©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
Nurs 5462 Headache Exam Study Guide.
• Primary headache - Answers✔common and is not a symptom of another medical condition •
Migraine • Tension-type • Cluster
Secondary Headache - Answers✔specific etiologies-and sx depend on these pathologies
Gender differences - Answers✔migraine/tension/Giant Cell Arteritis-more common in women.
Cluster more common in men
Onset over 50 - Answers✔or worsening headache check for underlying neurological disease,
17% of older adults report frequent headche
Headache Needing Investigation - Answers✔• Sudden onset of new, severe headache •
Progressively getting worse • After exertion, straining, coughing, or sex-suggests inc ICP-needs
CT • With associated symptoms - "worst headache I have ever had" • First headache occurring
after the age of 50 years
Cortical Spreading Depression - Answers✔• Basis of the migraine aura • Cortical neuronal
activity followed by a postictal depression of neuronal firing • CSD can trigger meningeal pain
mechanisms via neurogenic inflammation, vasodilation and plasma extravasation • Blood barrier
is activated—which may explain some of the pain • Glutamatergic synapses in the cortex are
activated
Brain Stem Generator - Answers✔• Meningeal pain mechanisms are activated through the
trigeminovascular pathways • This causes release of inflammatory cytokines, neuroinflammatory
peptides and calcitonin gene-related peptide—this hormone causes the vasodilation • Peripheral
nociceptors are activated—this mechanism is referred to as peripheral sensitization • When the
trigeminal nucleus caudalis and rostral brain structures are activated—it is known as central
sensitization
Clinical Presentation: Migraine - Answers✔• Migraine without aura • Common migraine • Most
common headache • One sided headache • Pounding/throbbing • Moderate to severe intensity •
Lasts 4-24 hours, May be associated with nausea, vomiting, sensitivity to light or sound
Clinical Presentation: Migraine (aura) - Answers✔• Aura usually occurs before onset of
headache • Auras usually last seconds, but can last up to 20", patient then gets headache •
, ©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
"Fortification spectrum" occurs in 10% [Jagged lines similar to stone fortifications around a
fort], • Visual auras can be spots, shimmering bright lights or visual loss [scotomas] • Sensory
auras include tingling, numbness of fingers, motor disturbances such as hemiparesis or
monoparesis and cognitive disorders
"prodrome" to a migraine - Answers✔• Increased irritability, decreased energy, food cravings •
A signal that a headache is coming and may allow patient to use methods to abort the headache
IHS Criteria for Migraine without Aura - Answers✔A At least 5 attacks fulfilling criteria B
through D B Headache lasting 4-72 hrs. [treated or untreated] C Headache has at least 2 of the
following: Unilateral location Pulsating quality Moderate to severe intensity Worse with walking
stairs or physical activity D During headache, at least one of the following: Nausea, vomiting [or
both] Photophobia and/or phonophobia E No evidence of related organic disease
IHS Criteria for Migraine with Aura - Answers✔A At least 2 attacks fulfilling criterion B: B At
least 3 of the following characteristics: One or more fully reversible aura symptoms At least 1
aura symptom develops gradually over >4" or 2 or more symptoms occur in succession No single
aura symptoms lasts >60" Headache follows aura with a free interval of <60" C No evidence of a
secondary cause
*MgSO4 [with aura] 1-2 grams IV
Clinical Presentation: Tension-Type Headache - Answers✔• Feeling like a tight band is around
head • Nausea/vomiting are not present • Mild to moderate intensity • Can last minutes to hours •
Not increased with physical activity, present most of the day and may start after patient wakes up
[Does not wake patient at night], stress is common trigger, most common in older adult and Gen
pop-78% incidence
• Chronic tension-type headache - Answers✔similar, but occurs more than 15 days a month
IHS Criteria for Tension-Type Headache - Answers✔Criteria A At least 10 previous headaches
fulfilling criteria B through D B Headache lasts 30" to 7 days C At least 2 of the following:
Pressing/tightening [nonpulsating] quality Mild to moderate intensity Bilateral No aggravation
by walking stairs or other physical activity D Both of the following: Absence of nausea and
vomiting Absence of photophobia and phonophobia
Clinical Presentation: Cluster - Answers✔• Patient usually awakened at night with severe,
unilateral, retro-orbital pain • Headache reaches maximum intensity in 15 minutes, lasts about 90
minutes, but can last up to 3 hours • Attacks occur several times during the day • Boring pain,
severe, Lacrimation, rhinorrhea and a partial Horner's syndrome can be seen-ipsilateral
•Chronic Cluster Headache - Answers✔•Same presentation, but remission does not last more 14
days • Resistant to treatment •ETOH precipitates attacks
ALL RIGHTS RESERVED.
