Headache - vertigo

Question 1

headache - definition / MC in (sex)

Answer 1

• pain due to irritation of of structure such as dura, cranial nerves or extracranial structures
• MC in women, except clusters

Question 2

main types of headache

Answer 2

1. cluster
2. tension
3. migraine

Question 3

other causes of headache (10)

Answer 3

1. subarachnoid hemorrhage
2. meningitis/encephalitis
3. hydrocephalus
4. neoplasia
5. arteritis
6. trigeminal neuralgia
7. head injury
8. acute glaucoma
9. sinusitis
10. venous sinus thrombosis

Question 4

main types of headache - localization

Answer 4

1. cluster –> unilateral
2. tension –> bilateral
3. migraine –> unilateral

Question 5

main types of headache - duration

Answer 5

1. cluster –> 15min-3h repetitive
2. tension –> more than 30 min (typically 4-6h)
   constant
3. migraine –> 4-72h

Question 6

tension headache - characteristic of pain and other symptoms

Answer 6

• steady pain
• No photophobia
• No phonophobia
• No aura

Question 7

cluster headache - characteristic of pain and other symptoms

Answer 7

• Repetitive brief headaches
• Excruciating periorbital pain with lacrimation
• Rhinorrhea
• may present with HORNER syndrome

Question 8

cluster headache may induce …

Answer 8

HORNER syndrome

Question 9

cluster headache is more common in

Answer 9

males

Question 10

Migraine - characteristic of pain and other symptoms

Answer 10

• pulsating pain
• nausea
• photophobia or phonophobia
• may have aura

Question 11

Migraine mnemonic

Answer 11

POUND

Pulsatile, One-day duration, Unilateral, Nausea, Disabling

Question 12

migraine is due to

Answer 12

irritation of: 1. CN V 2. Meninges 3. Blood vessels

Question 13

migraine due to blood vessel irritation - mechanism

Answer 13

release of substance P, calcitonin gene-related peptide, vasoactive peptide

Question 14

cluster headache - treatment

Answer 14

acute: 1. 100% 02 2. sumatriptan
prophylaxis: verapamil

Question 15

tension headache - treatment

Answer 15

1. Analgesics
2. NSAID
3. acetaminophen
4. Amitryptyline for chronic pain

Question 16

Migraine - treatment

Answer 16

Acute: triptans, NSAIN, dihydroergotamine
ProphylaxiS: lifestyle changes (sleep, exercisem diet eg,) propranolol, topiramate, Ca2+ channel blockers, amitriptyline, valproate

Question 17

trigeminal neuralgia headache - duration / type of pain

Answer 17

typically less than 1 minute

repetitive shooting pain in distribution of CN V

Question 18

Vertigo - definition

Answer 18

sensation of spinning while actually stationary. (subtype of dizziness but distinct from lightheadedness

Question 19

types of vertigo (MC?)

Answer 19

1. peripheral vertigo (MC)

2. central vertigo

Question 20

peripheral vertigo - etiology

Answer 20

inner ear etiology

1. semicircular canal debris (benign position vertigo)
2. vestibular nerve infection
3. Meniere disease
4. ototoxic drugs
5. Ramsay Hunt syndrome

Question 21

peripheral vertigo - diagnosis

Answer 21

positional testing –> delayed horizontal nystagmus

Question 22

causes of central vertigo

Answer 22

Brain stem or cerebellar lesion

eg. stroke affecting vestibular nuclei or posterior fossa tumor

Question 23

central vertigo findings

Answer 23

1. directional change of nistagmus
2. skew deviation
3. diplopia (eyes)
4. dysmetria
5. focal neurological findings

Question 24

dysmetria

Answer 24

lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye. It is a type of ataxia.

Question 25

central vertigo diagnosis

Answer 25

1. positional testing --> immediate nystagmus in andy direction, may change direction 2. Focal neurologic findings

Question 26

prophylaxis of migraine

Answer 26

1. propranolol 2. topiramate 3. Ca2+ channel blockers 4. amitriptyline 5. life style modifications 6. valproate

Question 27

triptans - clinical use

Answer 27

1. acute migraine | 2. cluster headache attacks

Question 28

triptans - mechanism of action

Answer 28

5-HT (1B/1D) agonists (seretonin) --> a. inhibit trigeminal nerve activtion b. prevent vasoactive peptide release c. induce vasoconstriction

Question 29

triptans - toxicity

Answer 29

1. coronary vasospasm | 2. mild paresthesia

Question 30

triptans are contraindicated in

Answer 30

patients with CAD or Prinzmetal angina

Question 31

headache - pain due to irritation of structures such as

Answer 31

1. dura 2. cranial nerves 3. extracranial nerves

Question 32

meningism signs

Answer 32

- acute severe headache, felt over most of the head - nech stiffness - photophobia

Question 33

causes of headache with meningism

Answer 33

meningitis encephalitis subarachnoid hemorrhage

Question 34

encephalitis vs meningitis according ONE clinical sign

Answer 34

encephalitis --> strange behaviour

Question 35

sinusitis - pain worse when

Answer 35

bending over

Question 36

Horner syndrome - headache

Answer 36

1. cluster | 2. venous sinus thrombosis

Question 37

migraine due to blood vessel irritation - mechanism - release of

Answer 37

1. substance P 2. calcitonin gene-related peptide 3. vasoactive peptides

Question 38

tension headache - treatment for chronic pain

Answer 38

amitriptyline

Question 39

vertigo is always worsened by

Answer 39

movement

Question 40

semicircular canal debris -->

Answer 40

benign position vertigo

Question 41

1st line for trigeminal neuralgia

Answer 41

Carbamazepine

Question 42

positional testing for nystagmus is also called

Answer 42

Hallpike manoeuvre

Question 43

Epley manoeuvre -->

Answer 43

clear the debris from the semicircular canalas (benign positional vertigo)

Question 44

Menierre disease - symptoms

Answer 44

1. recurrent attacks of vertgio (>20 mins) 2. tinnitus 3. hearing loss 4. fullness sensation