muscle contraction headaches”)

Question 5

Common psychological etiologies of tension headaches

Answer 5

anxiety, stress, depression

Question 6

Prescription med for tension headaches

Answer 6

Muscle relaxant- Robaxin.

Question 7

Prescription meds for prevention of tension headaches

Answer 7

Amitriptyline and Topiramate

Question 8

An episodic headach disorder characterized by neurologic, GI, and autonomic changes

Answer 8

Migraines

Question 9

Caused by spasm of vertebral vessels. Pain caused by subsequent dilation of extracranial arteries

Answer 9

Migraine headaches

Question 10

Sx include: no aura, throbbing/pulsating, aggravated by activity, N/V, photophobia or phonophobia

Answer 10

Common migraine

Question 11

Sx include: scintillating scotoma prior to HA, aura, throbbing/pulsating, N/V, photophobia or phonophobia, aggravated by activity

Answer 11

classic migraine

Question 12

Sx include: Lateralized pain, N/V, DIPLOPIA, Involves CN III, VI, and lasts more than a couple of days

Answer 12

Ophthalmoplegic migraine

Question 13

Type of migraine characterized by bilateral visual disturbance, ataxia, dysarthrias

Answer 13

Basilary migraine

Question 14

First line of tx for moderate to severe migraines

Answer 14

Triptans

Question 15

Name the three more common triptans

Answer 15

Rizatriptan (Maxalt), Zolmitriptan (Zomig), Sumatriptan (Imitrex)

Question 16

CI for triptans

Answer 16

coronary vasospasm, IHD, CV disease, >65yrs

Question 17

Which triptan has the fastest onset of action?

Answer 17

Rizatriptan (Maxalt)

Question 18

Which triptan suppresses the inflammation of a migraine?

Answer 18

Zolmitriptan (Zomig)

Question 19

Which triptan has the most options for drug delivery?

Answer 19

Sumatriptan (Imitrex)

Question 20

Gold standard for prevention of pain and associated symptoms or recurrent headaches

Answer 20

Propanolol (Inderal). Except for smokers > 60yrs

Question 21

Type of headache that is more rare, but the most severe. Can last days-months, then subside. Attacks can be provoked by ETOH.

Answer 21

Cluster Headaches

Question 22

Headache that may involve pain around one eye, along with drooping of the lid, tearing and congestion on the same side as the pain

Answer 22

Cluster headache

Question 23

Syndrome characterized by combination of drooping of the eyelid (ptosis) and constriction of the pupil (miosis). Seen with cluster headaches

Answer 23

Horner’s syndrome

Question 24

First line tx for cluster headaches

Answer 24

triptans, oxygen or both

Question 25

Pharm prophylaxis for cluster headaches

Answer 25

Verapamil

Question 26

Hemorrhage charactized by thunderclap headaches

and Worse headache of life

Answer 26

subarachnoid hemorrhage

Question 27

Syndrome of elevated ICP frequent in obese patients associated with papilledema and pulsatile tinnitus

Answer 27

Idiopathic Intracranial Hypertension (IIH) (aka pseudotumor cerebri)

Question 28

Pharm tx for IIH

Answer 28

acetazolamide (Diamox)

Question 29

Sx include: HA, fever, weight loss, jaw or tongue claudication, visual impairment, temporal pain

Answer 29

Giant Cell Arteritis (Temporal Arteritis)

Question 30

Diagnostics that should be done for suspected Giant Cell Arteritis(Temporal Arteritis)

Answer 30

ESR and temporal artery biopsy for confirmation

Question 31

Tx for Giant Cell Arteritis(Temporal Arteritis)

Answer 31

steriods

Question 32

Sx include: HA, blurry vision, halos, intense eye pain, N/V

Answer 32

acute angle glaucoma