Diagnosing and Managing Headaches

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. A majority of patients seeking physician’s help with their headaches are experiencing:

a) a vascular headache
b) tension-type headache
c) traction and inflammatory headache

2. These types of headaches typically occur 2 to 8 times per month:

a) migraine headaches
b) chronic tension-type headaches
c) cluster headaches
d) inflammatory headaches

3. When examining the eyes to evaluate for cluster headaches, which of the following may be noted:
1. conjunctivitis
2. nystagmus
3. lacrimation
4. unilateral ptosis

a) 1 and 3
b) 2 only
c) 2 and 4
d) 3 and 4
e) 1 and 2

4. When comparing the CT scan and magnetic resonance imaging, the MRI can detect certain abnormalities at a very early stage.

a) True
b) False

5. Hypothyroidism has been noted to cause headaches. Which of the following should be obtained:

a) EEG
b) CBC
c) T 3 and T 4
d) lumbar puncture

6. The displacement of structures, such as blood vessels as a result of traction, may lead to a “traction headache.”

a) True
b) False

7. This type of tumor will cause seizures, focal symptoms and/or progressive impairment of intellectual function before they produce a headache:

a) gliomas
b) a posterior fossa tumor
c) hypophysial adenoma
d) meningioma

8. Headache is a prominent symptom of a subdural hematoma; however, other symptoms are:
1. apathy
2. drowsiness
3. slowness in thinking
4. seizures

a) 1 and 2
b) 2 and 3
c) 3 and 4
d) 2 and 4
e) 1 and 3

9. Blood in the subarachnoid space causes a chemical meningitis. These meningeal signs include:

a) mental confusion
b) vomiting
c) kernig’s sign
d) diplopia
e) the patient stating, “this is the worst headache ever.”

10. This is significant in the pathophysiology of a brain abscess:

a) headache
b) seizures
c) unequal pupils
d) cerebral edema

11. The headache associated with meningitis is:

a) dull and diffuse
b) throbbing in nature
c) constant and severe
d) often accompanied by hiccups

12. Benign intracranial hypertension can resolve spontaneously.

a) True
b) False

13. Giant cell arteritis is confirmed with:

a) lab tests
b) an EEG
c) a temporal biopsy
d) an MRI

14. This is a major diagnostic clue in trigeminal neuralgia:

a) splinting the painful area
b) burning and aching of a trigger point
c) interruption in sleep
d) an “avoidance mechanism”
e) an auscultating cranial bruit

15. According to the neurovascular theory, migraine attacks are generated:

a) in the brain
b) by vasoconstriction and vasodilation
c) by stress
d) due to elevated hormonal levels

16. Personality features of migraine patients tend to include:
1. high anxiety and stress
2. perfectionism
3. rigidity
4. overwork
5. compulsiveness

a) 1, 2, and 4
b) 3 and 5
c) 1 and 2
d) 3 and 4
e) 2, 3, and 5

17. Abdominal migraines may occur in children with symptoms of:

a) extreme hunger
b) abdominal pain and nausea
c) cyclical vomiting and attacks of vertigo
d) nervousness and diarrhea

18. Which of the following should be avoided on a tyramine-free diet:

a) velveeta, bagels, and pudding
b) macaroni, tuna, and yogurt
c) chocolate, doughnuts and raisins

19. The subcutaneous form of this drug was introduced in 1991. Headache relief was achieved in 70% of patients within 1 hour of a single 6 – mg subcutaneous dose:

a) sumatriptan (Imitrex)
b) eletriptan (Relpax)
c) amotriptan (Axert)
d) ergotamine tartrate with caffeine (Cafergot)

20. This parenteral form of NSAID is non-narcotic, nonhabituating, and has a low side effect profile:

a) orudis
b) toradol
c) reglan
d) dolophine
e) phenergan

21. Prophylactic therapy is indicated for patients:
1. who have migraines preceded with an aura
2. experiencing more than two migraines a month
3. who have menstrual migraines
4. having attacks that last several days
5. with such seve

a) 1 and 2
b) 3 and 5
c) 2 and 4
d) 1, 3, and 4
e) 1, 4, and 5

22. These two ß-blockers have been used successfully in the treatment of migraine headaches:

a) catapres and Calan
b) inderal and Blockadren
c) corgard and Depakote
d) elavil and Tenormin

