NMS Q&A Family Medicine

30 NMS Q&A Family MedicineQuestions 11 and 12 for the clinical setting of temporalarteritis. Although it might briefly be considered, againthe bruit would have to be otherwise explained.16. The answer is C. These are prototypical tension orvascular headaches. Onsets are gradual, are often not preciselynoted, and subside gradually. The presence of aura,as well as exacerbation perimenstrually, perimenopausally,during pregnancy, and with oral contraceptives, ischaracteristic of migraine headaches. Migraine headachesare frequently associated with nausea and emesis, unliketension or cluster headaches. Both migraine and tensionheadaches are more common in women.17. The answer is C. The patient has typical clusterheadaches. The defining pattern is the daily recurring butshort-lived headache, the associated facial flushing andrhinorrhea, and the “remission” of a year between clusters.Retro-orbital headache is also a characteristic ofcluster headaches. These headaches traditionally affectmen eight times as frequently as women and come onbetween the ages of 30 and 50 years. That said, recentreports indicate the gender gap has been closing markedlyin recent years. Allergic rhinitis causes rhinorrheabut is not well noted for headache. (Many people withself-proclaimed sinus headaches may actually have clusterheadaches.) Migraine headaches last longer but donot recur in clusters. The patient’s history suggests thathe once had traumatic headaches following a concussion,but they would not recur after a year’s absence. Tensionheadaches are known for gradual beginnings and endingsrather than the sudden starts and stops depicted inthe vignette.ReferencesBeck E , Sioeber WJ , Frejo R . Management of cluster headaches .Am Fam Physician . 2005 ; 71 : 717 – 724 , 728 .Family Medicine Board Review 2009. May 3–9, 2009 .Kurowski K . Headache . In: Rudy DR , Kurowski K , eds. FamilyMedicine: House Officer Series . Baltimore : Williams & Wilkins ;1997 : 43 – 56 .Maitzels M . The patient with daily headaches . Am Fam Physician .2004 ; 70 : 2299 – 2306 .