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Neurology 2014-15
• A headache which your history and physical exam suggests is
due to the headache condition itself and not a separate cause.
While they are likely triggered by genetic, developmental, and
environmental factors, they are “idiopathic” in the sense that
they do not arise from another underlying disease.
• Symptoms
• bilateral
• band-like
• dull
• worse with activity
• age 20-50
• Treatment
• NSAIDS or Tylenol
• Symptoms
• unilateral
• Pulsating
• moderate to severe
• lasts 4-72 hours
• worse with activity
• may have aura, nausea and/or vomiting, photophobia and
photophobia
• often triggered by stress/foods/alcohol/sleep deprivation
• Treatment
• Acute setting: sumatriptan, DHE
• Earlier treatment delivery is associated with better outcomes.
• Prophylaxis: beta-blockers, calcium channel blockers, amtriptyline,
nortriptyline
• Symptoms
• unilateral
• stabbing
• retro-orbital
• lasts 15 minutes to 3 hours
• ipsilateral lacrimation, ptosis, nasal congestion, rhinnorrhea
• Patients are M>F, age 20-30
• Treatment
• 100% oxygen or low-dose prednisone
• A secondary headache is a headache that is
present because of another condition (such as a
sinus headache from sinusitis). They are less common
than primary headaches.
• Diagnosis
• noncontrast head CT
• lumbar puncture (RBCs and xanthochromia)
• Treatment
• neurosurgical evaluation
• calcium channel blocker (nimodipine) to prevent vasospasm
• blood pressure control (MAP <110 for unsecured aneurysm, <130 for
coiled/clipped aneurysm)
• Symptoms
• unilateral
• temporal
• associated with jaw claudication
• temporal artery tenderness to palpation
• Diagnosis
• ESR >50
• temporal artery biopsy
• often associated with polymyagia rheumatica
• Treatment
• steroids
• do not delay steroids for biopsy!
• can lead to blindness if not treated early
• Symptoms
• unilateral facial pain
• episodic, severe, shooting
• Lasts seconds to minutes
• Often triggered by light touch, cold air, chewing
• hemifacial spasm: “tic douloureux”
• One, two, or three branches of the facial nerve may be affected; usually
V2-3; (10% are bilateral)
• Treatment
• carbamazepine
• second line treatments are also in the AED family: lamotrigine,
oxcarbazepine, phenytoin, gabapentin
• Meningitis
• Intracranial Neoplasm
• Pseudotumor cerebri
• New onset of headache or new pattern of headache and age
> 40
• Focal signs or symptoms occurring with the headache, including
auras
• Headaches worse with valsalva or worse in the laying down
position (venous sinus thrombosis, intracranial hypertension)
• Headaches associated with severe vomiting
• obese patient with intractable headaches or papilledema
(pseudotumor)
• focal neurologic signs or symptoms or MRI findings needing
cytological diagnosis (malignancy)
• subarachnoid hemorrhage older than 6 hours
• A 65 y/o gentleman presents to his PCP with
headache and transient “funny vision” in the R eye.
Headache was in the right-sided, intermittent, pressure
pain, started 2 weeks ago, progressively worse. He
never had similar headache in the past. Also felt
fatigue recently and had a low grade fever. Two days
ago, he had an episode of right temporal vision loss
for about 10 mins. Today, he had another similar
episode for about 15 mins.