Headaches

Question 1

Migrane

Answer 1

• unilateral throbbing
• more women affected than men (teen/young adults)
• you know the rest

Question 2

Tension headache

Answer 2

Gradual, constant, bilateral, dull, achind, squeezing

• slightly more prevalent in women
• associated with fatigue, pericranial muscle tenderness, and sleep disturbance

Question 3

Trigeminal autonomic cephalalgias

Answer 3

Cluster, Paroxysmal Hemicrania, and SUNCT

• ipsilateral to headache you see autonomic changes such as:
• lacrimation, nasal congesion/rhinorrhea, eyelid edema, forehead/facial sweating, forehead/facial flushing, sensation of fullness in ear, and miosis and/or ptosis (Horner’s syndrome)

Question 4

Medication overuse headache

Answer 4

• risk factor: taking abortive meds more than 2x weekly
• headaches occur more than 15 days per month in pt with a preexisting headache disorder
• regular overuse for more than 3 months
• culprits: opioids, caffiene, excedrin, fioricet, triptans, ergotamine

Question 5

Low CSF Pressure Headache

Answer 5

• positional (only upon sitting or standing)
• can be from rupture Tarlov cyst
• self-limiting
• tx with IV fluids, IV caffiene, or epidural blood patch
• follows after LP

Question 6

Idiopathic intracranial hypertension

Answer 6

• AKA pseudotumor cerebri
• elevated ICP but no structural abnormality nor CSF outflow obstruction
• chronic headache (positional), tinnitus, overweight
• blurred vision with papilledema, diplopia (abducens nerve palsy)
• high opening pressure for LP
• need to rule out sinus venous thrombosis

Question 7

Chiari malformaion

Answer 7

• common syringomyelia in cervial SC
• tx: suboccipital craniectomy, C1 ring laminectomy
• occipital/upper cervical headache w. Valsalva
• neck/shoulder/back cape pain
• brainstem or SC dysfunction (urinary incontinence, CN dysfunction)
• ataxia, clumsy
• down-beating nystagmus, vision issues
• sleep apnea
• speech/swallow issues, diminished gag, vocal cord paralysis
• tinnitus, fluctuating hearing loss, vertigo, nausea

Question 8

Neuralgia (big example)

Answer 8

• Neuopathic pain, trigem neuralgia, occipital neuralgia, glossopharyngeal
• Trigem occurs usually in older adults, women>men, tx with anticonvulsants (carbamazepine), can arise from MS

Question 9

Temporal arteritis

Answer 9

Inflammatory arteritis of temporal artery

• hedahce, monocular vision loss (Irreversible), jaw claudication, loss of temporal artery pulse, systemic symptoms
• increased erythrocyte sedimentation rate (ESR)
• dx via temporal artery biopsy
• tx with steroids

Question 10

Cluster headaches

Answer 10

1-8 attacks/day

• can last for weeks or months
• attacks separated by remission periods usually lasting months/yrs
• maximal orbitally, supraorbitally, temporally
• restless/agitated
• excrutiating boring pain
• all ages
• more men than women
• men peak in 30’s, women peak in 20’s or 60’s
• no prodrome
• headaches last 15 min to hours
• can wake ppl out of sleep
• worse with smoking and EtOH
• hereditary
• acute tx with high flow O2
• prevent with verapamil
• circadian periodicity

Question 11

Paroxysmal hemicrania

Answer 11

Severe, unilateral orbital/supraorbital/temporal pain lasting 2-30 min and occurs several times/day.

• can be txed with indomethacin
• sharp/throbbing pain
• sometimes correlates with circadian rhythm

Question 12

SUNCT

Answer 12

3-200 attacks/dauy

• very short duration (Seconds)
• stabbing/burning pain
• no circadian periodicity