Headaches

Question 1

Primary headaches

Answer 1

migraine
tension
cluster

Question 2

secondary headaches

Answer 2

caused by underlying organic disease

Question 3

cervicogenic headaches

Answer 3

secondary although some classify as primary

Question 4

abnormal findings with headaches warrant what?

Answer 4

neuroimaging to rule out intracranial pathology

Question 5

what is the preferred method to rule out hemorrhage?

Answer 5

CT

Question 6

MRI is necessary for imaging what?

Answer 6

posterior fossa

Question 7

what are CSF analyses for?

Answer 7

hemorrhage
infection
tumor
CSF disorders

Question 8

headache onset after 50 years is?

Answer 8

a red flag

Question 9

ddx for headaches beginning after 50 years

Answer 9

temporal arteritis

mass lesion

Question 10

possible work ups for headaches beginning after 50

Answer 10

ESR/CRP, neural imaging

Question 11

ddx for sudden onset headache

Answer 11

subarachnoid hemorrhage
mass lesion
vascular malformation

Question 12

possible workup for sudden onset headache

Answer 12

neuroimaging

lumbar puncture if neuroimaging is negative

Question 13

ddx for increased frequency and severity of headache

Answer 13

mass lesion
subdural hematoma
medication overuse

Question 14

possible workup for increasing frequency and severity of headache

Answer 14

neuroimaging

drug screening

Question 15

red flags considering headaches

Answer 15

>50 years
sudden onset
increase in frequency and severity
HIV/cancer
systemic illness (fever, stiff neck, rash)
focal neurological S&S
papilledema
subsequent to head trauma

Question 16

ddx for headache from HIV/cancer

Answer 16

meningitis
abcess
metastasis

Question 17

possible workup for headache from HIV/cancer?

Answer 17

neuroimaging

lumbar puncture if neuroimaging is negative

Question 18

ddx for headaches from systemic illness

Answer 18

meningitis
encephalitis
lyme disease
systemic infection
collagen vascular disease

Question 19

possible workup for headaches from systemic illness

Answer 19

neuroimaging
lumbar puncture
serology

Question 20

ddx for focal neurological S&S

Answer 20

mass lesion
vascular malformation
stroke
collagen vascular disease

Question 21

possible workup for headaches from focal neurological S&S

Answer 21

neuroimaging

collagen vascular evaluation

Question 22

ddx for a headache with papilledema

Answer 22

mass lesion

meningitis

Question 23

possible workup for headache with papilledema

Answer 23

neuroimaging

lumbar puncture

Question 24

ddx for headache from subsequent trauma

Answer 24

intracranial hemorrhage
subdural/epidural hematoma
posttraumatic headache

Question 25

possible workups for headaches from subsequent trauma

Answer 25

neuroimaging of the brain, skull and possibly cervical spine

Question 26

migrain pain location

Answer 26

unilateral

Question 27

tension headache pain location

Answer 27

band like and bilateral

Question 28

cluster headache location

Answer 28

strictly unilateral

Question 29

temproal arteritis headache location

Answer 29

distribution of temporal artery

Question 30

trigeminal neuralgia pain location

Answer 30

distribution of trigeminal nerve

Question 31

acute glaucoma pain location

Answer 31

eye pain

Question 32

what is one of the most common cause of headaches?

Answer 32

whiplash

Question 33

4 primary headache patterns

Answer 33

migrain tension type cluster headache cervicogenic

Question 34

when must acute headache be evaluated?

Answer 34

if associated with neurologic S&S

Question 35

describe a migraine

Answer 35

associated with nausea, vomiting, or sleepliness and separated by pain free intervals

Question 36

what is a chronic progressive headache? What may be suspected?

Answer 36

severity and frequency increase over time | structural disorder of CNS

Question 37

what is a chronic nonprogressive headache?

Answer 37

most typical type, usually related to stress

Question 38

most patients presenting to physician's office for evaluation of headache have what?

Answer 38

either a tension headache or migraine

Question 39

S&S of a migraine

Answer 39

``` nausea photophobia phonophobia exacerbation by physical activity aura ```

Question 40

intracranial organic pathologies are from what?

Answer 40

``` infection intracranial mass lesion hemorrhage hypertensive parenchymal hemorrhage, subdural hematoma ischemic conditions traumatic brain injury ```

Question 41

other organic syndromes

Answer 41

``` cluster headache cranial bone pain scalp pain vascular involvement eye pain ear pain acute sinusitis dental pain facial nerve pain neck pain acute febrile illness metabolic disorders ```

Question 42

red flags for headaches

Answer 42

``` sudden, severe headache new headache, older patient headache due to head trauma associated residual neurologic S&S cognitive changes vomiting w/o nausea persistent or progressive headache nuchal rigidity with or without fever suspicion of drug or alcohol dependance headache associated w' 15-mm Hg persistent/severe headache in child ```

Question 43

headaches associated with exertion may mean

Answer 43

underlying tumor or vascular weakness

Question 44

when do you do a CT/MRI for post traumatic headaches?

Answer 44

signs of neurological dysfunction and loss of consciousness

Question 45

most primary headaches occur when?

Answer 45

at an early age and are recurring

Question 46

when should a new headache be a concern?

Answer 46

if they are middle aged or older complaining of a new headache

Question 47

older patients with a temporal headache need to be considered to have..

Answer 47

temporal arteritis

Question 48

headaches that are constant and more severe without reprieve likely indicate

Answer 48

intracranial process and should necessitate a referral for evaluation

Question 49

how to manage a headache without red flags

Answer 49

modify patient behavior (sleep, diet, exercise) manage with CMT supplements or herbal alternates nonpharmacological treatments, if chiro is unsuccessful (acupuncture/biofeedback) refer for medical management if still unsuccessful