Headache Practice Questions

30 multiple-choice questions on Headache for paramedic and EMT students, from Chapter 19 (Neurologic Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. The most common type of primary headache is:

   1. A. Tension-type
   2. B. Migraine type
   3. C. Cluster type
   4. D. Sinus-related
   Show answer

   Answer: A. Tension-type

   Tension-type headache is the most common primary headache, typically a bilateral, band-like, pressing pain without nausea or significant photophobia.

2. A 29-year-old woman has a throbbing one-sided headache with nausea and light sensitivity, similar to prior episodes. This most likely represents:

   1. A. Cluster headache
   2. B. Tension headache
   3. C. Subarachnoid bleed
   4. D. Migraine
   Show answer

   Answer: D. Migraine

   Unilateral, pulsating pain with nausea, photophobia, and phonophobia, recurring in a familiar pattern, is typical of migraine.

3. A patient reports seeing zigzag flashing lights for 20 minutes before her headache began. This is a:

   1. A. Retinal detachment
   2. B. Seizure postictal sign
   3. C. Migraine aura
   4. D. Cluster prodrome
   Show answer

   Answer: C. Migraine aura

   Visual auras such as scintillating zigzag lines typically last 5 to 60 minutes and precede or accompany migraine headache.

4. A 40-year-old man has severe stabbing pain behind his right eye with tearing and a runny nostril on the same side, recurring nightly for weeks. This is most likely:

   1. A. Migraine without aura
   2. B. Cluster headache
   3. C. Temporal arteritis
   4. D. Trigeminal neuralgia
   Show answer

   Answer: B. Cluster headache

   Cluster headaches are severe, unilateral orbital pains with ipsilateral autonomic signs, occurring in clusters, most often in men.

5. Which prehospital treatment is notably effective for cluster headache?

   1. A. High-flow oxygen
   2. B. Low-flow nasal oxygen
   3. C. Ice packs to the neck
   4. D. Oral acetaminophen
   Show answer

   Answer: A. High-flow oxygen

   High-flow oxygen (about 12 to 15 L/min by nonrebreather mask for 15 minutes) aborts many cluster attacks.

6. Patients with cluster headache are commonly described as:

   1. A. Lying still in the dark
   2. B. Sleeping through the pain
   3. C. Calm and expressionless
   4. D. Restless and pacing
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   Answer: D. Restless and pacing

   Unlike migraine sufferers, who prefer to lie still in a dark room, cluster patients are often agitated and pace during attacks.

7. A sudden headache that reaches maximum intensity within one minute is called a:

   1. A. Cluster headache
   2. B. Rebound headache
   3. C. Thunderclap headache
   4. D. Exertional headache
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   Answer: C. Thunderclap headache

   Thunderclap headache is a red flag for subarachnoid hemorrhage, arterial dissection, or venous thrombosis and requires emergency evaluation.

8. Which headache feature is a red flag for a dangerous secondary cause?

   1. A. Pain similar to past migraines
   2. B. New onset after age 50
   3. C. Gradual onset with stress
   4. D. Bilateral band-like pressure
   Show answer

   Answer: B. New onset after age 50

   New headaches after 50, sudden onset, neuro deficits, fever, or a change in pattern suggest secondary causes such as bleeding, tumor, or arteritis.

9. A 34-year-old with a history of migraine has had her usual migraine for 4 days despite her home medicines. Her neurologic exam is normal and the headache feels like her typical attacks. How is this best described?

   1. A. A tension-type headache
   2. B. Medication overuse headache
   3. C. Status migrainosus
   4. D. A cluster headache
   Show answer

   Answer: C. Status migrainosus

   A debilitating migraine lasting more than 72 hours is called status migrainosus. It often needs hospital treatment with IV fluids, antiemetics and other drugs, and any change from the patient's usual pattern still calls for a search for a dangerous cause. Tension-type headache is mild and without vomiting, medication overuse headache is a near-daily headache from frequent pain-reliever use, and cluster headaches last minutes to hours.

