Headaches

Question 1

Migraine

Answer 1

Greater than 5 attacks lasting at least 4 hours
At least 2 of the following:
Unilateral
Pulsating
Moderate severity
aggravated by physical activity

Can be associated with nausea, vomiting, photophobia, phonophobia

Question 2

Migraine Aura

Answer 2

Lasts 5-20 minutes. Disappears with onset of headache

Question 3

Treatment for migraines with psych comorbidities

Answer 3

Sleep hygiene, exercise, avoiding EtOH, CBT, Biofeedback, TCAs (more than SNRIs)

Question 4

Childhood Migraines

Answer 4

Shorter, bilateral often, more severe, responds to Tylenol and NSAIDs (unlike in adults)

Question 5

Basilar Type Migraine

Answer 5

Ataxia, vertigo, dysarthria, or diplopia

Question 6

Hemiplegic Migraine

Answer 6

Hemiparesis of various grades

Question 7

Familial Hemiplegic Migraine

Answer 7

Autosomally dominant migraine

Question 8

Food-induced Headaches

Answer 8

Migraine sufferers should avoid 4 Cs: Chocolate, cheese, ….
But there is an intense craving for these foods.

Question 9

Med-induced HA

Answer 9

Nitroglycerine, Isosorbide, others

Question 10

Sex or exertion related HAs

Answer 10

Propranolol or Indomethacin prophylactically can help

Question 11

Acute Tx of Migraine

Answer 11

CBT relaxation techniques, opiates (but risk rebound), Triptans, Ergotamine, DHE, Reglan (for nausea), parenteral meds if can’t take PO

Question 12

Preventative Treatment of Migraines

Answer 12

Antidepressants, antihypertensives, and _________. TCAs; Topiramate, Valproate,

Question 13

Chronic Daily Headaches

Answer 13

Most likely due to Medication overuse (triptans and opiates). Commonly Fiorinal, NSAIDs, Benzos.

Question 14

Cluster HA

Answer 14

45-90 min. Intense searing pain behind one eye. Eye tearing. Nasal congestion. Partial Horner Syndrome. Severe. 1-8 attacks per day for month then remits (they come in clusters)

Question 15

Cluster HA Treatment

Answer 15

Most meds don’t work. Sumatriptan + OXYGEN, + DHE injection can abort it. Especially O2.

Question 16

Temporal Arteritis

Answer 16

Autoimmune. Dull and constant pain in temporal region. Can cause sudden blindness

Question 17

Intracranial masses

Answer 17

Subdural hematomas, etc

Question 18

Chronic Meningitis

Answer 18

Can cause facial palsy, hearing loss, extra ocular palsies.

Question 19

Pseutotumor Cerebir

Answer 19

Papilledema and blind spots; Compressed/small ventricles on MRI

Question 20

Subarachnoid Hemorrage

Answer 20

Worst HA of your life; Sudden; CT can reveal. Do CT before Lumbar tap so you don’t cause herniation;

Question 21

MAOIs and hypertensive crisis

Answer 21

MAOIs can react with tyramine rich foods or other medications to cause this. Phentolamine can reverse it. Chlorpromazine and Propranolol can help.

Question 22

Trigeminal Neuralgia

Answer 22

Impingement of the nerve. Stabbing pains. Tx is Carbamazepine; Surgical interventions now.