Headache Diagnosis and Management
49 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the definition of a headache, or cephalalgia, according to the text?

  • Diffuse pain in various parts of the head, not confined to the area of distribution of a nerve (correct)
  • Sharp, localized pain in a specific area of the head
  • Pain confined to the area of distribution of a nerve
  • Pain that occurs only in the forehead region

    • What percentage of young women experienced headache during a 12-month period according to the text?

  • 80 percent
  • 50 percent
  • 60 percent
  • 95 percent (correct)

    • What are the two categories into which headaches are divided for evaluation and management?

  • Acute and chronic
  • Benign and malignant
  • Primary and secondary (correct)
  • Vascular and non-vascular

    • What is the estimated annual cost associated with missed workdays and medical benefits due to headaches in the American industry?

    <p>$50 billion</p> Signup and view all the answers

    What is the typical age range for the onset of most primary headache disorders?

    <p>Childhood or between 20 and 50 years of age</p> Signup and view all the answers

    When does the onset of headache after 50 years of age raise concern for secondary headache disorders?

    <p>Temporal arteritis or mass lesions</p> Signup and view all the answers

    What is necessary for careful evaluation of new-onset headache in adults?

    <p>Neuroimaging and/or cerebrospinal fluid (CSF) analysis</p> Signup and view all the answers

    What may the sudden onset of headache indicate?

    <p>Subarachnoid hemorrhage, pituitary apoplexy, or hemorrhage into a mass lesion or vascular malformation</p> Signup and view all the answers

    What requires thorough evaluation in a patient with new-onset headache?

    <p>Risk factors for HIV infection or cancer metastasis</p> Signup and view all the answers

    What may focal neurologic signs or symptoms of systemic illness indicate?

    <p>A serious condition</p> Signup and view all the answers

    Why is it crucial to determine whether the current episode of headache is typical if the patient routinely experiences headaches?

    <p>To identify potential life-threatening secondary disorders</p> Signup and view all the answers

    How can symptoms experienced before and during the headache help in the evaluation?

    <p>Identify primary headache disorders or potentially life-threatening secondary disorders</p> Signup and view all the answers

    Why are questions about the time and nature of headache onset essential?

    <p>In identifying secondary headache disorders</p> Signup and view all the answers

    What is important in distinguishing between different types of headaches?

    <p>Determining the location and radiation of pain</p> Signup and view all the answers

    What should be considered in patients over 50 with acute headache and elevated ESR?

    <p>Temporal arteritis</p> Signup and view all the answers

    When is CSF analysis needed for patients with acute headache?

    <p>When they have red flags and normal neuroimaging</p> Signup and view all the answers

    What percentage of patients had CT scans ordered in the evaluation of headaches?

    <p>3%</p> Signup and view all the answers

    What were the main reasons for ordering CT scans in the evaluation of headaches?

    <p>Suspected tumor (49%) or subarachnoid hemorrhage (9%)</p> Signup and view all the answers

    What led to 17% of CT scans in the evaluation of headaches?

    <p>Patient expectations and medicolegal concerns</p> Signup and view all the answers

    What is preferred to rule out subarachnoid hemorrhage within the first 48 hours?

    <p>Lumbar puncture</p> Signup and view all the answers

    What is more sensitive than CT in identifying intracranial changes?

    <p>MRI</p> Signup and view all the answers

    When should neuroimaging be considered in patients?

    <p>With unexplained abnormal findings on neurologic exam</p> Signup and view all the answers

    What factors should be considered when ordering CT or MRI for evaluation of headaches?

    <p>Need to identify acute hemorrhage and posterior fossa evaluation</p> Signup and view all the answers

    What percentage of CT scans were ordered due to suspected tumor in the evaluation of headaches?

    <p>49%</p> Signup and view all the answers

    What should be considered in patients with unexplained abnormal findings on neurologic exam?

    <p>Neuroimaging</p> Signup and view all the answers

    Which type of headache is strictly unilateral?

