Headaches

Question 1

Migraine without aura (common migraine)

Answer 1

Most common type
Pain is usually unilateral with throbbing or pulsatile quality
With increase discomfort may have N/V
Photophobia and Phonophobia common

Question 2

Migraine with brainstem aura

Answer 2

Uncommon form of migraine
More often female vs male
Onset ages 7-20 y/o
Brainstem auras consist of:
Vertigo
Dysarthria
Tinnitus
Diplopia
Ataxia
Decreased level of consciousness
Hypacusis
Needs two of the above to make diagnosis

Question 3

RED FLAGS

Answer 3

The “worst or first” headache
Significant change in severity, frequency, or pattern
New or unexplained neurologic symptoms
Headache always on the same side
New onset headaches after age 50
Headaches not responding to treatment
New onset headache in patients with HIV/cancer
S/S: Stiff neck, fever, papilledema, cognitive impairment, or personality change

Question 4

Migraine Prevention

Answer 4

Beta-blockers — Propranolol
Calcium channel blockers — Verapamil Especially if a patient has high BP
Anticonvulsants — valproate
Tricyclic antidepressants —amitriptyline (Elavil)
Serotonin antagonists — Methysergide (Sansert)

Question 5

Tension HA 3 subtypes

Answer 5

Infrequent episodic: <1 day/month
Frequent episodic: 1-14 days/month
Chronic: 15 or more days/month

Question 6

Cluster Headache

Answer 6

Characterized by recurrent severe HA on one side of the head, typically around the eye
Can have symptoms associated with the eye

Question 7

Cluster Headache Prevention Tx.

Answer 7

Verapamil

Question 8

Temporal Arteritis Diagnosis

Answer 8

Temporal artery biopsy (Gold Standard)

Question 9

Temporal Arteritis Treatment

Answer 9

Initiantion of glucocorticoid therapy
Prednisone 40-60mg daily
Taper over 2-3 months
Requires 1-2 years of treatment

Question 10

Intracranial Pressure Treatment

Answer 10

ICP Monitoring: Intraventricular (Gold Standard)