Headache

QUESTIONS

1. What are the classic symptoms associated with migraine headaches?

A. Anxiety

B. Numbness

C. Throbbing

D. None of the above

1. Answer: C. Throbbing. Although throbbing is always emphasized as a typical feature of migraine, it does not have to be of this character to be a migraine.

2. A 23-year-old female presents with onset of headache on one side, which spreads to involve the whole side of her head. She describes it as pulsatile, and it stays on one side. The headache is usually self-limiting lasting 30 minutes to a few hours. What is the most likely diagnosis?

A. Occipital migraine

B. Cluster headache

C. Classic migraine

D. Tension headache

E. None of the above

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2. Answer: C. Classic migraine. The description above fits only with the classic migraine.

3. What is the most common headache type?

A. Tension headache

B. Classic headache

C. Vasospastic migraine

D. Low pressure headache

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3. Answer: A. According to the American Academy of Neurology, the most common headache type is tension headache.

4. What is the ratio of men to women affected by cluster headaches?

A. 1:1

B. 2:1

C. 5:1

D. 3:2

E. 1:4

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4. Answer: C. Men are more affected by cluster headaches than women, and the ratio is 5 to 1.

5. What percentage of migraine sufferers are women?

A. 10%

B. 25%

C. 50%

D. 75%

E. None of the above

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5. Answer: D. According to the National Institute of Health, about 75% of migraine sufferers are women.

6. Which of the following is not a type of vascular headache?

A. Migraine

B. Toxic

C. Tension

D. Cluster

E. All of the above are vascular headaches.

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6. Answer: C. Tension headaches are caused by muscle contraction or tightening of the facial and neck muscles.

7. A 34-year-old female presents with daily headache. She has been taking ibuprofen 800 mg three to four times a day. She also drinks four cups of coffee per day. She states she used to have headaches on the left side of her head but now the pain is diffuse and bilateral. What is the best treatment for this type of headache?

A. Triptan

B. Oxygen

C. Stop ibuprofen

D. Increase her caffeine intake

E. Get more sleep

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7. Answer: C. The type of headache she has is rebound headaches. It results due to over-medication for a previous headache. The National Headache Foundation states they are more common if the part of the drugs include caffeine. The “rebound” happens as the effects from the medication start to wear off. The person then continues to take more and more medication and perpetuates the cycle.

8. A 40-year-old male presents to the emergency department (ED) with a severe, stabbing, burning, and throbbing headache. He describes the pain as piercing and unbearable. He also describes a runny nose on the same side as his headache. This happened once about 6 months ago but went away naturally. He was given oxygen and a sumatriptan, which provided pain relief. What is the most likely neuropeptide involved?

A. Acetylcholine

B. Dopamine

C. Histamine

D. Aldosterone

E. Melatonin

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8. Answer: C. The patient has cluster headache. The National Headache Foundation states that histamine is the most likely culprit; however, antihistamines have not proven to be effective treatment.

9. Which of the following is the most common aura associated with tension headaches?

A. Zig-zag lines

B. Blurry vision

C. Taste change

D. Strange smell

E. None of the above

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9. Answer: E. Tension headaches are not associated with any preheadache syndrome (aura). Also, there has been no link to hormones, foods, or any strong hereditary association.

10. A 35-year-old female presents with chronic daily headache and depression. She reports severe tenderness on her scalp and neck. She also complains of pain with neck flexion. She denied any visual changes, and the rest of her neurologic examination was normal. She works in an office and sits in front of a computer all day. She does drink one cup of coffee per day but does not associate her headaches with this. She also states her son recently was evicted out of his apartment. She denies taking any over-thecounter medications for this pain. Which of the following is not a cause of her headache?

A. Stress or anxiety

B. Depression

C. Poor posture

D. Caffeine

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10. Answer: D. The patient has a tension headache, and caffeine is not a known trigger for this type of headache. The other possibilities are all probably contributing to the patient’s headache.

11. In the patient above, what is the best first-line treatment?

A. Exercise

B. Adequate sleep

C. Cognitive behavioral therapy

D. Nonsteroidal anti-inflammatory drugs (NSAIDs)

E. All of the above

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11. Answer: E. There are various modalities to treat tension headaches.

12. A 45-year-old tall, rugged man presents with severe headaches that debilitate him once a year. He states that oxygen is the only treatment that helps. He is diagnosed with cluster headaches. What is the most likely mode of inheritance?

A. Autosomal recessive

B. X-linked dominant

C. Sporadic

D. Anticipation

E. None of the above

View Answer

12. Answer: C. Cluster headaches have consistently been found to be caused by a sporadic model of inheritance. There are cases of an autosomal dominant pattern within single families, which suggests there may be a genetic component.

13. Which of the following has recently been associated with increased attack frequency and severity of migraines?

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