Minicase - HA

Question 1

W/u for migraine (4)

Answer 1

1. MRI brain (intracranial neoplasm)
2. CT head
3. CBC
4. ESR

Question 2

W/u for cluster headache (4)

Answer 2

1. MRI brain (intracranial neoplasm)
2. CT head
3. CBC
4. ESR

Question 3

W/u for temporal arteritis (6)

Answer 3

1. temporal artery biopsy
2. ESR (temporal arteritis)
3. CRP (temporal arteritis)
4. CBC
5. doppler U/S-carotid
6. MRI brain (intracranial neoplasm)

Question 4

W/u for acute sinusitis (3)

Answer 4

1. CBC
2. XR sinus
3. CT sinus
   (ddx inccludes tension headache, meningitis in which case you’d want the meningitis w/u below)

Question 5

W/u for tension HA (4)

Answer 5

1. lytes
2. CBC
3. MRI brain (neoplasm)
4. LP w/ CSF analysis (pseudotumor cerebri w/ openig pressure)

Question 6

W/u for SAH (8)

Answer 6

1. CT head w/o contrast
2. LP w/ CSF analysis and opening pressure
3. CBC
4. PT/PTT/INR
5. Urine toxicology
6. Digital subtraction angiography
7. MRI brain
8. CT angiography

Question 7

W/u for meningitis (6)

Answer 7

1. LP w/ CSF analysis, opening pressure, gram stain, PCR, culture)
2. BCx
3. CBC
4. CT head w/o contrast (SAH, intracranial abscess)
5. MRI brain
6. PT/PTT/INR (SAH)

Question 8

W/u for pseudotumor cerebri (6)

Answer 8

1. Urine hCG
2. LP w/ CSF analysis and opening pressure
3. dilated fundoscopy examination
4. funduscopic eye exam
5. MRI brain (intracranial neoplasm)
6. visual field testing

Question 9

W/u for trigeminal neuralgia

Answer 9

1. MRI brain
2. CBC
3. ESR
   (ddx includes: cluster HA, TMJ disorder, temporal arteritis)

Question 10

Migraine hx findings (7)

Answer 10

1. HA
2. episodic
3. throbbing nature
4. unilateral
5. duration (hours to days, I think)
6. neurologic symptoms (N/V, aura, photophobia)
7. alleviation by rest/dark room

Question 11

Cluster hx findings (6)

Answer 11

1. HA
2. gender and age- young male
3. unilateral
4. rhinorrhea, eye tearing and redness
5. episodic and same time at night
6. duration (~45 min)

Question 12

Tension hx findings (5)

Answer 12

1. HA
2. bilateral
3. squeezing nature
4. episodic
5. associated with stress

Question 13

Temporal arteritis hx findings (10, exam included as 1)

Answer 13

1. HA
2. elderly
3. episodic
4. unilateral
5. blurred vision
6. temporal location
7. weight loss
8. jaw pain when chewing
9. shoulder, hip pain
10. Exam: temporal TTP, reduced visual acuity

Question 14

Acute sinusitis hx findings (6)

Answer 14

1. HA
2. frontal HA
3. fever
4. nasal dicharge
5. worsen when bend forward
6. hx of allergies

Question 15

SAH hx findings (7)

Answer 15

1. HA
2. severe
3. acute
4. vomiting
5. confusion/AMS
6. FNDs (hemiplegia)
7. nuchal rigidity

Question 16

Meningitis hx findings (6)

Answer 16

1. HA
2. confusion
3. photophobia
4. high fever
5. nuchal rigidity
6. consider exposures (dorms, army, etc)

Question 17

Pseudotumor cerebri hx findings (8)

Answer 17

1. HA
2. obesity
3. female gender
4. blurred vision
5. pulsatile in nature
6. N/V
7. OCP use
8. frequency - daily for 2-3 wks

Question 18

Trigeminal neuralgia hx findings

Answer 18

1. HA
2. elderly
3. unilateral
4. cheek location
5. triggered by touch
6. frequency - daily for month
7. duration - 1-2 minutes
8. stabbing and electric character

Question 19

What is TMJ (temporomandibular joint) disorder?

Answer 19

• TMJ joint dysfunction
• crepitus with jaw movement
• pain with chewing

Question 20

HA hx question nemonnic

Answer 20

1. OPQRST
2. AT&T WIRELESS

A - aura
T - timing (in OPQRST)
N - N/V
T - tearing, eye symptoms
W - wt loss
I - injury
E - estrogen exposure (OCPs)
L - leg (jt) pain
E - energy level (consititutional symptoms)
S - stress
S - speech difficulties

Question 21

Basic HA differential (9)

Answer 21

1. migraine
2. tension
3. cluster
4. pseudotumor cerebri
5. sinusitis
6. meningitis
7. temporal arteritis
8. SAH
9. intracranial mass