QUESTIONS WITH VERIFIED ANSWERS
ALREADY GRADED A BY EXPERTS
What are some secondary causes of headache? - CORRECT ANSWER>>>>-
Glaucoma
-Meningitis
-Preeclampsia/eclampsia
-Temporal arteritis
-Shingles
-Tumor
-Bleeds/hemorrhage
True or False: Most headaches are benign - CORRECT ANSWER>>>>True
-Most common type of headache
-Patho/Etiology: multifactorial, genetics, muscle tension, stress, minor trauma to
the head or neck, dehydration, fatigue
-Clinical Manifestations: bilateral, nonpulsatile, band-like head pain, mild to
moderate intensity, described as an "ache", "pressing" or "tight", tenderness of the
face, head, shoulder and upper back muscles
-Pain may be episodic or chronic
-Episodic: lasting 30min- 7 days, without nausea or vomiting, occurring 1-14 days
per month
-Chronic: on 15 or more days per month, lasting hours to days
-Labs/Diagnostics: clinical diagnosis
-Treatment/Plan:
•Acute: NSAIDs (Ibuprofen- Advil, Motrin) 200mg or 400mg
Naproxen (Aleve)
•Acetaminophen (Tylenol) only option in the pregnant patient
•Muscle tension: heat, muscle relaxants, physical therapy and stress reduction
•Severe: IM ketorolac
•Alternative: massage, relaxation, stress management
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,•Prevention (chronic): amitriptyline - CORRECT ANSWER>>>>Tension
headache
What should you think if someone says "this is the worst headache of my life" or
thunderclap headache? - CORRECT ANSWER>>>>Subarachnoid headache
Which type of headache is most common? - CORRECT ANSWER>>>>Tension
headache
What are some causes of tension headaches? - CORRECT ANSWER>>>>-Stress*
-Muscle tension
-Minor trauma to head or neck
-Dehydration
What are the symptoms of a tension headache? - CORRECT ANSWER>>>>-
Bilateral, non pulsatile, "band-like" head pain*
-Can be mild to moderate intensity*
-Described as an "ache", "pressing" or "tight"
-Tenderness of the face, head, shoulders, and upper back muscles
Episodic vs chronic tension headache - CORRECT ANSWER>>>>Episodic:
-Lasting 30 mins to 7 days without nausea or vomiting and occurring 1-14
days/month
Chronic:
-Lasting hours to days and occurring 15 or more days per month
What are the labs and diagnostics for tension headaches? - CORRECT
ANSWER>>>>Clinical diagnosis
What is the treatment/plan for tension headaches? - CORRECT
ANSWER>>>>Acute
-NSAIDs: Ibuprofen (Advil, Motrin) 200mg or 400mg
•Naproxen (Aleve)*
•Acetaminophen (Tylenol) only option in the pregnant patient
•Muscle tension: heat, muscle relaxants, physical therapy and stress reduction
•Severe: IM ketorolac
•Alternative Treatment
•Massage
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, •Relaxation and stress management
Prevention (Chronic)
•Amitriptyline
What is administered via intramuscular injection to treat severe tension headaches?
- CORRECT ANSWER>>>>Ketorolac
What is given to treat chronic tension headaches/prevent them? - CORRECT
ANSWER>>>>Amitriptyline
Type of headache:
-Attacks may happen up to 8x daily and are short in duration
-Epidemiology: <1% of headaches, males >females, middle age
-Patho/Etiology: "hypothalamic activation with secondary activation of the
trigeminal-autonomic reflex, probably via a trigeminal-hypothalamic pathway"
UpToDate
-Triggers: alcohol, stress, glare
-Clinical manifestations: unilateral, periorbital, ipsilateral: increased lacrimation,
conjunctival injection, rhinorrhea, nasal congestion, ptosis, miosis
-Symptoms may wake patient
-Cluster: attacks 8x daily for 6-12 weeks, attacks lasting about 15-180 minutes
-Labs/Diagnostics:
•Mostly a clinical diagnosis based on criteria
•MRI of the brain with and without contrast
-Treatment/Plan:
•Acute/Abortive, 1st line: 100% oxygen and/or triptan
•Preventive: Verapamil daily,
•Also consideration for oral steroids: 5 days after an attack to prevent the next one
- CORRECT ANSWER>>>>Cluster headache
What can trigger a cluster headache? - CORRECT ANSWER>>>>-Alcohol
-Stress
-Glare
Cluster headaches are caused by "hypothalamic activation with secondary
activation of the ________-autonomic reflex, probably via a ________-
hypothalamic pathway" - CORRECT ANSWER>>>>Trigeminal
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