10. Medical control is choosing IV treatment for a patient with a typical severe migraine. Which first-line choice is supported by headache guidelines?

    1. A. Morphine titrated until the pain is relieved
    2. B. An antiemetic such as prochlorperazine
    3. C. Hydromorphone as a single IV dose
    4. D. IV diazepam for muscle relaxation
    Show answer

    Answer: B. An antiemetic such as prochlorperazine

    American Headache Society guidance for the emergency department supports dopamine-blocking antiemetics such as prochlorperazine or metoclopramide (and subcutaneous sumatriptan) for acute migraine, and advises against opioids such as morphine and hydromorphone as first-line treatment because they work less well and lead to return visits. Benzodiazepines such as diazepam are not a migraine treatment. Watch for akathisia or dystonia after dopamine blockers.

11. A patient with a typical severe migraine has a BP of 164/96 mm Hg. Her neurologic exam is normal and she has no other symptoms. How should you interpret the BP?

    1. A. A hypertensive emergency needing quick lowering
    2. B. Likely raised by pain; recheck after treatment
    3. C. Proof of a brain hemorrhage
    4. D. A sign that the migraine is a stroke
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    Answer: B. Likely raised by pain; recheck after treatment

    Pain, nausea and anxiety commonly raise the BP during a migraine. With a normal neurologic exam and no signs of organ damage, treat the symptoms and recheck the BP, which often falls as the pain improves. A hypertensive emergency requires acute organ damage, and a moderately raised BP does not prove a hemorrhage or a stroke, though any new deficit would change that.

12. A 76-year-old taking apixaban has a new, moderate headache that started this morning. She does not remember hitting her head and her exam is normal. What is the main concern?

    1. A. Bleeding inside the skull
    2. B. A migraine starting late in life
    3. C. Caffeine withdrawal
    4. D. Muscle tension from poor sleep
    Show answer

    Answer: A. Bleeding inside the skull

    Any new headache in a patient taking an anticoagulant raises concern for intracranial bleeding, even without a clear injury and with a normal exam, so she needs transport for imaging. Migraine rarely begins after age 50, and caffeine withdrawal or muscle tension should be considered only after bleeding has been excluded.

13. A 35-year-old has a headache and neck pain that began after a rollercoaster ride, now with a right-sided Horner syndrome. You should suspect:

    1. A. Carotid dissection
    2. B. Cervical muscle strain
    3. C. Cluster headache
    4. D. Occipital neuralgia
    Show answer

    Answer: A. Carotid dissection

    Cervical artery dissection can follow minor neck trauma and presents with headache or neck pain, Horner syndrome, and possible stroke symptoms.

14. Which headache feature suggests idiopathic intracranial hypertension?

    1. A. Elderly man, jaw claudication
    2. B. Nightly orbital pain with tearing
    3. C. Fever and petechial rash
    4. D. Obese young woman, vision changes
    Show answer

    Answer: D. Obese young woman, vision changes

    Idiopathic intracranial hypertension typically affects obese women of childbearing age, causing headache, transient visual changes, and papilledema.

15. A woman on oral contraceptives has a progressive headache over several days with a seizure. Which condition should be considered?

    1. A. Cluster headache
    2. B. Tension headache
    3. C. Cerebral venous thrombosis
    4. D. Medication overuse headache
    Show answer

    Answer: C. Cerebral venous thrombosis

    Cerebral venous sinus thrombosis is associated with hormonal contraceptives, pregnancy, and the postpartum period and may present with headache, seizures, and deficits.

16. A patient takes pain relievers almost daily for headaches and now has a near-constant headache. This is likely:

    1. A. Episodic cluster headache
    2. B. Medication overuse headache
    3. C. Giant cell arteritis
    4. D. Bacterial brain abscess
    Show answer

    Answer: B. Medication overuse headache

    Frequent use of analgesics or triptans can cause chronic daily headache, sometimes called rebound headache.