Nurs 5462 Headache Exam Study Guide.
• Primary headache - Answers✔common and is not a symptom of another medical condition •
Migraine • Tension-type • Cluster
Secondary Headache - Answers✔specific etiologies-and sx depend on these pathologies
Gender differences - Answers✔migraine/tension/Giant Cell Arteritis-more common in women.
Cluster more common in men
Onset over 50 - Answers✔or worsening headache check for underlying neurological disease,
17% of older adults report frequent headche
Headache Needing Investigation - Answers✔• Sudden onset of new, severe headache •
Progressively getting worse • After exertion, straining, coughing, or sex-suggests inc ICP-needs
CT • With associated symptoms - "worst headache I have ever had" • First headache occurring
after the age of 50 years
Cortical Spreading Depression - Answers✔• Basis of the migraine aura • Cortical neuronal
activity followed by a postictal depression of neuronal firing • CSD can trigger meningeal pain
mechanisms via neurogenic inflammation, vasodilation and plasma extravasation • Blood barrier
is activated—which may explain some of the pain • Glutamatergic synapses in the cortex are
activated
Brain Stem Generator - Answers✔• Meningeal pain mechanisms are activated through the
trigeminovascular pathways • This causes release of inflammatory cytokines, neuroinflammatory
peptides and calcitonin gene-related peptide—this hormone causes the vasodilation • Peripheral
nociceptors are activated—this mechanism is referred to as peripheral sensitization • When the
trigeminal nucleus caudalis and rostral brain structures are activated—it is known as central
sensitization
Clinical Presentation: Migraine - Answers✔• Migraine without aura • Common migraine • Most
common headache • One sided headache • Pounding/throbbing • Moderate to severe intensity •
Lasts 4-24 hours, May be associated with nausea, vomiting, sensitivity to light or sound
Clinical Presentation: Migraine (aura) - Answers✔• Aura usually occurs before onset of
headache • Auras usually last seconds, but can last up to 20", patient then gets headache •
, ©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
"Fortification spectrum" occurs in 10% [Jagged lines similar to stone fortifications around a
fort], • Visual auras can be spots, shimmering bright lights or visual loss [scotomas] • Sensory
auras include tingling, numbness of fingers, motor disturbances such as hemiparesis or
monoparesis and cognitive disorders
"prodrome" to a migraine - Answers✔• Increased irritability, decreased energy, food cravings •
A signal that a headache is coming and may allow patient to use methods to abort the headache
IHS Criteria for Migraine without Aura - Answers✔A At least 5 attacks fulfilling criteria B
through D B Headache lasting 4-72 hrs. [treated or untreated] C Headache has at least 2 of the
following: Unilateral location Pulsating quality Moderate to severe intensity Worse with walking
stairs or physical activity D During headache, at least one of the following: Nausea, vomiting [or
both] Photophobia and/or phonophobia E No evidence of related organic disease
IHS Criteria for Migraine with Aura - Answers✔A At least 2 attacks fulfilling criterion B: B At
least 3 of the following characteristics: One or more fully reversible aura symptoms At least 1
aura symptom develops gradually over >4" or 2 or more symptoms occur in succession No single
aura symptoms lasts >60" Headache follows aura with a free interval of <60" C No evidence of a
secondary cause
*MgSO4 [with aura] 1-2 grams IV
Clinical Presentation: Tension-Type Headache - Answers✔• Feeling like a tight band is around
head • Nausea/vomiting are not present • Mild to moderate intensity • Can last minutes to hours •
Not increased with physical activity, present most of the day and may start after patient wakes up
[Does not wake patient at night], stress is common trigger, most common in older adult and Gen
pop-78% incidence
• Chronic tension-type headache - Answers✔similar, but occurs more than 15 days a month
IHS Criteria for Tension-Type Headache - Answers✔Criteria A At least 10 previous headaches
fulfilling criteria B through D B Headache lasts 30" to 7 days C At least 2 of the following:
Pressing/tightening [nonpulsating] quality Mild to moderate intensity Bilateral No aggravation
by walking stairs or other physical activity D Both of the following: Absence of nausea and
vomiting Absence of photophobia and phonophobia
Clinical Presentation: Cluster - Answers✔• Patient usually awakened at night with severe,
unilateral, retro-orbital pain • Headache reaches maximum intensity in 15 minutes, lasts about 90
minutes, but can last up to 3 hours • Attacks occur several times during the day • Boring pain,
severe, Lacrimation, rhinorrhea and a partial Horner's syndrome can be seen-ipsilateral
•Chronic Cluster Headache - Answers✔•Same presentation, but remission does not last more 14
days • Resistant to treatment •ETOH precipitates attacks
