Neurology 2.7

Question 1

What is a primary headache?

Answer 1

H/A with “intrinsic dysfunction” of CNS; no underlying structural, infectious, toxic/metabolic cause; Genetic!

ex: migraine, cluster H/A, tension H/A

Question 2

What is a secondary headache?

Answer 2

H/A which are secondary to “organic or psychiatric processes”; identifiable cause

ex: tumor, hemorrhage, meningitis

Question 3

What are the features differentiating migraine from some other headaches?

Answer 3

• one-sided, throbbing, incapacitating
• neausea/vomiting
• sensitive to light/sound
• worse with movement or straining
• duration 4-72 hrs

Question 4

How do migraine affect visual fields?

Answer 4

• affects both eyes

- usually aura preceeding migraine pain

Question 5

Where does the pain come from in a headache?

Answer 5

• memingeal irritation* to:
• trigeminal nerve (CN V)
• brainstem
• pain sensation areas of the brain via thalamus

Question 6

How is genetics tied to headaches/migraines?

Answer 6

abnormal sensory processing in the third cortical pathway causes lower pain/migraine perception threshold;
“central sensitization”

Question 7

Which type of headache category does a sinus headache fall into?

Answer 7

secondary; but many sinus headaches are actually migraines in disquise

Question 8

What are symptoms of a thunderclap headache?

Answer 8

• rapid onset and sensitivity to pain
• nausea
• emesis
• numbness
• weakness

Question 9

What is the most important differential diagnostic to make when a patient presents with a thunderclap headache?

Answer 9

rule out sudden intracranial bleed from ruptured intracranial aneurysm

Question 10

What is commonly misdiagnosed with migraines?

Answer 10

recurrent sinus infections when the real pathology is a migraine without aura

Question 11

What is commonly misdiagnosed with a visual aura before a migraine?

Answer 11

• retinal detachment (looks like aura, but doesn’t have shimmering)
• key is to check if it affects one or both eyes [both in migraine]