17. A patient who received an epidural during labor yesterday has a headache that worsens when sitting up. This is most consistent with:

    1. A. Post-dural puncture headache
    2. B. Subarachnoid hemorrhage
    3. C. Migraine without an aura
    4. D. Hypertensive emergency
    Show answer

    Answer: A. Post-dural puncture headache

    Post-dural puncture headache results from CSF leak and is characteristically positional, worsening upright and improving lying flat.

18. Which comfort measure is most appropriate for a migraine patient during transport?

    1. A. Play music to distract the patient
    2. B. Repeat penlight pupil checks often
    3. C. Sit the patient fully upright
    4. D. Dim lights, reduce noise
    Show answer

    Answer: D. Dim lights, reduce noise

    Migraine patients are often photophobic and phonophobic; a dark, quiet environment can reduce symptoms. Music adds the sound that worsens phonophobia, and repeated bright penlight checks add light exposure without changing care when the neurologic exam is normal, so check the pupils when needed rather than over and over. Sitting fully upright is not required; let the patient choose a position of comfort.

19. A 28-year-old who smokes has migraine with aura and takes a combined estrogen birth control pill. Why is this combination concerning?

    1. A. It causes medication overuse headache
    2. B. It raises her risk of ischemic stroke
    3. C. It makes the aura more painful
    4. D. It blocks the effect of triptans
    Show answer

    Answer: B. It raises her risk of ischemic stroke

    Migraine with aura is linked to a higher risk of ischemic stroke, and estrogen-containing contraceptives and smoking raise that risk further, so CDC contraceptive guidance advises against combined hormonal methods in women with migraine with aura. The pill does not cause medication overuse headache, does not make the aura painful, and does not block triptans.

20. Every Saturday morning, a busy office worker who drinks five cups of coffee on weekdays wakes up with a dull headache that is relieved by coffee. What is the most likely cause?

    1. A. A brain tumor
    2. B. Caffeine withdrawal
    3. C. Cluster headache
    4. D. Carbon monoxide exposure
    Show answer

    Answer: B. Caffeine withdrawal

    Regular caffeine users often get a headache 12 to 24 hours after their usual intake stops, typically on weekends or days off, and caffeine relieves it within an hour. A tumor headache progresses and does not follow a weekend pattern, cluster headaches are severe and one-sided around the eye, and carbon monoxide headaches affect others in the home and do not improve with coffee.

21. Brief, electric-shock-like facial pain triggered by chewing or touching the cheek most suggests:

    1. A. Trigeminal neuralgia
    2. B. Bell palsy (CN VII)
    3. C. Cluster headache
    4. D. Temporal arteritis
    Show answer

    Answer: A. Trigeminal neuralgia

    Trigeminal neuralgia causes paroxysms of severe, lancinating pain in the CN V distribution, often triggered by light touch, eating, or talking.

22. Several days before a major subarachnoid hemorrhage, some patients have a milder sudden headache called a:

    1. A. Rebound headache
    2. B. Cluster headache
    3. C. Tension headache
    4. D. Sentinel headache
    Show answer

    Answer: D. Sentinel headache

    A sentinel headache may represent a small warning leak from an aneurysm; any sudden severe headache warrants evaluation.

23. Which statement about headache relief after medication is most accurate?

    1. A. Relief rules out a hemorrhage
    2. B. Relief confirms it is a migraine
    3. C. Relief does not rule out danger
    4. D. Relief excludes meningitis
    Show answer

    Answer: C. Relief does not rule out danger

    Headaches from subarachnoid hemorrhage and other serious causes can improve with analgesics, so response to treatment should not be used to rule out dangerous causes.

24. A patient with headache and neck stiffness has photophobia but no fever. Which condition must still be considered?

    1. A. Cluster headache
    2. B. Subarachnoid hemorrhage
    3. C. Acute sinus headache
    4. D. Tension-type headache
    Show answer

    Answer: B. Subarachnoid hemorrhage

    Blood in the subarachnoid space irritates the meninges, causing neck stiffness and photophobia without infection.

