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20 Cards in this Set

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Key History -
Duration
location - esp. u/l vs. b/l
quality
intensity
timing - disturb sleep?
associated neuro Sxs
nausea
jaw claudication
recent trauma
dental surgery
sinusitis Sxs

exacerbating factors -
stress
fatigue
menses
exercise

alleviating factors -
rest
medicines

past h/o headache
family h/o migraines
Key PE -
VS
inpection and palpation of
entire head
ENT inspection
complete neuro exam,
including funduscopic
21 y/o F
presents with several episodes of throbbing left temporal pain that lasts for 2-3 hrs.
Prior to its onset, she sees flashes of light in her right visual field.
She feels weakness and numbness on the right side of her body for a few minutes.
Headaches are often associated with n/v.
She has family h/o migraine.

What is Differential?
Migraine (complicated)
tension headache
cluster headache
pseudotumor cerebri
trigeminal neuralgia
CNS vasculitis
partial seizure
intracranial neoplasm
21 y/o F
presents with several episodes of throbbing left temporal pain that lasts for 2-3 hrs.
Prior to its onset, she sees flashes of light in her right visual field.
She feels weakness and numbness on the right side of her body for a few minutes.
Headaches are often associated with n/v.
She has family h/o migraine.

What is Workup?
CBC
ESR
CT - head
MRI - brain
LP
26 y/o M
presents with terrible right temporal headaches associated with ipsilateral rhinorrhea and eye tearing and redness.
Episodes have occurred at the same time every night for the past wk. and last for 45 mins.

What is Differential?
Cluster headache
migraine
tension headache
sinusitis
pseudotumor cerebri
trigeminal neuralgia
intracranial neoplasm
26 y/o M
presents with terrible right temporal headaches associated with ipsilateral rhinorrhea and eye tearing and redness.
Episodes have occurred at the same time every night for the past wk. and last for 45 mins.

What is Workup?
CBC
ESR
CT - head
MRI - brain
LP
65 y/o F
presents with severe, intermittent right temporal headache, fever, blurred vision in her right eye and pain in her jaw when chewing.

What is Differential?
Temporal arteritis (giant cell arteritis)
migraine
cluster headache
tension headache
meningitis
carotid artery dissection
pseudotumor cerebri
trigeminal neuralgia
intracranial neoplasm
65 y/o F
presents with severe, intermittent right temporal headache, fever, blurred vision in her right eye and pain in her jaw when chewing.

What is Workup?
CBC
ESR
CRP
temporal artery Bx
doppler US - carotid
MRI - brain
30 y/o F
presents with frontal HA, fever and nasal discharge.
Pain on palpation of frontal and maxillary sinuses.
She has a h/o sinusitis.

What is Differential?
Sinusitis
migraine
tension HA
meningitis
intracranial neoplasm
30 y/o F
presents with frontal HA, fever and nasal discharge.
Pain on palpation of frontal and maxillary sinuses.
She has a h/o sinusitis.

What is Workup?
CBC
CT - sinus
LP
50 y/o F
presents with recurrent episodes of b/l squeezing HA that occur 3-4/week.
She's experiencing significant stress in her life

What is Differential?
Tension HA
migraine
depression
caffeine or analgesic withdrawal
HTN
cluster HA
pseudotumor cerebri
intracranial neoplasm
50 y/o F
presents with recurrent episodes of b/l squeezing HA that occur 3-4/week.
She's experiencing significant stress in her life

What is Workup?
CBC
electrolytes
ESR
CT - head
LP
35 y/o M
presents with severe HA, vomiting, confusion, left hemiplegia and nuchal rigidity

What is Differential?
SAH
migraine
meningitis/encephalitis
intracranial hemorrhage
vertebral artery dissection
intracranial venous thrombosis
acute HTN
intracranial neoplasm
35 y/o M
presents with severe HA, vomiting, confusion, left hemiplegia and nuchal rigidity

What is Workup?
CT - head
LP
CBC
PT/PTT
MRI/MRA - brain
25 y/o M
presents with high fever, severe HA, confusion, photophobia and nuchal rigidity.
Kernig's and Brudzinski's signs are positive.

What is Differential?
Meningitis
migraine
SAH
sinusitis/encephalitis
intracranial or epidural abscess
25 y/o M
presents with high fever, severe HA, confusion, photophobia and nuchal rigidity.
Kernig's and Brudzinski's signs are positive.

What is Workup?
CBC
CT - head
MRI - brain
LP - CSF analysis
18 y/o obese F
presents with HA, vomiting, blurred vision for the past
2-3 weeks.
She is taking OCPs.

What is Differential?
Pseudotumor cerebri
tension HA
migraine
cluster HA
meningitis
intracranial venous thrombosis
intracranial neoplasm
18 y/o obese F
presents with HA, vomiting, blurred vision for the past
2-3 weeks.
She is taking OCPs.

What is Workup?
Urine hCG
CBC
CT - head
LP - opening pressure and
CSF analysis
47 y/o M
c/o daily pain in the right cheek over the past month.
The pain is electric in character and occurs while he's shaving.
Each episode lasts 2-4 mins.

What is Differential?
Trigeminal neuralgia
tension HA
migraine
cluster HA
TMJ dysfunction
intracranial neoplasm
47 y/o M
c/o daily pain in the right cheek over the past month.
The pain is electric in character and occurs while he's shaving.
Each episode lasts 2-4 mins.

What is Workup?
CBC
ESR
MRI - brain