    <p>Cluster headache</p> Signup and view all the answers

    What can trigger drug-rebound and nonspecific headaches?

    <p>Caffeine-containing analgesics</p> Signup and view all the answers

    Which condition makes patients more likely to have an organic cause of their headaches?

    <p>HIV</p> Signup and view all the answers

    What type of headache can trauma, such as head injuries, trigger?

    <p>Migraine</p> Signup and view all the answers

    What is essential to identify causes of secondary headaches?

    <p>Physical examination</p> Signup and view all the answers

    What should prompt additional evaluation in the context of headaches?

    <p>Papilledema</p> Signup and view all the answers

    What should be investigated further for secondary headache disorders?

    <p>Unilateral loss of sensation</p> Signup and view all the answers

    What type of headache is usually bilateral and band-like?

    <p>Tension-type headache</p> Signup and view all the answers

    What can be indicative of specific underlying conditions, such as temporal arteritis?

    <p>The type of pain described by the patient</p> Signup and view all the answers

    What is limited laboratory testing performed for when temporal arteritis is a possibility?

    <p>Complete blood count</p> Signup and view all the answers

    What is essential to diagnose migraine without aura and migraine with aura?

    <p>Characteristics such as duration, pain intensity, and associated symptoms</p> Signup and view all the answers

    What may be performed when systemic or intracranial infection is suspected?

    <p>Complete blood count</p> Signup and view all the answers

    What is the preferred imaging modality to rule out hemorrhage in the evaluation of acute headaches?

    <p>Noncontrast CT scan</p> Signup and view all the answers

    When abnormal findings are observed during a neurologic examination, what is warranted to rule out intracranial pathology?

    <p>CT scan</p> Signup and view all the answers

    In the evaluation of acute headaches, what can help to confirm or rule out hemorrhage, infection, tumor, and disorders related to CSF hypertension or hypotension?

    <p>Cerebrospinal fluid (CSF) analysis</p> Signup and view all the answers

    For which type of imaging is MRI necessary, but it is more expensive and less widely available than CT scanning in the evaluation of acute headaches?

    <p>MRI</p> Signup and view all the answers

    What is the appropriate course of action for patients with headaches that are difficult to diagnose, worsen, or fail to respond to management?

    <p>Refer for further evaluation</p> Signup and view all the answers

    Which type of headache disorders are usually recurrent without organic disease as their cause?

    <p>Migraine, tension-type, and cluster headaches</p> Signup and view all the answers

    What is crucial to determining the etiology of a headache in the evaluation of acute headaches?

    <p>Detailed headache history</p> Signup and view all the answers

    What can a thorough headache history facilitate in the evaluation of acute headaches?

    <p>Generation of a differential diagnosis</p> Signup and view all the answers

    What question is essential to identify red flags that suggest an underlying organic disorder as the cause of headache?

    <p>Is this your first or worst headache?</p> Signup and view all the answers

    What is the preferred imaging modality to rule out subarachnoid hemorrhage within the first 48 hours?

    <p>Noncontrast CT scan</p> Signup and view all the answers

    What are primary headache disorders usually recurrent with, without organic disease as their cause?

    <p>Migraine, tension-type, and cluster headaches</p> Signup and view all the answers

    What is necessary for careful evaluation of new-onset headache in adults?

