Headache Test.
Last 4 digits of social security number……………
Circle the correct answer.
1.
Which of the following neurotransmitters is most closely associated with
the development of migraine?
a.
b.
c.
d.
Gaba amino butyric acid (GABA)
Acetylcholine
Dopamine
Serotonin.
2.
Deirdre is a 25-year-old computer programmer with chronic migraine. She
requests something to prevent the headache saying “I’m tired of all these
interruptions, every time I get a headache it costs me half a day at work.” She
has no systemic diseases. Which of the following prophylactic strategies would
be most appropriate?
a.
b.
c.
d.
3.
Propranolol
Nifedipine
Feverfew
Cyproheptadine.
The following causes of headaches are life threatening except
a.
b.
c.
d.
Intracranial hemorrhage
Temporal arteritis
Meningitis
Hypertensive encephalopathy.
4.
The presence of neck stiffness in a patient presenting with meningitis has
a sensitivity of
a.
b.
c.
d.
10%
35%
70%
95%
5.
Richard is a 56-year-old teacher who presents with recurrent generalized
headaches that he rates as 4/10 on the pain scale. He denies photophobia,
phonophobia, nausea or vomiting, chest pain, blurred vision or shortness of
breath. He has no other symptoms. On examination he is afebrile with a blood
pressure of 170/95 and no neck stiffness. The rest of the examination including a
full neurological examination is normal. What is the most likely cause of his
headache?
a.
b.
c.
d.
Hypertensive encephalopathy
Migraine
Tension type headache
Meningitis
6.
Mary has been diagnosed with chronic tension type headaches. To how
many days a week would you advise her to restrict her medication use?
a.
b.
c.
d.
7.
2 days a week
4 days a week
6 days a week
Daily use is OK
Which of the following is a contraindication to triptan therapy
a.
b.
c.
d.
Contraceptive pill
Ischemic heart disease
Controlled hypertension.
Migraine with aura.
8.
Which of the following medications have been associated with rebound
headaches?
a.
b.
c.
d.
Triptans only.
Narcotics and NSAIDs only.
Triptans, narcotics and NSAIDs
Narcotics only.
9. Typical features of tension-type headaches include all of the
following except?
A.
B.
C.
D.
E.
Bilateral location
Mild or moderate pain described as tightness, pressure, or dull ache
Pain often radiating to posterior neck muscles
Headache accompanied by visual disturbances
Pain lasting from 30 minutes to several days
10. Which one of the following is considered a “red flag” in an adult with a
headache?
A.
B.
C.
D.
E.
Slow onset
Onset before age 50
Short term nausea and vomiting
Subsequent to head trauma
Exacerbation by climbing stairs
11. Which of the following is true in relation to migraine headache?
A.
B.
C.
D.
E.
Men are more likely to have migraine than women
Most people with migraine are not diagnosed
Migraine is almost always associated with aura symptoms
Lack of throbbing quality of pain rules out the diagnosis of migraine
Lack of a one-sided headache rules out the diagnosis of migraine.
12. Migraine with aura has which one of the following features?
A.
B.
C.
D.
E.
Ipsilateral lacrimation or nasal congestion
Irreversible aural symptoms indicating focal cerebrocortical or brain-stem
dysfunction
Reversible aura symptoms and headache with a pulsatile quality
Pressing or tightening quality
Pressing or tightening quality
Answer the following questions by circling true or false.
1.
The majority of patients with a subarachnoid hemorrhage have
neck stiffness.
True/False
2.
The diagnosis of meningitis may effectively be eliminated if the
patient has absence of fever, no neck stiffness and no change
in mental status.
True/False
3.
Kernigs and Brudzinski signs have a low sensitivity but a high
specificity.
True/False
4.
The resolution of a headache with ketoralac (an NSAID) rules
out that the cause of the headache is an intracranial bleed.
True/False
5.
For a headache to be diagnosed as a migraine it must be
associated with nausea or vomiting.
True/False
6.
A tension headache is increased by physical activity.
True/False
7.
In the treatment of migraine steroids are more likely to be
successful than opiates
True/False
8.
A headache that increases with valsalva is associated with an
abnormality found on neuroimaging.
True/False