Module 2: Headache

Question 0

Primary headaches?

Answer 0

#Migraine
#tension
#Cluster
#Idiopathic

Question 1

Treatment of choice for trigeminal neuralgia?

Answer 1

Carbamazepine

Question 2

Secondary headaches?

Answer 2

#Intracranial hypertension
#Intracranial hypotension
#Subarachnoid hemorrhage
#GCA
#CNS infection
#Cranial neuralgia's
#Brain tumor

Question 3

Red flags in headache history?

Answer 3

HPI: 
#Age over 50
#Worse upon wakening
#Change in typical pattern
#Change in personality
#seizures

PMH:
#History of cancer
#HIV

Focal:
#Fever
#Visual loss
#Diplopia

Question 4

Red flags in headache physical exam?

Answer 4

#Fever
#Meningeal irritation
# Papilledema/enlarged blind spot/loss of visual acuity
#Tender temporal artery
#Focal neurologic findings

Question 5

Most severe primary headache? Most common?

Answer 5

Cluster; tension

Question 6

Criteria for migraines?

Answer 6

#one or both of:
nausea/vomiting OR photophobia/phonophobia

2+ of:
#Unilateral
#Pulsating
#Intense
#Aggravated by physical activity

Question 7

Visual aura signs?

Answer 7

#Fortification spectra (zig-zags)
#Scintillating scotoma (shimmering)
#Phosphenes (seeing light without actual light) 
#Metamorphopsia (changes in shapes of objects)

Question 8

Migraine aura – develops over how long? Migraine follows after how long?
Possible mechanism of Aura? Non-Visual aura?

Answer 8

Minutes; an hour

Cortical spreading depression due to vasoconstriction

#Numbness from hand to mouth
#aphasia
#Unilateral weakness
#Slurring of speech

Question 9

First-line abortive therapy for migraines? Can also work for what type of headache? To function properly, must be taken within? Avoid in patients with?

Answer 9

Triptans; cluster

Within two hours;

#CAD
#CVA
#Pregnancy
#Complicated migraine

Question 10

First line Prophylactic migraine therapies?

Answer 10

#Non selective Beta blockers (propranolol/nadolol)
#Tricyclics (amitriptyline, nortriptyline)
#Antiepileptics (topiramate, valproate)

Question 11

Side effects of topiramate?

Answer 11

Word finding difficulties

Question 12

Therapy for chronic migraine?

Answer 12

Botulinum toxin

Question 13

Most common sign associated with brain tumor?

Answer 13

Seizure >headache

Question 14

Differences between tension type headache (versus migraine)?

Answer 14

#Moderate intensity (does not prohibit activities)
#No nausea/vomiting
#Photophobia or phonophobia but not both
#Bilateral

Question 15

Patient has side-locked headache that occurs at exactly the same time every day? Other features?

Answer 15

Cluster headaches

#Conjunctival irritation
#tearing
#Nasal congestion
#Meiosis
#Ptosis

Question 16

Cluster headaches – acute treatment options? Prophylactic treatment options?

Answer 16

Oxygen, triptans, ergot alkaloid

Lithium, corticosteroids, verapamil

Question 17

Normal ICP? Why does ICP increase in the morning?

Answer 17

5-20 cm H2O

#Gravity
#Decrease breathing increases PCO2, increases vasodilation (increased area of brain)

Question 18

Causes of brain bleeds?

Answer 18

#Epidural – middle meningeal artery rupture
#subdural – bridging vein rupture
#Subarachnoid – berry aneurysm, AVM
#Intraparenchymal
#Intraventricular – premature babies/ATM

Question 19

Why can subarachnoid hemorrhage result in instant death?

Answer 19

Cerebral perfusion pressure = MAP - ICP

In hemorrhage, ICP approaches MAP, pushing cerebral perfusion pressure to 0

Question 20

Patient presents with headache disappears completely went supine but we reemerges when upright – suspected diagnosis? Likely due to? Treatment?

Answer 20

Intracranial hypotension (traction on the dural nerves when the ICP it low)

Epidural blood patch

Question 21

Sub acute onset of a headache at older age with scalp tenderness – suspected diagnosis? Essential lab funding?

Answer 21

Giant cell arteritis; elevated ESR