23. Biofeedback training traces its origins to the discipline of:

a) self-awareness
b) control
c) relaxation
d) hypnosis
e) deprivation

24. A cluster headache, according to the International Headache Society:
1. is severe, strictly unilateral pain orbitally, supraorbitally and/or temporally
2. is bitemporal tightness
3. lasts 15 to 180 minutes
4. is of mild to moderate sev

a) 2 and 5
b) 2 and 4
c) 3, 4, and 5
d) 1 and 3
e) 1 only

25. Cluster headaches:
1. are most frequently in spring and fall
2. subside with rest
3. mainly occur during the day
4. are primarily a male disorder
5. are induced by a high tyramine diet

a) 2, 3, and 5
b) 1 and 3
c) 1 and 4
d) 2 and 5
e) 4 only

26. Oxygen at 8 L/minute by facial mask for 10 to 15 minutes is effective abortive therapy for a cluster headache.

a) True
b) False

27. A family history of a migraine is ______%, a cluster headache ______%.

a) 12, 80
b) 3, 95
c) 80, 15
d) 90, 7

28. The goal of prophylactic therapy is to limit the length of the cluster period and decrease the _________ of attacks.

a) frequency
b) severity

29. Tension-type headaches are identified as being:

a) mild or severe
b) typical or atypical
c) episodic or chronic
d) acute or chronic

30. A study has reported a combination agent containing which of the following was successful in treating tension-type headaches:

a) tylenol and nicotine
b) aspirin and tannic acid
c) naproxen and Saint John’s Wort
d) ibuprofen and caffeine

31. Which of the following are the agents of choice in the prophylactic treatment of chronic, tension-type headaches associated with depression:

a) analgesics
b) MAO inhibitors
c) anti-anxiety drugs
d) tricyclic antidepressants

32. Many patients with coexisting migraine and tension-type headaches have been mis-diagnosed and treated inappropriately.

a) True
b) False

33. An essential aspect of treating the patient with coexisting migraine and tension-type headaches is:

a) effective medication including copharmacy
b) the use of biofeedback and relaxation technique
c) continuity of care
d) avoid drugs that cause dependency

34. In the research by Bille in a 40-year follow-up study, by the age of 25 years, 23 % were migraine free, the remission was more significant among:

a) females
b) males

35. The exertional headache in children may be related to weight-lifting and running and have symptoms of:

a) a severe and throbbing headache
b) a stiff neck with nausea and vomiting
c) squinting and a fever
d) palpitations and fatigue

36. Prior to puberty, a migraine is:

a) more prevalent in females
b) more prevalent in males
c) of equal distribution

37. Some children present with a complicated migraine and should be evaluated for:

a) an infection
b) trauma
c) drug usage
d) an aneurism
e) hydrocephalus

38. As part of the workup for the adolescent with chronic, tension-type headaches, the Minnesota Multiphasic Personality Inventory is indicated.

a) True
b) False

39. The most common cause of chronic, tension-type headache in the elderly is:

a) hypertension
b) glaucoma
c) underlying depression
d) stress
e) stroke

40. The “menstrually-related migraine” is a form of migraine __________ an aura which may present around the menstrual period or at other times during the menstrual cycle.

a) with
b) without

41. Which of the following are indicated for the menstrual migraine:

a) nonsteroidal anti-inflammatory drugs
b) analgesics
c) estrogen replacement therapy
d) tricyclic antidepressants
e) triptans

42. Which of the following drugs has a very short half-life and can be used for an acute migraine attack when breastfeeding:

a) baclofen
b) ergotamine tartrate
c) lidocaine
d) triptans
e) toradol

43. The onset of chronic post-traumatic headache would be more than 14 days after the significant event and would continue:

a) for ten days
b) as long as there is intercranial swelling
c) for greater than 8 weeks
d) longer if surgery is involved

44. In the research of the 1940s led by Brenner, the symptom complex was related to:
1. personality of the injured
2. previous headache disorder
3. compensation elements
4. depression and anxiety
5. alcohol abuse and smoking

a) 1 and 2
b) 2, 3, and 4
c) 4 and 5
d) 5 only
e) 1 and 3

45. The “footballer’s” migraine may be precipitated by the heading of a ball in soccer.

a) True
b) False

46. Traumatic dysautonomic cephalgia results from a:

a) fracture to the jaw or facial bones
b) soft-tissue injury to the neck surrounding the carotid vessels
c) whiplash

47. Which headache is the most prevalent type in patient’s visiting the ED:

a) migraine
b) cluster
c) tension-type
d) exertional

48. A sedimentation rate by Westergren’s method should be performed on any patient over 50 years of age with a change in headache pattern to rule out temporal arteritis and prevent:

a) a stroke
b) a subdural hematoma
c) electrolyte loss
d) irreversible blindness

49. The patient with a subarachnoid hemorrhage presenting to the ED may have:

a) a “thunderclap” headache
b) a 20% mortality rate
c) blood in the cerebral spinal fluid
d) malignant hypertension
e) a localized dull headache

50. Diagnosis of a hypertensive headache is confirmed by:

a) a systolic pressure greater than 200 mm Hg
b) a pulse pressure greater than 80 mm Hg
c) a mean arterial pressure greater than 60 mm Hg
d) a diastolic pressure greater than 110 mm Hg