Neuro Review FINAL

Question 1

What is the MC type of primary headache?

Answer 1

Tension headache

Question 2

Treatment for a tension headache

Answer 2

NSAIDs (Aspirin or Acetaminophen), local heat

Question 3

Trigeminal Neuralgia
-MC in who?
-In younger patients, suspect ______.
-Symptoms
-Treatment with Rx

Answer 3

-MC in middle-aged women
-In younger patients, suspect MS
-Symptoms: brief, episodic, stabbing or shock-like pain in the 2nd or 3rd division of the Trigeminal Nerve. Worse with touch, chewing, drafts of wind, movements. Starts near mouth and shoots to eye, ear, and nostril.
-Treatment: Carbamazepine

Question 4

Migraines
-MC type
-Symptoms

Answer 4

-Migraine without Aura (MC)

-Lateralized, pulsatile throbbing headache with nausea, vomiting, photophobia, and phonophobia. Worse with routine activity.
-Auras (visual MC): last < 60 minutes.

Question 5

Migraines
-Symptomatic (Abortive) Tx
-Prophylactic Tx

Answer 5

-Symptomatic: NSAIDs, Acetaminophen, Aspirin (first line). IVF and Place patient in dark room. Triptans or Ergotamines if no response. Antiemetics (Metoclopramide, Prochlorperazine)

-Prophylactic: BB and CCB

Question 6

Triptans and Ergotamines
-MOA
-Contraindications

Answer 6

Serotonin agonists cause vasoconstriction and block pain pathways in the brainstem.

-C/I: Ischemic stroke, ischemic heart disease, CAD, HTN, and PAD

Question 7

Cluster Headache
-MC in who?
-Triggers?
-Symptoms
-Exam Findings (Eye)
-Acute Management
-Prophylaxis

Answer 7

-MC in young males
-Triggers: worse at night, alcohol, stress, foods
-Symptoms: severe, unilateral periorbital or sharp temporal pain. Bouts last <2 hours with spontaneous remission.
-Exam: Ipsilateral findings (Horner’s Syndrome): ptosis, miosis, anhidrosis, nasal congestion, rhinorrhea, conjunctivitis, lacrimation
-Acute: 100% oxygen
-Prophylaxis: Verapamil