Headache

Question 0

Migraine

Answer 0

Moderate to severe attacks of a pulsatile and unilateral quality, lasting 4-72 hours

• aura is kind of a migraine giveaway, but most do not have auras
• aggravated by activity
• at least one of the following: N/V, phono/photophobia

Question 1

Spirochetal meningitis/aceptic/encephalitis (or viral encephalitis)

Answer 1

• elevated WBCs, increased proteins, normal glucose

- aseptic meningitis: really high protein

Question 2

Migraine history criteria

Answer 2

• A history and physical and neurologic exam do not suggest a secondary cause
• Secondary cause present but headache not temporally associated with the disorder

Question 3

Migraine with an aura

Answer 3

• not lasting more than 60 mins
• attacks follow aura with free interval of less than 60 mins
• at least one of the following: Exam does not suggest a secondary headache, Secondary headache suspected but ruled out by tests, Secondary headache disorder is present but headaches are not temporally associated with the disorder

Question 4

Migraine trt

Answer 4

• eliminating triggers;caffeine, EtOH, stress
• triptans (sumatriptan, zolmitriptan, rizatriptan)
• ## 5HT agonism -> cerebral vasoconstriction

Question 5

Triptans

Answer 5

• suma, zolmi, riza
• SE: flushing, chest tightness, dizziness (rare cardiac events)
• Cind: cardiovascular, cerebrovascular, periph. Vascular
• Interactions: SSRIs, CYP450

Question 6

Tension headache criteria

Answer 6

Rule out migraine

Lack nausea and vomiting, photophobia and phonophobia are absent (one or the other)

Question 7

Tension HA trt

Answer 7

Usually good response to over-the-counter analgesics

- Aspirin or acetaminophen in combination with caffeine and a short acting barbiturate

Question 8

Cluster headaches

Answer 8

• Patients with cluster headaches cannot sit still or lie down and may prefer to sit or rock
• Pain is always unilateral on the same side for each attack
• Attacks may occur very regularly
• typical secondary HA rule out

Question 9

Secondary HA: symptoms

Answer 9

• sudden onset “worst HA of my life”
• progressively
• stiff neck
• headache onset with exertion (valsalva)
• after age 50
• altered cognitive function
• abnormality on exam

Question 10

Subarachnoid hemorrhage: diagnosis

Answer 10

• Unenhanced CT with LP to rule out

Question 11

Arteritis

Answer 11

• sed rate indicator of inflammatory condition
• combined with fever, malaise, myalgias, visual loss, jaw claudication, and temporal artery tenderness
• high sed rate may indicate other pathologies (MM, malignancy, infection et al)

Question 12

Venous thrombosis

Answer 12

• dural venous sinus
• usually progressive, drowsiness and lethargy develop, as well as focal signs of papilledema and coma
• preggers/oral contraceptive uses at higher risk

Question 13

Meningitis

Answer 13

• developing HA, nuchal rigidity
• rapid administration of Abx is vital to good outcome
• must get CT and an LP (but trt empirically)

Question 14

Intercranial neoplasms

Answer 14

• typically focal signs also present (seizure, cortical dysfunction )
• may be worse in the morning to sustained ICP from lying down all night

Question 15

Benign intercranial HTN

Answer 15

• pseudotumor cerebri
• continuous headaches lasting weeks to months
• elevated opening pressure
• papilledema
• usually no other findings
• more common on obese 16-40 y/o females

Question 16

Intercranial hypotension

Answer 16

• usually occur following LP

- present with standing, relieved by laying down

Question 17

Cluster trt

Answer 17

• O2, subQ sumatriptan, nasal lidocaine