Headache Evaluation and Diagnosis Quiz
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Questions and Answers

Which of the following is a less common acute primary headache disorder?

  • Benign exertional headache (correct)
  • Tension-type headache
  • Cluster headache
  • Migraine with aura

    • What is the primary task of the family physician in evaluating headaches?

  • Managing cluster headaches
  • Diagnosing migraine with aura
  • Identifying tension-type headaches
  • Ruling out potentially life-threatening causes (correct)

    • According to the text, who coordinates the series of articles on 'Problem-Oriented Diagnosis'?

  • Department of Neurology at the Uniformed Services University of the Health Sciences
  • International Headache Society
  • Cephalalgia Committee
  • Department of Family Medicine at the Uniformed Services University of the Health Sciences (correct)

    • Which publication is the text adapted from for the classification and diagnostic criteria for headache disorders?

    <p>Cephalalgia 1988</p> Signup and view all the answers

    What is the preferred imaging modality to identify acute hemorrhage?

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

    Which imaging modality is generally more available?

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

    What is the percentage of abnormalities noted on CT scans that potentially benefit from neurosurgical intervention?

    <p>0.01 percent</p> Signup and view all the answers

    According to the U.S. Headache Consortium guidelines, when should neuroimaging be considered in patients with non-acute headache?

    <p>When there is an unexplained abnormal finding on the neurologic examination</p> Signup and view all the answers

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

    <p>CT scanning without contrast medium, followed by lumbar puncture if the scan is negative</p> Signup and view all the answers

    What does xanthochromia in the CSF indicate?

    <p>A relatively recent hemorrhage</p> Signup and view all the answers

    What is the significance of lumbar puncture in assessing the CSF?

    <p>Useful for assessing the CSF for blood, infection, and cellular abnormalities</p> Signup and view all the answers

    According to the National Headache Foundation, what is the role of EEG in the evaluation of headaches?

    <p>Not been shown to effectively identify headache subtypes or headaches caused by structural defects</p> Signup and view all the answers

    What is the CSF pressure associated with headaches related to CSF hypotension?

    <p>Less than 90 mm of water</p> Signup and view all the answers

    According to the National Headache Foundation, when is routine use of EEG in the evaluation of headaches warranted?

    <p>It is not warranted</p> Signup and view all the answers

    What are the Grade A recommendations of the U.S. Headache Consortium based on?

    <p>Multiple, well-designed, randomized clinical trials and a consistent relevant pattern of findings</p> Signup and view all the answers

    When is lumbar puncture preferred according to the text?

    <p>To rule out subarachnoid hemorrhage if the CT scan is negative</p> Signup and view all the answers

    Which type of headache is usually recurrent and has no organic disease as its cause?

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

    What is a red flag for consideration of a secondary headache disorder?

    <p>Onset of headache after 50 years of age</p> Signup and view all the answers

    What warrants lumbar puncture with cerebrospinal fluid analysis and pressure measurement?

    <p>Suspicion of specific central nervous system infections</p> Signup and view all the answers

    What is crucial to determining the etiology of a headache?

    <p>Thorough history</p> Signup and view all the answers

    Which type of headache is associated with signs of systemic illness, focal neurologic signs, or symptoms of disease?

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

    What are the red flags in the evaluation of acute headaches in adults?

    <p>Headaches increasing in frequency and severity</p> Signup and view all the answers

    What is used for the diagnosis and preliminary classification of the headache type?

    <p>The International Headache Society's criteria</p> Signup and view all the answers

    What is mandatory for the diagnosis and preliminary classification of the headache type?

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

    What are specific work-ups that may be necessary based on red flags identified in the evaluation of acute headaches in adults?

    <p>Neuroimaging, lumbar puncture, and serology</p> Signup and view all the answers

    What is included in the approach to the headache history?

    <p>Questions about the nature, frequency, onset, location, and associated symptoms of the headache</p> Signup and view all the answers

    What type of headache is a recurrent headache with no organic disease as its cause?

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

    What is used for the diagnosis and preliminary classification of the headache type?

    <p>The International Headache Society's criteria</p> Signup and view all the answers

    Which type of headaches are strictly unilateral?

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

    What is a red flag indicating serious underlying conditions in headaches?

    <p>Focal neurological findings</p> Signup and view all the answers

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

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

    In which patients should limited laboratory testing include a complete blood count for suspected infection?

    <p>Patients with secondary headaches</p> Signup and view all the answers

    What is characterized by specific criteria including a free interval of less than 60 minutes between aura and headache?

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

    What type of headaches generally begin unilaterally but may progress?

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

    When should neuroimaging, such as CT scanning or MRI, be considered in the evaluation of adult patients with acute headache disorders?

    <p>Based on specific indications</p> Signup and view all the answers

    What did a study find regarding the ordering of CT scans for patients with headache?

    <p>CT scans were ordered for approximately 3% of patients with headache</p> Signup and view all the answers

    What type of headache is characterized by fully reversible aura symptoms and a gradual development of symptoms?

