OME - HA

Question 1

What are the red flags for headache?

Answer 1

1. Fever
2. Focal deficit
3. New onset over 50 yo
4. Thunderclap
5. Progressive N/V often worse in AM

Question 2

Work up for red flag HA?

Answer 2

1. CT
2. LP
3. Biopsy

Question 3

Presentation brain tumor?

Answer 3

1. Focal Neurologic deficit

2. Progressive N/V

Question 4

Presentation brain abscess?

Answer 4

1. Fever
2. HA
3. Progressive deficit

Question 5

Time constriction for thunderclap?

Answer 5

Reaches peak within 60 seconds

Question 6

4 classes HA?

Answer 6

1. Tension
2. Analgesic Rebound
3. Cluster
4. Migraine

Question 7

Most common HA?`

Answer 7

Tension HA: Muscular Pain

Question 8

Causes HA?

Answer 8

1. Stress
2. Poor sleep
3. Muscular tension

Question 9

Presentation tension HA

Answer 9

1. Starts in front radiates to neck
2. Worse on sound exertion
3. Bilateral
4. Vice like

Question 10

Rx Tension HA?

Answer 10

1. NSAIDs

2. Acetaminophen

Question 11

Pathophys rebound HA?

Answer 11

Withdrawal from overuse of analgesics for HA too often

Question 12

Most common drugs in rebound?

Answer 12

1. Triptans
2. Opiates
3. Butalbital

Question 13

Criteria rebound HA?`

Answer 13

1. Use of analgesic over 10x per month

2. HA worse on stopping med

Question 14

Rx rebound HA?

Answer 14

STOP TAKING MED: will be worse for a few days but will resolve

Question 15

Pathophys cluster HA?

Answer 15

Vascular

Question 16

Presentation cluster HA?

Answer 16

1. Asymptomatic for months
2. Many attacks then clustered together
3. 8-10x per day: same each time
4. Unilateral Eye pain
5. Horner syndrome
6. Eye pain
7. Goes away on own

Question 17

What is horner syndrome?

Answer 17

1. Rhinorrhea
2. Conjunctival injection
3. Lig sagging
4. Lacrimation

Question 18

Abortive Rx cluster?

Answer 18

1. Oxygen nasal cannula

2. Triptans SC - second line

Question 19

Prophylactic Rx cluster?

Answer 19

1. Verapamil

Question 20

Work up cluster

Answer 20

1 x brain imaging - CT or MRI

- To rule out more serious cause

Question 21

Pathophys migraine?

Answer 21

Vascular source usually vasodilation

Question 22

Presentation migraine?

Answer 22

1. Unilateral
2. Pulsatile
3. Photo / phonophobia
4. Debilitating
5. N / V
6. Aura
7. Trigger
8. 4 - 72 hours
9. Aborting = hangover

Question 23

Additional workup migraine?

Answer 23

None: clinical diagnosis

Question 24

Rx mild migraine?

Answer 24

NSAIDs

Question 25

Rx severe / refractory migraine?

Answer 25

1. Triptans

2. Ergots

Question 26

When to avoid triptans / ergots?

Answer 26

CAD: these cause vasospasm

Question 27

Which HA med to never use?

Answer 27

Butalbital

Question 28

Prophylaxis Migraine?

Answer 28

1. BB - Propranolol
2. VPA
3. Topiramate

Question 29

Pathophys idiopathic intracranial hypertension “IIP”?

Answer 29

• Increased ICP for no reason

Question 30

Presentation IIP?

Answer 30

• Female patient
• Signs increased ICP:
  1. Papilledema
  2. Neurologic deficit
  3. N/V
  4. Negative CT

Question 31

Other Name IIP?

Answer 31

Pseudotumor cerebri

Question 32

Causes IIP?

Answer 32

1. OCP
2. LP - Opening pressure over 25
3. LP causes relief

Question 33

Rx IIP?

Answer 33

1. Acetazolamide
2. Serial LP
3. VP Shunt if all fails

Question 34

First line for HA?

Answer 34

Topomax

Question 35

Side effects topamax?

Answer 35

1. Weight loss
2. Dopomax
3. Numbness / tingling
4. Glaucoma
5. Kidney stone

Question 36

Side effects phenytoin?

Answer 36

1. Increased LFT
2. Gum hyperplasia
3. Interacts with almost everything

Question 37

Side effects Carbamazepine?

Answer 37

1. HYPOnatremia

2. Leukopenia

Question 38

Side effects phenobarbital?

Answer 38

1. Decreased IQ

2. Drowsiness