HEADACHE

Question 1

Migraine DDX:

6

Answer 1

1. Tension HA.
2. Cluster.
3. Pseudotumor.
4. CNS vasculitis.
5. Partial seizures.
6. Intracranial neoplasm.

Question 2

Migraine workup:

5

Answer 2

1. CBC.
2. ESR.
3. CT head.
4. MRI brain.
5. LP-CSF analysis.

Question 3

Cluster HA DDx:

4

Answer 3

1. Migraine.
2. Tension HA.
3. Intracranial neo.
4. Pseudotumor.

Question 4

Cluster workup:

5

Answer 4

1. CBC.
2. CT head.
3. MRI brain.
4. LP-CSF analysis.
5. ESR.

Question 5

Temporal arteritis (giant cell arteritis) DDX:

9

Answer 5

1. Migraine.
2. Cluster.
3. Tension.
4. Meningitis.
5. Carotid artery dissection.
6. Pseudotumor.
7. Trigeminal neuralgia.
8. Intracranial neo.
9. Temporomandibular joint (TMJ) disorder.

Question 6

Temporal arteritis workup:

7

Answer 6

1. ESR.
2. CBC.
3. CRP.
4. Temporal artery biopsy.
5. Doppler US carotid.
6. MRI brain.
7. LP-CSF analysis.

Question 7

Sinusitis DDx:

4

Answer 7

1. Migraine.
2. Tension.
3. Meningitis.
4. Intracranial neo.

Question 8

Sinusitis workup:

4

Answer 8

1. CBC.
2. XR-sinus.
3. CT-sinus.
4. LP-CSF analysis.

Question 9

Tension DDx:

7

Answer 9

1. Migraine.
2. Depression.
3. Caffeine or analgesic withdrawal.
4. HTN.
5. Cluster.
6. Pseudotumor.
7. Intracranial neo.

Question 10

Tension workup:

5

Answer 10

1. CBC.
2. Electrolytes.
3. ESR.
4. CT-head.
5. LP-CSF analysis.

Question 11

SAH DDx:

7

Answer 11

1. Migraine.
2. Meningitis/encephalitis.
3. Intracranial hemorrhage.
4. VAD.
5. Intracranial venous thrombosis.
6. Acute HTN.
7. Intracranial neo.

Question 12

SAH workup:

5

Answer 12

1. Noncontrast CT-head.
2. LP-CSF analysis.
3. CBC.
4. PT/PTT/INR.
5. Urine toxicology.

Question 13

Meningitis DDx:

4

Answer 13

1. Migraine.
2. SAH.
3. Sinusitis/encephalitis.
4. Intracranial or epidural abscess.

Question 14

Meningitis workup:

4

Answer 14

1. CBC.
2. CT-head.
3. MRI-brain.
4. LP-CSF analysis — cell count, protein, glucose, gram, PCR for pathogens, culture.

Question 15

Pseudotumor DDx:

6

Answer 15

1. Tension.
2. Migraine.
3. Cluster.
4. Meningitis.
5. Intracranial venous thrombosis.
6. Intracranial neoplasm.

Question 16

Pseudotumor workup:

4

Answer 16

1. Urine hCG.
2. CBC.
3. CT-head.
4. LP-opening pressure and CSF analysis.

Question 17

Trigeminal neuralgia DDx:

5

Answer 17

1. Tension.
2. Migraine.
3. Cluster.
4. TMJ disorder.
5. Intracranial neo.

Question 18

Trigeminal neuralgia — Workup:

3

Answer 18

1. CBC.
2. ESR.
3. MRI-brain.

Question 19

Key Physical Exam Steps for Headache

Answer 19

Vitals (HTN?)
Palpate head, neck, and sinuses
ENT exam
Complete neuro exam (include funduscopic exam)
Meningeal signs (if acute)

Question 20

Key History for Headache

Answer 20

Onset/Duration/intermittence/time of day/chronicity
Frequency
What happens before/during/after headache?
Location (unilateral vs bilateral)
Quality
Radiation
Severity
Aggravating: stress, fatigue, menses, exercise, food, EtOh
Alleviating: rest, medications
Associated sx : parasthesias, numbness, tingling, vision changes, dizziness, photophobia, stiff neck

N/V, jaw claudication, dental surgery, constitutional sx
H/o trauma
Family history