Headache/Temporal Arteritis

Question 0

Headache with nuchal rigidity, photophobia and prostration? Further workup?

Answer 0

Suspect meningitis. Lumbar puncture

Question 1

Red flags for headaches?

Answer 1

1. Fundamental change in pattern
2. First severe and/or worst headache
3. Abrupt onset attacks especially those that awaken from sleep
4. Neurologic symptoms lasting >1 hour
5. You headache in the patient’s 50 years old
6. You headache in patients with cancer, immunosuppression, pregnancy
7. Headache triggered by exertion, sexual activity, or valsalva

Question 2

Patient with nuchal rigidity and headache with clouded consciousness? Work up?

Answer 2

Intracranial hemorrhage.

1) CT scan
2) lumbar puncture’s shows bloody tap and xanthochromic (if older)

Question 3

Patient with severe new pounding headaches associated with nausea and vomiting localized to one side. Work up?

Answer 3

Brain tumor. CT or MRI

Question 4

Patient > 50 with Unilateral pounding headache and vision changes? Work up?

Answer 4

Temporel arteritis. ESR >50, arterial biopsy

Question 5

Patient with severe eye pain and nausea and vomiting. Pupil partially dilated? Measure?

Answer 5

Glaucoma, elevated intraocular pressure.

Question 6

Headache precipitated by alcohol and occurs with rhinorrhea and lacrimation?

Answer 6

Cluster headache

Question 7

Xanthochromia indicates?

Answer 7

Presence of Bilirubin, differentiating subarachnoid hemorrhage from traumatic tap

Question 8

Criteria for giant cell arteritis?

Answer 8

Three or more of the following:

1. Age >50 years
2. New onset/type of headache
3. Tenderness or decreased pulsation of the Temporal artery
4. Elevated ESR
5. Abnormal findings on temporal artery biopsy

Question 9

GCA closely related to? Symptoms?

Answer 9

Polymyalgia rheumatic. Stiffness of the neck, torso, shoulders, proximal muscles

Question 10

Drug/Dose to treat GCA? For polymyalgia rheumatica?

Answer 10

Prednisone 40 to 60 mg

Prednisone 10 to 20 mg

Question 11

Cranial autonomic features of migraines?

Answer 11

Tearing or nasal congestion

Question 12

Treatment of migraines?

Answer 12

Preventative: Tricyclic antidepressants, beta blockers

Acute episode: NSAIDs, sumatriptan, dihydroergotamine