OnlineMedEd: Neurology - Headache

Question 1

What are the red-flag symptoms that indicate further workup for headache?

Answer 1

• Fever (meningitis)
• Focal neurologic deficit (MS, tumor, stroke, hemorrhage)
• Age greater than 50
• Sudden onset (subarachnoid hemorrhage)
• Progressive nausea and vomiting (cancer)

Question 2

List the four kinds of primary headache.

Answer 2

• Tension
• Analgesic rebound
• Cluster
• Migraine

Question 3

Describe tension headaches.

Answer 3

• Bilateral
• Starts in the front and radiates to the neck
• “Vice-like” pain
• Treatable with OTC meds

Question 4

Describe rebound analgesic headaches.

Answer 4

• Headaches that occur with med discontinuation

* Greatest risk from using medicines more than 10x per month

Question 5

Describe cluster headaches.

Answer 5

• Occur from vascular pathologies
• Patients may go months without symptoms but then a group of headaches will occur in series (in a cluster…), may occur up to 10x per day
• Unilateral
• Eye pain
• Rhinorrhea
• Usually goes away on its own

Question 6

How are cluster headaches treated?

Answer 6

Acute:
• Oxygen
• Triptans

Prophylactic:
•Verapamil or diltiazem

Question 7

Describe migraine headaches.

Answer 7

• Vascular pathology (too much dilation)
• Debilitating
• Pulsatile and unilateral
• Nausea and vomiting
• Wakes patient up at night
• Aura
• Triggered by random stuff (e.g., MSG, chocolate)
• Can be aborted by sleep

Question 8

How are migraines treated?

Answer 8

Acute:
•NSAIDs (immediately when symptoms start)
•Triptans or ergots for if symptoms don’t respond to NSAIDs

Prophylactic:
•Valproic acid, propranolol, topiramate

Question 9

The only primary headache that warrants imaging is _______________.

Answer 9

cluster headaches

Question 10

What three treatments can help pseudotumor cerebri?

Answer 10

• Acetazolamide
• Serial LPs
• VP shunt