Headache I
This is the most common cause of thunderclap headaches
Subarachnoid hemorrhage (SAH)
If you suspect a thunderclap headache, this type of testing should be performed
CT Brain/Head without contrast
What are two treatment options for IIH
Weight loss, Acetazolamide, or Topiramate
You diagnose a patient with tension-type headache, what imaging should you order next
Don't
Chronic migraine is defined as being equal to or greater than this frequency
15 or more migraines per month for greater than 3 months
An elevation greater than this confirms idiopathic intracranial hypertension
250 mm H2O
Thunderclap headaches typically reach their maximum intensity within this amount of time
within 1 minute
List 3 risk factors for cervical artery dissection
Hypertension, migraine, polycystic kidney disease, and connective tissue disorders
This disease is characterized by recurrent thunderclap headache and multifocal constriction of intracranial vessels normalizing within 3 months of onset
Reversible cerebral vasoconstriction syndrome
What is the typical patient population affected by Idiopathic Intracranial Hypertension?
90% of affected persons are women of childbearing age with elevated BMI
Typical CSF findings for SAH
Erythrocyte count >10,000/microliter and an elevation in protein level
Second-line testing for a thunderclap headache if initial imaging is non-diagnostic
Lumbar puncture
Anticoagulation with warfarin for cerebral vein thrombosis is recommended for this length of time
3 to 6 months
When should imaging be repeated in reversible cerebral vasoconstriction syndrome
12 weeks
Trigeminal Neuralgia in individuals <50 should prompt workup for this other disease
Multiple sclerosis
List 3 of the 4 features that increase the risk of SAH
1. Age 40 years or older
2. Onset during exertion
3. Witnessed loss of consciousness
4. Concomitant neck pain
What three tests are recommended by MKSAP if you are obtaining an LP for a thunderclap headache?
Opening pressure, cell counts, and xanthochromia (testing for bilirubin in the CSF)
Name 4 findings of increased intracranial pressure according to MKSAP
Pain w/ Valsalva maneuver, pulsatile tinnitus, diplopia, papilledema, decreased mentation, seizures. *Will also accept Abducens (CN VI) nerve palsy
Medications indicated for reversible cerebral vasoconstriction syndrome (name both)
Verapamil and nimodipine
Treatment for migraines should be limited to this frequency to prevent migraine overuse headache
10 days per month
List 5 of the 9 "red flags" associated with headaches
1. First or worst headache
2. Abrupt onset or thunderclap attack
3. Progression or fundamental change in headache pattern
4. Abnormal physical exam findings
5. Neurological symptoms lasting longer than 1 hour
6. New headache in persons < 5yo or >50yo
7. New headache in patients with malignancy, coagulopathy, immunosuppression or pregnancy
8. Association w/ alteration in or loss of consciousness
9. Headache triggered by exertion, sexual activity or valsalva
List the 2 testing options which are third-line for patients with thunderclap headaches
MRA or CTA
In SAH, Xanthochromia takes 1) this long to develop and 2) is 100% sensitive between this time period
1) it takes 4 hours or more to develop
2) it is 100% sensitive between 12 hours and 7 days
What are the 5 International Headache Society criteria for Migraine without Aura
A. 5 or more attacks fulfilling B-D
B. Headache lasting 4-72 hours
C. At least 2 of the following 4 characteristics: Unilateral, pulsating, Moderate/sever limiting ADLs, worse with going up/down stairs or other similar physical activity
D. Nausea/Vomiting or Photophobia/Phonophobia
E. Headache is not caused by another ICHD-3 diagnosis
Name 5 acute migraine treatment options and their dosages
See table 8