Section 3: Headache and Dizziness/Vertigo Flashcards
Triggers of Migraine headache
- Cheese
- Caffeine
- Menstruation
- Oral contraceptive
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 7087). . Kindle Edition.
List the symptoms that may precede a migraine headache
- Aura of bright flashing lights
- Scotomata
- Abnormal smells
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7088-7089). . Kindle Edition.
Indications for CT scan in migraine
- Sudden and/ or severe
- Onset after age 40
- Associated with focal neurological findings
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 7092). . Kindle Edition.
Best initial (abortive) therapy for migraine headache
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7093-7094). . Kindle Edition.
- Sumatriptan or
- Ergotamine.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7093-7094). . Kindle Edition.
What is the indication for the prophylactic Rx of migraine headache
When the patient has 4 or more headaches per month
Medications for prophylactic Rx of migraine
Beta blockers (propranolol)
Calcium channel blockers (CCB)
Tricyclic antidepressants
SSRIs
Cluster headaches (CH) are 10 times more in men than in women. List the CF of CH
- Exclusively unilateral
- Redness of the eye
- Tearing of the eye
- Rhinorrhea
Differentiate between migraine and cluster headache
Headache Type Migraine Cluster
Gender Much more common in men
Presentation Unilateral or bilateral
Aura Only unilateral
Tearing or redness of eye; rhinorrhea
No aura
Abortive Sumatiptan Sumatiptan
Special: 100% oxygen
Prophylactic Propranolol None
CF of temporal arteritis
- Tenderness of the temporal area
- Jaw claudication
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7135-7140). . Kindle Edition.
Diagnostic tests in temporal arteritis
- Testing Sedimentation rate (ESR)
- Most accurate test: Temporal artery biopsy
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7135-7140). . Kindle Edition.
Best initial test in temporal arteritis
Give steroids first and fast if these are available. A delay may result in permanent vision loss.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7135-7140). . Kindle Edition.
Presentation and CF of Pseudomotor cerebri
- Look for an obese young woman
- Headache
- Double vision
- Papilledema
- CT/ MRI is normal
- Vitamin A use is suggestive
- Pseudotumor = Headache plus: • Sixth nerve palsy • Visual field loss • Transiently obscure vision • Pulsutile tinnitus
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7141-7149). . Kindle Edition.
Most accurate test for pseudomotor cerebri
LP with measurement of the opening pressure
Rx of pseudomotor cerebri
- Weight loss
- Acetazolamide
- Surgery if they fail: VP shunt, optic nerve sheath fenestration
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7153-7155). . Kindle Edition.
CF of vertigo
- Room spinning
- Nausea and vomiting
- Nystagmus (horizontal)
Best initial diagnostic test for vertigo
MRI of the internal auditory canal
DD of diziness/vertigo with hearing loss/tinnitus
- Which of these is associated with trauma
- Which of these is associated with ataxia
Labyrinthitis
Meniere’s disease
Acoustic neuroma
Perilymph fistula
- Perilymph fistula
- Acoustic neuroma
Diagnosis:
- Vertigo, changes position
- No hearing loss
- No tinnitus
- No ataxia
- Possible positive Dix-Hallpix maneuver
Rx of above condition
Benign positional vertigo
Meclizine
Diagnosis:
- Vertigo, occurs without change in position
- Dizziness
- No hearing loss
- No tinnitus
Rx of above condition
Vestibular neuritis
Meclizine
Diagnosis:
- Vertigo
- Dizziness
- Hearing loss
- Tinnitus
- Acute onset
Rx of above condition
Labyrinthitis
Self-limited; may be treated with meclizine
Diagnosis:
- Vertigo
- Dizziness
- Hearing loss
- Tinnitus
- Chronic onset with remitting and relapsing episodes
Rx of above condition
Meniere’s disease
Salt restrictions and diuretics
Diagnosis:
- Vertigo
- Dizziness
- Hearing loss
- Tinnitus
- Ataxia
Diagnostic test for above condition
Rx of above condition
What condition can be related to above diagnosis
Acoustic neuroma
MRI of the internal auditory canal
Surgical resection of the tumor
Neurofibromatosis (von Recklinghausen’s disease)
Diagnosis:
- Vertigo, occurs without change in position
- Dizziness
- Hearing loss
- Tinnitus
- Associated with head trauma
Perilymph fistula
CF of Wernicke-Korsakoff syndrome
- History of chronic heavy alcohol use
- Confusion with confabulation
- Ataxia
- Memory loss
- Gaze palsy/ ophthalmoplegia
- Nystagmus
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7210-7216). . Kindle Edition.
Minimum diagnostic tests to carry out in a patient with Wernicke-Korsakoff syndrome
- Head CT
- B12 level
- Thyroid function (T4/ TSH)
- RPR or VDRL
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7210-7216). . Kindle Edition.
Rx for Wernicke-Korsakoff syndrome
- Thiamine. Acutely, give IV dose; then may switch to oral
- Also give glucose with thiamine, but administer thiamine first, then glucose.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7210-7216). . Kindle Edition.
