Types of headache and management

1. HEADACHE (cephalalgia)

2. Headache
• Headache is defined as diffuse pain in various
parts of the head, with the pain not confined
to the area of distribution of a nerve.

3. • 30 years female
• Episodic throbbing headache
• One half of the face
• Associated with nausea vomiting parasthesia
of right upper and lower limb
• No aura
• Similar headaches in her mother

4. • 40 years old male
• Limited to right side head
• Daily headache
• 2 attack/day for 3 weeks
• Awakens the patient from sleep
• Associated with lacrimation, nasal stuffiness

5. • 65 years old female
• Right sided headache and blindness * 2 years
• Thick cord like structure on the lateral side of
the head
• ESR 80mm/hr in the first hour

6. • 45 yrs hypertensive male
• Sudden onset severe headache
• Associated with vomiting and neck stiffness
• No focal neurological deficit

7. Headache
Primary:
•Tension Type(69%)
•Migraine (16%)
•Idiopathic stabbing
•Exertional
•Cluster
Secondary Headache:
•Systemic infection
•Head injury
•Vascular Disorder
•SAH
•Brain tumour

9. Migraine
• Fronto-temporal
• Uni or bilateral
• Young female
• Throbbing (pulsatile)
• Upon awakening
• Bright light, noise, tension, alcohol,
• Nausea, vomiting, +- aura

12. Cluster Headache
• Orbito-temporal
• Adolescent male(90%)
• Intense, non throbbing
• Behind the eyes
• 1-2 hrs after falling asleep
• Alcohol(rare)
• Lacrimation, stuffed nostril, rhinorrhoea,
conunctival congestion, ptosis

15. Tension Headache
• Generalized
• More in women
• Feeling of tight band around head
• Start in the daytime and progressive
throughout the day maximum in the evening.
• fatigue, nervous strain
• Depression, anxiety

17. • Brain tumours / raised ICP: headaches that disturb sleep/ early
morning headaches
• Early morning headache on waking up and again at the end of day is
due to Maxillary sinusitis (diurnal variation)
• Office headache: due to Frontal sinusitis [patient wakes up mostly
without pain due to overnight drainage, develops pain after a few
hours that lasts throughout the day]
• Vacuum headache: the headache on waking up that may occur in
Frontal sinusitis due to over night drainage.

19. 1.Age, Sex, Occupation:
Migraine headache – more frequent in teenagers & young adults,
higher occurrence in female.
Cluster headache – almost exclusively in males.
Cranial arteritis – more frequently in late middle age & in elderly.
2. Duration
Tension headache -often has long duration.
Headache due to expanding of intracranial disease – usually short
duration.
Headache due to meningeal cause – acute in onset.
Migraine headache – recur over a long period of time, with
symptoms free interval between attacks
3. Location
As a general rule localized headache is of greater significance than
diffuse headache.
Tension headache – typically generalized, band like or bi-occipital.
Migraine with aura – often unilateral & frequently more
prominent interiorly.
Migraine without aura – frequently bilateral.
Cluster headache – invariably limited to the same side of the
head in any given attacks & usually periorbital

20. 4. Prodromal symptoms
Migraine headache – often precede by neurological
symptoms as scintillating scotoma, transient hemianopias,
hemimotor or hemisensory disturbance & dysphasia.
5. Associated symptoms
Tension headache – often associated with other psycho-
physiologic disturbances.
Cluster headache – typically associated with ipsilateral
lacrimation, Conjunctival injection, Rhinorrhoea, & Facial
Flushing.
6. Quality of pain
Tension headache – Pressing, Squeezing, Tight or Heavy.
Migraine headache – Throbbing or Pounding.
Headache due to intracranial lesion – Relatively Mild.
Acute SAH- Pain tends to be explosive & intense.

21. 8. Frequency, duration & diurnal variation
Tension headache – often persist & may worsen as the day progress.
Migraine headache – the frequency is variable & unpredictable.
Although usual variation is from 4 - 72 hrs, they may persist for days.
Cluster headache – occur repetitively over a period of weeks or
months. Often there are 1 or 2 attacks daily. The headache typically
nocturnal & of brief duration (30 min to a few hours).
9. Family History
Migraine headache – strong family history.
Cluster headache – are not familial.
10. Intracranial Mass Lesion –
Associated symptoms are more prominent than headache. Some intra-
cerebral lesion may exhibit seizure or vomiting.
11. Cranial arteritis
Systemic symptoms as fever, anorexia & rheumatic symptoms.
12.Tension headache & Vascular Headache
Induced or aggravated by emotional factors.
Intraventricular & posterior fossa tumour – may be accentuated by
change in the head position, coughing & Valsalva maneuver

22. 1. General physical examination:
Flushed face, lacrimation, and unilateral rhinorrhoea – cluster
headache.
Systemic sign (fever, weight loss, anaemia) – infectious disease,
specific infection of CNS, metastatic disease of brain &/or
meninges.
2. Neurological examination:
No neurological abnormality – tension headache.
Evidence of cerebral ischaemia – small percentage of
migraine (permanent residual damage).
Horner’s syndrome – sometimes during migraine headache
(rarely permanent).
Localizing sign – expanding ICSOL.
Papilloedema -- ICP due to ICSOL.
Bruits over the eyes/cranium – vascular malformation.
Sign of meningeal irritation – lesion affecting the meninges.

23. Thank you