Headaches

Question 1

Tension, migraine, cluster severity and duration

Answer 1

Tension mild to moderate, 1 hr to 7 days
Migraine moderate to severe, 1 hour to less than 7 days
Cluster - short but very severe

Question 2

SNOOP

Answer 2

Systemic Symptoms 
Neurological signs 
Onset (sudden)
Older 
Prior HA history 

If negative, may be able to skip imaging

Question 3

Intracranial hemorrhage and subarachnoid

Answer 3

Produces focal deficit with stupor and coma

Subarachnoid is worst HA of life…syncope, seizure, confusion, neck stiffness, focal deficits and coma…nausea, vomiting, photophobia

Question 4

If CT normal and usspician high

Answer 4

Think meningitis

Question 5

Brain tumors

Answer 5

Insidious onset that may not cause HA early on

Question 6

Medication overuse HA

Answer 6

High risk - acetominophen, aspirin, caffeine, butalbitol combos, SA opioids

Lower - DHE, NSAIDS, analgesics, triptans

Don’t tx more than 2 HA per week

Difficult to manage because it gets worse before it gets better

Taper off the offending med…can also tx with LA NSAIDS and steroids or triptans

Question 7

Medication overuse headache development

Answer 7

HA outlasts drug effect and new pain is greater than origninal

Question 8

Cluster headache signs

Answer 8

Watery eye with drooping eyelid and runny nose

Question 9

Cluster headache

Sex, uni or bi, length, when in day, duration, others

Answer 9

5:1 Male to female
Unilateral
Attacks are short (15 min to 3 hours)
Typically at night about 2 hours after falling asleep
2-4 months
FOllowed by headache free intervals…seasonal regularity and clockwise

Question 10

Acute and prophylaxis of cluster headaches

Answer 10

O2
Sumatriptan
Ergotamine

Steroids
Verapamil
Valproic acid
Lithium

Question 11

Tnesion headache diagnosis

Answer 11

Headache lasting 30 min to 7 days

2 of following:
pressing/tightening (non pulse) quality
Mild or mod 
Bilaterla location 
No aggravation by walking 

Absence of N/V and photo/phonophobia

Question 12

Tension epidemiology and lifestyle/tx

Answer 12

Most common
More women than men

Use episodic combos and NSAIDS (watch for overuse)

Prophy - antidepressants, exercise, biofeedback, relaxation

Question 13

Trigeminal neuralgia signs and symptoms and population

Answer 13

Females>50 y/o
Intense pain 
Usually on lower face and short 
Can spread
Trigger may be present

Question 14

Pathophys and tx of trigeminal neuralgia

Answer 14

Chronic nerve compression results in demyelination

Carbamazepine is 1st line
Opioids with gabapentin
Maybe anti-depressant

Question 15

Hypnic description, diganosis, and tx

Answer 15

Moderate or throbbing 
Uni or bi 
Absent N and photophobia 
Begin 2 hours after sleep, 15 min to 3h duratipn 
Older patients
Same ttime each night

15 HA in 1 month

Lithium carbonate, verapamil, indomethacin

Question 16

Cough induced

age and sex, duration, sides, other

Answer 16

Valsava manuever 
5:1 male to female >40
Short duration
Bilateral
Warning sign to chekc out other things

Question 17

Exercise induced

Answer 17

If secondary, then vomiting, loss of consciousness, doublle vision, neck rigidity

5 min - 48 hiurs…secondary longer than that