American Board of Internal Medicine (ABIM) Certification Practice Exam

Secondary headache from a dangerous mechanism does not include which of the following?

1. Ejection from a motor vehicle

2. Falling from a height of more than 3 feet

3. Severe tension-type headache

4. Physical signs of skull fracture

The correct answer is: Severe tension-type headache

Secondary headaches arise from underlying medical conditions or dangerous mechanisms, often indicating a potential serious issue. The distinguishing characteristic of severe tension-type headaches is that they are primarily associated with muscle tension and do not stem from an underlying pathology that can cause dangerous or life-threatening conditions. In contrast, the other options presented—ejection from a motor vehicle, falling from a height greater than three feet, and physical signs of skull fracture—are associated with events that can lead to serious injuries, including trauma that could result in secondary headaches due to bleeding, increased intracranial pressure, or other complications. These situations have a clear connection to mechanisms that can potentially lead to acute or chronic conditions requiring medical attention. Tension-type headaches, while painful, are typically considered primary headaches, meaning they are not caused by another disease or condition and are not classified as secondary headache disorders resulting from dangerous mechanisms. This fundamental distinction makes severe tension-type headaches the correct answer to the question about secondary headaches from dangerous mechanisms.