Download Migraine

Migraine
Part One: Each item below contains a question or incomplete
statement followed by suggested responses. Select the one best
response to each question.
1. A 22-year-old woman reports a scotoma progressing across her left
visual field over the course of 30 min, followed by left hemicranial
throbbing pain, nausea, and photophobia. Her brother and mother have
similar headaches. Which of the following is present in classic migraine
but not in common migraine?
a. Photophobia
b. Familial pattern
c. Visual aura
d. Hemicranial pain
e. Nausea
2. A 16-year-old woman has been having attacks of weakness, blurry
vision, and loss of consciousness. Following consultation with a
neurologist, the diagnosis of basilar migraine is made. Basilar migraine
differs from classic migraine in which of the following ways?
a. Sex of the persons most often affected
b. Resistance of the visual system to involvement
c. Severity of symptoms
d. Duration of the aura
e. Sequence of neurologic deficits and headache
3. A 43-year-old woman describes lancinating pains radiating into the
right side of her jaw. This discomfort has been present for more than 3
years and has started occurring more than once a week. The pain is
paroxysmal and routinely triggered by cold stimuli, such as ice cream and
cold drinks. She has sought relief with multiple dental procedures and has
already had two teeth extracted. Multiple neuroimaging studies reveal no
structural lesions in her head. Assuming there are no contraindications to
the treatment, a reasonable next step would be to prescribe which of the
following?
a. Clonazepam (Klonopin), 1 mg orally three times daily
b. Diazepam (Valium), 5 mg orally two times daily
c. Divalproex sodium (Depakote), 250 mg orally three times daily
d. Indomethacin (Indocin), 10 mg orally three times daily
e. Carbamazepine (Tegretol), 100 mg orally three times daily
4. A 23-year-old woman has had 1 week of worsening facial pain. She
describes it as an intense shooting pain that comes and goes. It is present
only on her right face. Which of the following is most likely to be this
patient’s underlying problem?
a. Multiple sclerosis
b. Tolosa-Hunt syndrome
c. Migraine
d. Anterior communicating artery aneurysm
e. Falx meningioma
5. A 39-year-old left-handed woman is being treated with carbamazepine
for lancinating pain in her left face. The pain is paroxysmal, usually
occurring without apparent reason, but seems sometimes to be brought on
by a cold breeze. Both trigeminal neuralgia and atypical facial pain
involve pain that may be which of the following?
a. Lancinating
b. Paroxysmal
c. Associated with anesthetic patches
d. Abolished with resection of the gasserian ganglion
e. Unilateral
6. A 26-year-old graduate student presents to the emergency room with a
severe left-sided throbbing headache associated with nausea, vomiting,
and photophobia. She has tried taking ibuprofen without relief. On further
questioning, she relates that she has been having similar headaches three
to four times per month for the past year. Her mother had a similar
problem. Her exam is normal. Appropriate therapy for this patient’s
present headache might include which of the following drugs?
a. Ergotamine tartrate
b. Nitroglycerine
c. Verapamil
d. Amitriptyline hydrochloride
e. Phenobarbital
7. Appropriate long-term management of a patient with 14 migraine
headaches per month might include a prescription for daily use of which
of the following medications?
a. Metoclopramide hydrochloride
b. Sumatriptan
c. Oral contraceptives
d. Amitriptyline hydrochloride
e. Ergotamine tartrate
8. A 32-year-old woman is being evaluated for headaches. They started
about 6 months ago and occur a few times per week, lasting until she falls
asleep. The pain is constant and focused at the front and back of the head.
The pain is unrelated to position and tends to be worse later in the day.
There is mild photophobia. Which of the following findings is most
likely?
a. Slightly reduced neck range of motion and paracervical tenderness
b. Papilledema
c. Abnormal brain MRI
d. Abnormal brain CT
e. Abnormal EEG
9. A 22-year-old dance instructor routinely develops headaches on the
weekend. The headaches are almost always limited to the right side of her
head and centered about the right temple. She knows that a headache is
coming because of changes in her vision that precede the headache by 20
to 30 min. She sees scintillating lights just to the left of her center of
vision. This visual aberration then expands and interferes with her vision.
