Red flags to look for regarding headaches in adults? Right Ans - Rapid
onset with severe intensity ( thunderclap) headache. Fever, vision changes,
neck stiffness, HTN, mental status changes motor and sensory deficits.
What is the OTTAWA SAH clinical decision rule? Right Ans - provides 100%
sensitivity in predicting subarachnoid hemorrhage.
40 years or older
Neck pain/ stiffness
witnessed LOC
onset during exertion
thunderclap headache
limited neck flexion
Essentials of diagnosis for migraines? Right Ans - Pain is typically
unilateral, lasting 4-72 hours. Aggravated by routine physical activity,
pulsatile, nausea, photophobia, and phonophobia
symptomatic therapy for migraines? Right Ans - rest in quiet dark room,
analgesics, Ergotamines- cafergot, triptans- sumatriptan, eletriptan,
frovatriptan
What is a migraine aura? Right Ans - focal disturbance of neurological
function that may precede migraine IE: visual disturbances, aphasia,
numbness, paresthesia, clumsiness
Symptoms of tension type headache? Right Ans - Pt may complain of vise
like or tight pressure, constant daily HA, pain is non pulsatile, pain is not
associated with focal neuro symptoms or auras. Pain is most intense in back of
neck/ head. May be stress induced
What medication class is not recommended for tension type headache?
Right Ans - Triptans
What symptoms are associated with cluster headaches? Right Ans - Severe
unilateral periorbital pain, accompanied by 1 or more of the following
ipsilateral nasal congestion, rhinorrhea, lacrimation, redness of the eye
, How long do cluster headaches typically last? Right Ans - Typically occur at
night and self resolve in 15 minutes- 3 hours
What is the first line medication for cluster headaches? Right Ans -
Sumatriptan
What medications are used prophylactically for cluster headaches? Right
Ans - lithium, verapamil, topiramate
How are cluster headaches distinguished from other trigeminal autonomic
cephalgias? Right Ans - Different attack duration and frequency, and their
response to indomethacin
What is the treatment for post traumatic headaches? Right Ans - Simple
analgesics
How long must you take analgesics before analgesic rebound headaches
occur? Right Ans - Ergotamines, triptans, medications containing butalbital
and opioids- 10 days or more a month
Acetaminophen, acetylsalicylic acid and NSAIDS 15 days or more a month.
Key feature of intracranial mass? Right Ans - new or worsening headache
in middle or later in life, worse when lying down, awakens patient at night, or
peaks in the morning
What is trigeminal neuralgia? Right Ans - A nerve disorder affecting the
2nd and 3rd trigeminal nerve that causes sudden facial pain near one side of
the mouth that shoots towards the ear, eye, or nostril on the same side
What should you suspect if your patient is less than 40 and has trigeminal
neuralgia with no other presenting symptoms? Right Ans - Multiple
sclerosis
1st line treatment for trigeminal neuralgia? Right Ans - Oxcarbazepine and
carbamazepine
phenytoin if other meds are not tolerated
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