    <p>Thorough neurologic examination</p> Signup and view all the answers

    Study Notes

    Diagnosis and Management of Headaches

    • Different types of headaches can be indicative of specific underlying conditions, such as temporal arteritis, trigeminal neuralgia, or acute glaucoma.
    • The quality of the pain described by the patient can help classify the headache as migraine, tension-type, or cluster headaches.
    • Patients with concurrent medical conditions like HIV, cancer, or hypertension are more likely to have an organic cause of their headaches, such as CNS lymphoma or intracranial vascular disorders.
    • Medications, including over-the-counter ones and caffeine-containing analgesics, can trigger drug-rebound and nonspecific headaches.
    • Trauma, such as head injuries or medical procedures like lumbar puncture, can trigger migraines and cluster headaches.
    • Diagnostic criteria for migraine without aura and migraine with aura are based on characteristics such as duration, pain intensity, and associated symptoms like nausea and photophobia.
    • Cluster headaches are strictly unilateral, while tension-type headaches are usually bilateral and band-like.
    • The physical examination is essential to identify causes of secondary headaches, targeting areas identified as abnormal during the headache history.
    • Red flags for serious problems, such as focal neurologic findings and papilledema, should prompt additional evaluation.
    • Specific findings, including unilateral loss of sensation and hyperreflexia, should prompt further investigation for secondary headache disorders.
    • Limited laboratory testing, such as a complete blood count or erythrocyte sedimentation rate, may be performed when systemic or intracranial infection is suspected or when temporal arteritis is a possibility.
    • Historical and physical findings considered red flags offer the best means of identifying a secondary headache disorder, prompting additional evaluation.

    Evaluation of Acute Headaches in Adults

    • "Red flags" for secondary disorders include sudden onset of headache, onset after 50 years of age, increased frequency or severity, new onset with underlying medical condition, headache with concomitant systemic illness, focal neurologic signs or symptoms, papilledema, and headache subsequent to head trauma.
    • A thorough neurologic examination should be performed, with abnormal findings warranting neuroimaging to rule out intracranial pathology.
    • Noncontrast CT scan is the preferred imaging modality to rule out hemorrhage, followed by lumbar puncture if the CT scan is normal.
    • MRI reveals more detail and is necessary for imaging the posterior fossa, but it is more expensive and less widely available than CT scanning.
    • Cerebrospinal fluid (CSF) analysis can help to confirm or rule out hemorrhage, infection, tumor, and disorders related to CSF hypertension or hypotension.
    • Referral is appropriate for patients with headaches that are difficult to diagnose, worsen, or fail to respond to management.
    • Primary headache disorders include migraine, tension-type, and cluster headaches and are usually recurrent without organic disease as their cause.
    • Acute secondary headache disorders can be associated with head trauma, vascular disorders, nonvascular intracranial disorders, substance use or withdrawal, noncephalic infection, and metabolic disorders.
    • A thorough headache history is crucial to determining the etiology of a headache, as most patients with headache have normal neurologic and general physical examinations.
    • A detailed headache history facilitates the generation of a differential diagnosis and preliminary classification of the headache type based on the criteria established by the International Headache Society.
    • The question “Is this your first or worst headache?" is essential to identify red flags that suggest an underlying organic disorder as the cause of headache.
    • This article is part of a series coordinated by the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md., with guest editors Francis G. O’Connor, LTC, MC, USA, and Jeannette E. South-Paul, COL, MC, USA.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    "Diagnosis and Management of Headaches" quiz covers the evaluation and classification of different types of headaches, including migraine, tension-type, and cluster headaches. It delves into the red flags for secondary disorders, appropriate imaging modalities, and the importance of a thorough headache history and physical examination. This quiz is essential for healthcare professionals seeking to enhance their knowledge and skills in diagnosing and managing acute headaches in adults.

    More Like This

    T1 L24: Headaches and migraines, 04/12/23, JG
    26 questions

    T1 L24: Headaches and migraines, 04/12/23, JG

    ProlificSynergy avatar
    ProlificSynergy
    Headache Definition and Analysis
    18 questions

    Headache Definition and Analysis

    ConvincingEllipse avatar
    ConvincingEllipse
    Headache Diagnosis and Symptoms
    16 questions

    Headache Diagnosis and Symptoms

    IntelligentHeather avatar
    IntelligentHeather
    Headache Classification Criteria
    25 questions

    Headache Classification Criteria

    AdvantageousCornflower avatar
    AdvantageousCornflower
    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser