Headaches

Question 1

Most common type of HA:

Answer 1

Tension (W > M)

Question 2

SNOOP 4 flags for headache:

Answer 2

Systemic disease 
Neurologic signs
Onset that is sudden
Onset that is over 40
Previous HA with new features
Progressive 
Postural
Precipitation by valsalva/exertion

Question 3

Migraines will hit their max pain usually in:

Answer 3

1-2 hours

Question 4

What is a defining feature of migraines vs. SAH:

Answer 4

Transient with ipsilateral tearing and rhinorrhea

Question 5

Imaging needed for HA:

Answer 5

MRI without contrast

Question 6

Frequencies of HA:

Answer 6

Infrequent: <1 d/month
Frequent: 1-14
Chronic: >15/month

Question 7

Tension headache does NOT

Answer 7

Throb - it is a headband of pressure

Question 8

TTH has at least two of the following (4):

Answer 8

• Bilateral head or neck pain
• steady pressing or tightening and non-throbbing pain
• Mild to moderate pain
• not aggravated by normal physical activity

Question 9

Best treatment for tension

Answer 9

Rest

Question 10

Do not want to treat a HA for more than how many days a month (risk of developing MOH)?

Answer 10

More than 9

Question 11

Treatment for Tension headaches (4):

Answer 11

• Ibuprofen (600 I; 800 I)
• APAP 1000 x1
• Ketorolac injection IM
• Excedrin with caffeine (APAP)

Question 12

Cannot use what in pregnancy?

Answer 12

NSAIDS

Question 13

A menstrual migraine (starting 2-3 days) from too low estrogen does not have:

Answer 13

An aura

Question 14

Cluster headaches are more common:

Answer 14

In men and at night

Question 15

Cluster headaches have:

Answer 15

Throbbing

Question 16

Two most common types of aura:

Answer 16

1. visual

2. Sensory

Question 17

What is cutaneous allodynia?

Answer 17

Perception of pain produced by the innocuous stimulation of normal skin

Question 18

What type of headache affects young women and children?

Answer 18

Basilar - Vertigo + dysarthria

Question 19

Retinal ocular migrants result in:

Answer 19

Monoocular stomata that lasts an hour that is followed by a HA

Question 20

If you have someone with migrainous vertigo make sure they do not have:

Answer 20

Meniere’s

Question 21

Migraine without aura (more common) has more than two of the following 4:

Answer 21

• Unilateral location
• Pulsating quality
• Moderate-serve intensity
• aggravation by routing physical activity

Question 22

Food triggers are more likely to tip off a:

Answer 22

Migraine

Question 23

Why do oral agents not work as well when someone has a migraine?

Answer 23

Because there is secondary gastric stasis

Question 24

Options for acute treatment of a migraine:

Answer 24

• NSAID +/- APAP
• Triptan (inhaled)
• Ergots

Question 25

You can use what medications for nausea AS MONOTHERAPY?

Answer 25

IV Metoclopramine or IV/IM chlorpromazine and prochlorperazine or IV ondansetron (zofran)

Question 26

Do not use this for a headache!!!

Answer 26

Opioids

Question 27

If you have more than 4 HA a month, take prophylactic treatment (2):

Answer 27

1st line options: Beta-blockers (propranolol) and AEDS (topiramate) - need 4-6 weeks to work

Question 28

Menstrual HA treatment?

Answer 28

Long extended release OC and triptans

Question 29

What triggers an attack in a cluster HA most common in men?

Answer 29

Alcohol - will be sensitive during the episode

Question 30

Cluster HA happen at:

Answer 30

Night

Question 31

What are symptoms of cluster HA?

Answer 31

Unilateral throbbing, corners, rhinorrhea and conjunctiva injection

Question 32

What are two treatments for cluster HA?

Answer 32

Oxygen and triptans | *prednisone can be a bridge

Question 33

SUNCT syndrome is what?

Answer 33

Short-lasting unilateral neualgiform HA with conjunctival injection and tearing - more common in men

Question 34

If you have SUNCT, you need to do a:

Answer 34

MRI

Question 35

SUNCT is how short:

Answer 35

30-120 seconds

Question 36

What is chronic paroxysmal hemicranial?

Answer 36

More common in women, CONTINUOUS head pain

Question 37

Treatment for CPH

Answer 37

Indomethacin

Question 38

What is a sign of pseudotumor cerebri?

Answer 38

Papilledema

Question 39

Diagnosis for Pseudoturmor cerebri?

Answer 39

20-30 mL of CSF - will reduce pressure

Question 40

Treatment for pseudo tumor cerebri:

Answer 40

Acetazolimide - next best is topiramte

Question 41

What is the difference between hemicranial continua and CPH?

Answer 41

HEMICRANIA continua never really goes away