Brief presentation on how to approach a patient suffering from headache

1. Before diving the head-aching slides
What impression does
the next painting gives
you ??

3. :So
WHY worrying about headache , when some
people (including me  ) consider it part of their
lifestyle ?!
Is it dangerous ?
Is it annoying ?
ACTUALLY :
spectrum!!

4. Headache is just another pain
Site
Onset
Character
Radiation
Association
Timing
Exacerbating factors
Severity

5. Being afraid from the sinister part of
the spectrum :
We have to : Diagnose
Differentiate Classify
reassure
Or take it seriously … otherwise:

6. the approach
The patient will present with : ache in the head !
Is it your first time to develop headache ?
Or
is it your worst headache ?
yes :
Is there any feature of meningitis ?
Yes : go antibiotics and urgent Ix

7. Features of meningitis
Fever photophobia
Neck stiffness +ve kernigs
Signs of shock
Of the above,which one is specific for meningitis?

8. Farewell to meningitis
Any suspicion of acute intracranial pathology ?
How do we suspect acute problem ?
• glascow coma scale
• Focal neurolgical deficit
• New onset seizure
• Hx of recent head injury
• Any coagulopathy

9. Suspect SAH please
Acute in onset , and the most important :
Reaches the max. intensity within 5 minutes and
rarely resolves before one hour .
Neuroimaging and then CSF analysis are must
CT is sensitive in 95 % of bleeds
CSF after 12 hours . (What to find in CSF ? )
XANTHOCHROMIA

10. Look at the eye
Acute angle closure glaucoma
Suspect if middle or old aged
Patient developed periorbital
Pain , blurred vision , N&V
Conjunctival injection , halos
In addition to the headache .
Refer to Dr. NAJAH Immediately !
ER

11. Suspect Temporal Arteritis
• IF the patient is above 50 years
• Has jaw claudication , scalp tenderness , fever
• immediately send for ESR if raised give steroid
• Then confirm by temporal artery biopsy
Why the hurry
Ophthalmic artery is important for the patient

12. Take it easy it may be sinusitis
• the pain is dull , throbbing , with facial pain
over the affected sinus , worse on bending
forward . And there must be nasal symptoms
Refer to ENT

13. NONE OF THESE ? OKAY

14. Diagnostic criteria for migraine
• five or more headache episodes meeting the
following criteria , or two or more episodes
associated with typical aura .
1. headache duration of 4 – 72 hours
2. unilateral , pulsating , moderate to severe
intensity , disabling .
3. nausea , vomiting , photophobia ,
phonophobia

15. Diagnostic criteria for cluster
headache
• five or more episodes of headache with :
1. severe unilateral orbital , periorbital or
temporal pain .
2. duration from 15 min. – 3 hours frequent
times during the day
3. restlessness , agitation , ipsilateral
lacrimation , miosis , conjunctival injection

16. Cluster headaches

17. Or it could be Tension Headache

18. Tension Tension Tension

19. Tension headache

20. Diagnostic criteria for tension
headache
• Ten or more episodes of headache with the
following criteria ;
1. duration from 30 minutes – 7 days
2. Bilateral , tight or compressing , mild to
moderate intensity , non disabling .
3. No photophobia / phonophobia / nausea or
vomiting

21. To revise
• We have to exclude the rare but serious conditions
first in our differential , which was :
Meningitis
Acute intracranial pathology ( including SAH)
Acute angle closure glaucoma
Temporal arteritis
Sinusitis
Migraine
Cluster headache
Tension headaches

22. The spectrum
Meningitis tension headache
Dangerous annoying

24. Abstract art