Headache quiz – The Emergency Medicine Manual

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Created on July 13, 2025 By Bob Dunn

Headache quiz

This is a 10 question quiz of single best choice MCQs with 4 options.
The questions are randomly selected from a bank of 50 questions so will be different each time the quiz is taken.
Questions are of an ACEM Fellowship exam degree of difficulty.

1 / 10

1. The most common type of neuroimaging abnormality in posterior reversible encephalopathy is

a) Bilateral, symmetrical subcortical cerebral oedema

b) Unilateral subcortical oedema

c) Unilateral cortical cerebral oedema

d) Bilateral asymmetrical subcortical cerebral oedema

The most common type of neuroimaging abnormality in posterior reversible encephalopathy is bilateral, symmetrical subcortical cerebral oedema.

The most common type of neuroimaging abnormality in posterior reversible encephalopathy is bilateral, symmetrical subcortical cerebral oedema.

2 / 10

2. The clinical feature with the highest positive predictive value for SAH in patients with headache is

a) Vomiting

b) Onset during exertion

c) Syncope at onset

d) Hypertension

The clinical feature with the highest positive predictive value for aneurysmal SAH in patients with headache is syncope at onset. The other features are common with many other types of headache.

The clinical feature with the highest positive predictive value for aneurysmal SAH in patients with headache is syncope at onset. The other features are common with many other types of headache.

3 / 10

3. The most sensitive feature on neuroimaging for intracranial hypertension of the following is

a) Empty Sella sign

b) Trans falcine herniation

c) Tortuosity of the optic sheaths

d) Increase CSF space in lateral wall of the cavernous sinus

Tortuosity and thickening of the optic sheaths and flattening of the posterior sclera are the most common imaging findings in intracranial hypertension.

Tortuosity and thickening of the optic sheaths and flattening of the posterior sclera are the most common imaging findings in intracranial hypertension.

4 / 10

4. The sensitivity of a modern plain CT brain for the detection of SAH within 24 hours of symptom onset is approximately

a) 40%

b) 95%

c) 80%

d) 60%

The sensitivity of a modern plain CT brain for the detection of SAH within 24 hours of symptom onset is approximately 95%. Previous suggestions that the sensitivity of CT drops significantly starting at 6 hours after symptom onset relate to now outdated CT technology, improvements in reporting and the way previous study results were reported.

The sensitivity of a modern plain CT brain for the detection of SAH within 24 hours of symptom onset is approximately 95%. Previous suggestions that the sensitivity of CT drops significantly starting at 6 hours after symptom onset relate to now outdated CT technology, improvements in reporting and the way previous study results were reported.

5 / 10

5. The target systolic blood pressure for the treatment of ischaemic stroke receiving thrombolytic therapy is

a) < 180 mmHg

b) < 120 mmHg

c) < 160 mmHg

d) < 140 mmHg

The target systolic blood pressure for the treatment of ischaemic stroke receiving thrombolytic therapy is < 180 mmHg.

The target systolic blood pressure for the treatment of ischaemic stroke receiving thrombolytic therapy is < 180 mmHg.

6 / 10

6. The target systolic blood pressure for the treatment of non traumatic intracerebral haemorrhage is

a) < 140 mmHg

b) < 180 mmHg

c) < 120 mmHg

d) < 160 mmHg

The target systolic blood pressure for the treatment of non traumatic intracerebral haemorrhage is < 140mm Hg. Lower pressures are not associated with improved outcome, and may be harmful.

The target systolic blood pressure for the treatment of non traumatic intracerebral haemorrhage is < 140mm Hg. Lower pressures are not associated with improved outcome, and may be harmful.

7 / 10

7. The earliest a headache has reported to have resolved following a SAH following presentation is

a) 24 hours

b) 6 hours

c) 2 hours

d) 10 hours

The earliest a headache has reported to have resolved following a SAH following presentation is 10 hours.

The earliest a headache has reported to have resolved following a SAH following presentation is 10 hours.

8 / 10

8. The target systolic blood pressure for the treatment of aneurysmal subarachnoid haemorrhage is

a) < 120 mmHg

b) < 160 mmHg

c) < 180 mmHg

d) < 140 mmHg

The target systolic blood pressure for the treatment of aneurysmal subarachnoid haemorrhage is < 160 mmHg.

The target systolic blood pressure for the treatment of aneurysmal subarachnoid haemorrhage is < 160 mmHg.

9 / 10

9. Which one of the following best represents the preferred initial therapy of a non traumatic cerebral dural sinus thrombosis

a) Systemic anticoagulation with unfractionated heparin and sBP control to < 140 mmHg

b) Intrasinus thrombolysis and sBP control to < 140 mmHg

c) Systemic anticoagulation

d) Systemic thrombolysis and sBP control to < 180 mmHg

Systemic anticoagulation is the preferred initial therapy of a non traumatic cerebral dural sinus thrombosis, with interventional thrombolysis or clot retrieval usually being second line options. Blood pressure control is not usually indicated and can reduce cerebral perfusion due to the high intracerebral venous pressures.

Systemic anticoagulation is the preferred initial therapy of a non traumatic cerebral dural sinus thrombosis, with interventional thrombolysis or clot retrieval usually being second line options. Blood pressure control is not usually indicated and can reduce cerebral perfusion due to the high intracerebral venous pressures.

10 / 10

10. Which one of the following blood pressure lowering agents should be avoided in the treatment of posterior reversible encephalopathy syndrome.

a) Metoprolol

b) GTN

c) Labetalol

d) Hydralazine

The blood pressure lowering agent that should be avoided in the treatment of posterior reversible encephalopathy syndrome is GTN. Apart from being associated with worse outcomes, it also potentiates headache so is best avoided in all patients with headache who require BP control.

The blood pressure lowering agent that should be avoided in the treatment of posterior reversible encephalopathy syndrome is GTN. Apart from being associated with worse outcomes, it also potentiates headache so is best avoided in all patients with headache who require BP control.

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