The blind spot that it creates appears to have a scintillating margin. As the
blind spot clears, the headache starts. It rarely lasts more than 1 h, but is
usually associated by nausea and vomiting. What the most likely
diagnosis is?
a. Classic migraine
b. Cluster headache
c. Common migraine
d. Trigeminal neuralgia
e. Sinusitis
10. A 29-year-old woman comes to the emergency room with facial pain
of new onset. She has stabbing pains on the left side of her face just
below her eye. These last less than 1 s at a time, but are so severe that she
winces involuntarily with each pain. The pain seems to be triggered by
drinking cold fluids. The only other problems she has noticed are
clumsiness in her right hand and blurred vision in her right eye. Both of
these have been present for more than 2 years and have not interfered
with her normal activities. What the most likely diagnosis is?
a. Classic migraine
b. Cluster headache
c. Common migraine
d. Trigeminal neuralgia
e. Sinusitis
11. A 35-year-old man has severe throbbing pain waking him from sleep
at night and persisting into the day. This pain is usually centered about his
left eye and appears on a nearly daily basis for several weeks or months
each year. It occurs most prominently at night within a few hours of
falling asleep and is associated with a striking personality change in
which the man becomes combative and agitated. He never vomits or
develops focal weakness. What the most likely diagnosis is?
a. Classic migraine
b. Cluster headache
c. Common migraine
d. Trigeminal neuralgia
e. Sinusitis
12. A 76-year-old man develops a dull left-sided head pain with some
radiation of the discomfort to the right side of the head. He has no nausea
or vomiting with the pain, but has lost 10 lb over the previous 2 months.
His erythrocyte sedimentation rate is 102 mm/h, and he is mildly anemic.
An extensive investigation for malignancy reveals no signs of lymphoma,
carcinoma, or leukemia. What the most likely diagnosis is?
a. Classic migraine
b. Temporal arteritis
c. Common migraine
d. Trigeminal neuralgia
e. Sinusitis
13. An 81-year-old man with chronic lymphocytic leukemia develops
pain and burning over the right side of his face. Within a few days, a
vesiculopapular rash in the distribution of the first division of the
trigeminal nerve appears. The vesicles become encrusted, and the burning
associated with the rash abates. Within 1 month the rash has largely
resolved, but the man is left with a dull ache over the area of the rash that
is periodically punctuated by shooting pains. Imipramine 100 mg nightly
helps reduce the intensity of the chronic pain.
a. Classic migraine
b. Cluster headache
c. Common migraine
d. Postherpetic neuralgia
e. Sinusitis
14. An obese 37-year-old woman has had a daily headache, worse in the
morning, for 1 year. She has episodes of transient visual obscurations
affecting each eye, and also hears a pulsatile tinnitus. Examination is
notable for bilateral papilledema. There are no other abnormalities. What
the most likely diagnosis is?
a. Carotid artery dissection
b. Pseudotumor cerebri
c. Glioblastoma multiforme
d. Thunderclap headache
e. Analgesic rebound headache
15. A 42-year-old man presents with a sudden and severe headache
associated with nausea. The headache reaches maximal intensity within 5
seconds. He has no prior history of headache. Examination is
unremarkable. Computed tomography and spinal fluid examination show
no evidence of blood. He later admits that he had been engaged in sexual
activity when the headache occurred. What the most likely diagnosis is?
a. Carotid artery dissection
b. Pseudotumor cerebri
c. Glioblastoma multiforme
d. Thunderclap headache
e. Analgesic rebound headache
16. A 29-year-old man relates that he has had recent headaches only when
standing up. The headaches resolve quickly when he lies down, and are
accompanied by mild nausea. His examination is normal. What the most
likely diagnosis is?
a. Carotid artery dissection
b. Pseudotumor cerebri
c. Intracranial hypotension
d. Thunderclap headache
e. Analgesic rebound headache
17. What should be selected in treatment of migraine headaches?
a. Propranolol
b. Benzethidine
c. Nifedipine
d. Triptans
e. Methysergide
18. What is the most common migraine?
a. Typical migraine
b. Common migraine
c. Cluster headache
d. Retinal migraine
e. Vascular headache
19. The prevention and treatment of migraine, which is not correct?
a. Avoid excessive fatigue and mental stress
b. Do not be too hunger or too satiety
c. Do not drink alcohol and eat high fat foods
d. Avoid eating food that has been exciting.
e. Available blood vessel tension drugs
20. Frequent attacks, more than two times a month for the use of?
a. NSAIDs
b. Ergotamine and caffeine
c. 5-HT receptor agonist
d. Propranolol
e. Corticosteroid
Part Two: Fill in the blanks
1.
is easy to merge with medication overuse headache.
2. The most common aura of migraine is
.
3. Ophthalmoplegia migraine most often accumulated nerve is
.
4. The most common cause of secondary low intracranial pressure
headache is
.
5. Acute attack of cluster headache when the preferred treatment measure
is.
6. The most common clinical chronic headache is
7. Migraine persistent state refers to
.
.
8. Tension headache is a headache caused by
,
,
______due to long-term stress, anxiety or fatigue.
9. Cluster headache is a neurological disorder characterized by recurrent,
severe headaches on one side of the head, typically around
10. A few hours to a few days before migraine with
.
prodromal
symptoms.