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

    What did C. Randal Clinch, D.O., emphasize as 'red flags' warranting additional evaluation?

    <p>Focal neurologic findings</p> Signup and view all the answers

    When should referral to a headache subspecialist be considered?

    <p>In certain situations</p> Signup and view all the answers

    What is the evidence regarding the concern for brain tumors when ordering CT scans for headaches?

    <p>The evidence does not support high level of concern for brain tumors</p> Signup and view all the answers

    Which type of headache is characterized by fully reversible aura symptoms and a gradual development of symptoms?

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

    What is the significance of lumbar puncture in assessing the CSF?

    <p>To identify xanthochromia in the CSF</p> Signup and view all the answers

    What are specific signs associated with cluster headaches?

    <p>Conjunctival injection, lacrimation, and nasal congestion</p> Signup and view all the answers

    What is used for the diagnosis and preliminary classification of the headache type?

    <p>Patient's symptoms and history</p> Signup and view all the answers

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

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

    What is the primary task of the family physician in evaluating headaches?

    <p>Distinguishing between primary and secondary headache disorders</p> Signup and view all the answers

    What is the percentage of abnormalities noted on CT scans that potentially benefit from neurosurgical intervention?

    <p>50%</p> Signup and view all the answers

    What are specific symptoms that may indicate a potentially life-threatening secondary headache disorder?

    <p>Diplopia, stiff neck, and disorientation</p> Signup and view all the answers

    When should lumbar puncture with cerebrospinal fluid analysis and pressure measurement be warranted?

    <p>To rule out subarachnoid hemorrhage</p> Signup and view all the answers

    What is the role of EEG in the evaluation of headaches according to the National Headache Foundation?

    <p>Limited role in the evaluation of headaches</p> Signup and view all the answers

    What is the preferred imaging modality to identify acute hemorrhage?

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

    What warrants referral to a headache subspecialist according to the text?

    <p>Concurrent medical conditions like HIV infection</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 may symptoms like diplopia, stiff neck, and unilateral weakness indicate?

    <p>Potentially life-threatening secondary headache disorder</p> Signup and view all the answers

    What type of headache can be triggered by head trauma?

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

    Which headache disorder is characterized by signs like conjunctival injection, lacrimation, and nasal congestion?

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

    What type of headache lasts from 30 minutes to 7 days?

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

    What type of headache is crucial to distinguish from primary and secondary headache disorders?

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

    What characteristics can further classify the headache as migraine, tension-type, or cluster?

    <p>Quality of pain</p> Signup and view all the answers

    What may indicate potentially life-threatening secondary headache disorder?

    <p>Symptoms such as rash and fever</p> Signup and view all the answers

    What might headache subsequent to trauma signify?

    <p>Postconcussive disorder</p> Signup and view all the answers

    What should be reviewed as they can trigger drug-rebound and nonspecific headaches?

    <p>Medications, both prescription and over-the-counter</p> Signup and view all the answers

    What may headache subsequent to trauma signify?

    <p>Postconcussive disorder</p> Signup and view all the answers

    What type of headache is associated with common medical procedures like lumbar puncture?

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

    Study Notes

    Emergency Department Evaluation of Headache

    • Patients complaining of first or worst headache of any age require evaluation.
    • It is crucial to distinguish between primary and secondary headache disorders based on the patient's symptoms.
    • Symptoms such as diplopia, stiff neck, disorientation, rash, fever, and unilateral weakness may indicate a potentially life-threatening secondary headache disorder.
    • Onset of headache should be assessed for sudden, severe onset which may indicate secondary headache disorders like subarachnoid hemorrhage or vascular malformations.
    • Location of pain and radiation should be determined, as cluster headaches are strictly unilateral, tension-type headaches are usually bilateral, and migraines may start unilaterally but progress.
    • Quality of pain, whether throbbing, stabbing, dull, or pressure-like, can further classify the headache as migraine, tension-type, or cluster.
    • Patients with concurrent medical conditions like HIV infection or cancer are more likely to have an organic cause of headache, such as meningitis, CNS lymphoma, or intracranial vascular disorder.
    • Medications, both prescription and over-the-counter, should be reviewed as they can trigger drug-rebound and nonspecific headaches.
    • Headache subsequent to trauma may signify a postconcussive disorder, and it's essential to suspect intracranial hemorrhage.
    • Migraine and cluster headaches can be triggered by head trauma, and headaches have been associated with common medical procedures like lumbar puncture.
    • Cluster headaches are characterized by severe unilateral orbital, supraorbital, or temporal pain associated with signs like conjunctival injection, lacrimation, and nasal congestion.
    • Tension-type headaches are characterized by headache lasting from 30 minutes to 7 days, with specific pain characteristics and absence of nausea or vomiting.

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    Description

    Test your knowledge of headache evaluation and diagnosis with this quiz. Learn about different types of headaches, red flags for serious underlying conditions, and the importance of distinguishing between primary and secondary headache disorders. Explore the criteria for diagnosing secondary headaches and the indications for neuroimaging.

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