25. A patient's headache began gradually over weeks, is worse in the morning, and is associated with vomiting. This pattern suggests:

    1. A. Raised intracranial pressure
    2. B. Tension-type headache
    3. C. Episodic cluster headache
    4. D. Caffeine withdrawal
    Show answer

    Answer: A. Raised intracranial pressure

    Morning headaches with vomiting that progress over weeks suggest a mass lesion or other cause of raised ICP. Pressure rises when lying flat overnight.

26. Which element of the history most helps distinguish a primary headache from a new dangerous one?

    1. A. Comparison with prior headaches
    2. B. Its response to pain medicine
    3. C. How long they slept last night
    4. D. The patient's family history of migraine
    Show answer

    Answer: A. Comparison with prior headaches

    Asking whether this headache is like the patient's usual headaches, or different in onset, severity or features, is the most useful way to spot a new dangerous cause. Relief after a pain reliever does not separate a benign headache from a dangerous one, because headaches from a bleed can also ease with analgesics. How long they slept last night matters only because sleep loss can trigger a primary headache but does not exclude a dangerous one, and a family history of migraine does not rule out a new secondary headache.

27. Why should headache patients receive a full neurologic exam in the field?

    1. A. To classify the headache type
    2. B. To detect focal deficits
    3. C. To exclude a bleed if it is normal
    4. D. To choose the right pain medicine
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    Answer: B. To detect focal deficits

    Focal neurologic findings such as weakness, aphasia, or abnormal pupils indicate a secondary cause like stroke, hemorrhage, or mass lesion. A normal exam does not exclude a bleed, since a subarachnoid hemorrhage can present with headache alone, and the exam neither classifies primary headaches such as migraine or tension-type nor decides which pain medicine to give.

28. A 40-year-old has had headaches for 3 weeks that get sharply worse when he coughs, sneezes or strains, and he now wakes with headache and vomiting. Why is this pattern a red flag?

    1. A. It is typical of a tension headache
    2. B. It confirms a sinus infection
    3. C. It suggests raised brain pressure
    4. D. It points to caffeine withdrawal
    Show answer

    Answer: C. It suggests raised brain pressure

    Headache triggered or worsened by coughing, straining or lying down, especially with morning vomiting, suggests raised intracranial pressure or a lesion in the back of the skull, such as a tumor or a Chiari malformation, and needs imaging. Tension headaches are not triggered by straining, sinus infections cause facial pressure and fever, and caffeine withdrawal does not cause vomiting on waking.

29. A man with untreated hypertension and a BP of 162/98 mm Hg says his new daily headaches must be from his blood pressure. Which statement is most accurate?

    1. A. This BP level rarely causes headache
    2. B. This BP explains daily headaches
    3. C. His headache proves end-organ damage
    4. D. Lowering BP quickly will cure them
    Show answer

    Answer: A. This BP level rarely causes headache

    Most people with chronic hypertension have no headache unless the BP is very high, usually 180/120 mm Hg or more with signs of organ damage. A new daily headache at a moderately raised BP should not be blamed on BP alone, so look for another cause. A headache alone does not prove end-organ damage, and lowering the BP quickly is not indicated.

30. A 7-year-old has had morning headaches with vomiting for 3 weeks, and his parents notice that he is now clumsy and walks with his feet wide apart. What should you suspect?

    1. A. Childhood migraine with no danger
    2. B. A viral stomach infection
    3. C. A tumor in the back of the skull
    4. D. Poor vision from needing glasses
    Show answer

    Answer: C. A tumor in the back of the skull

    Most brain tumors in children arise in the posterior fossa near the cerebellum. They often block CSF flow, causing morning headache and vomiting from raised pressure, and the cerebellar involvement causes a wide-based, unsteady gait. Migraine does not cause ataxia, a stomach infection does not last weeks with clumsiness, and poor vision does not cause morning vomiting or an ataxic gait.