11. Low intracranial pressure headache is the main feature of
12. Cluster headache is the main characteristics of
13. The main feature of migraine is
.
.
.
14. The main feature of tension headache is
.
15. Termination of mild to moderate migraine with acute attack preferred
treatment is
.
16. Termination of moderate to severe acute migraine attacks and in the
past the first choice for the treatment of NSAIDs response is not good
treatment is
.
17. The specific drug for the treatment of migraine is
.
18. Nonspecific drug for the treatment of migraine is
.
19. Migraine prophylactic drug is
.
20. Acute attacks of cluster headache when the preferred treatment
is
.
Part Three: Definitions
1. Headache
2. Migraine
3. Tension headache
4. Cluster headache
5. Magraine with aura
Part Four: General questions
1. Please sketch the causes of headache.
2. The main clinical characteristics of classic migraine headache.
3. Please sketch the drug treatment of migraine headache.
4. The classic presentation of cluster headache.
5. Please sketch the pain-sensitive structures within the cranial vault.
Part Five: Case analysis
A 22-year-old woman reports a scotoma progressing across her left
visual field over the course of 30 minutes, followed by left hemicranial
throbbing pain, nausea, and photophobia. Her brother and mother have
similar headaches. Now please answer several questions:
1. What is the most probable diagnosis?
2. How to treat her headache?
3. What are the precipitating factors of her headache?
Answers
Part One: Choice questions
1 to 5:
cceae
6 to 10:
adaad
11 to 15: b b d b d
16 to 20:
cdbed
Part Two: Fill in the blanks
1. Migraine without aura
2. Visual aura
3. Oculomotor nerve
4. After epidural or lumbar puncture
5. Oxygen inhalation therapy
6. Tension headache
7. Migraine duration more than 72 hours
8. The continued contraction of neck muscles, muscle blood circulation
disorders, ischemia
9. The eye
10. Burnout, inattention and yawning
11. Postural headache
12. One side of the orbital around the onset of headache
13. Side fluctuating headache
14. Stressful or oppressive headache
15. NSAIDs
16. Ergot preparations
17. Ergot preparations
18. NSAIDs
19. Calcium antagonist
20. Oxygen inhalation therapy
Part Three: Definitions
1. Headache: Headache is a pain you feel inside your head.
2. Migraine: Migraine is a very severe type of headache which often
makes a person feel sick and have difficulty in seeing.
3. Tension headache: Tension headache is a headache caused by the
continued contraction of neck muscles, muscle blood circulation
disorders and ischemia due to long-term stress, anxiety or fatigue.
4. Cluster headache: Cluster headache is a neurological disorder
characterized by recurrent, severe headaches on one side of the head,
typically around the eye
5. Magraine with aura: A few hours to a few days before migraine with
burnout, inattention and yawning prodromal symptoms.
Part Four: General questions
1. (1) Acute onset:
Common causes: Subarachnoid hemorrhage, other cerebrovascular
diseases, Meningitis or encephalitis, Ocular disorders.
Less common causes: Seizures, Lumbar punctures, Hypertensive
encephalopathy, Coitus.
(2) Subacute onset: giant cell arteritis, Intracranial mass, pseudotumor
neuralgia, glossopharyngral neuralgia.
(3) Chronic: Migraine, Cluster headache, Tension headache, Cervical
spine disease, Sinusitis, dental disease.
2. Classic migraine headache is preceded by transient neurologic
symptoms-the
aura,
including
visual
alterations,
particularly
hemianopic field defects and scotomas. The headache, almost
hemicranial pain, begins at the same time with the aura or within 60
minutes after the aura. And during the headache, associated symptoms
include nausea, vomiting, photophobia, irritability, osmophobia, and
lassitude.
3. (1) Acute treatment: simple analgesics, ergot preparations, Narcotics
analgesics, 5-HT agonists.
(2)
Prophylactic treatment:
anti-inflammatory agents, tricyclic
antidepressants, β-receptor antagonists, methysergide, anticonvulsants,
calcium channel antagonists.
4. The syndrome presents as clusters of brief, very severe, unilateral,
constant nonthrobbing headache that last from 10 minutes to less than
2 hours. The headache usually recurs on the same side. The headache
commonly occurs at night, and recurs daily, often at nearly the same
time of day, for a cluster of period of weeks to months.
5. The pain-sensitive structures within the cranial vault includes the
venous sinuses, the anterior and middle meningral arteries, the dura at
the base of the skull, the trigeminal (V), glossopharyngeal (IX), and
vagus (X) nerves, the proximal portions of the internal carotid artery
and its branches near the circle of Wills, the brain stem priaqueductal
gray matter, and the sensory nuclei of the thalamus.