SlideShare a Scribd company logo
1 of 30
Download to read offline
HEADACHE
HEADACHE
HEADACHE

• Headache affects 75% of population per year (45 million
 people) and 25% of Neurology OP referrals
HEADACHE

• Headache affects 75% of population per year (45 million
 people) and 25% of Neurology OP referrals
• Daily   headache affects 4% of population
HEADACHE

• Headache affects 75% of population per year (45 million
 people) and 25% of Neurology OP referrals
• Daily   headache affects 4% of population
• Onany day 90,000 people are absent from work or school
 because of headache
HEADACHE

• Headache affects 75% of population per year (45 million
 people) and 25% of Neurology OP referrals
• Daily   headache affects 4% of population
• Onany day 90,000 people are absent from work or school
 because of headache
• Migrainealone accounts for 20 million lost work or school
 days per year
CLASSIFICATION OF HEADACHE 1. PRIMARY
                     HEADACHE
                         (FROM IHS 2003)

(must have characteristic or benign features without abnormal
    neurological signs)

	

   1. Migraine

	

   2. Tension-type headache
      3. Cluster
CLASSIFICATION OF HEADACHE 2. SECONDARY
                       HEADACHE
                                (FROM IHS 2003)


	

   4. Head or neck trauma 

	

 5. Cranial or cervical vascular disorders (Temporal Arteritis)

	

 6. Non-vascular intracranial disorders (tumor, IIH,)

	

 7. Substances or their withdrawal

	

 8. Infection (meningitis)

	

 9. Disorder of homeostasis (bleed)
MIGRAINE

•   Age of onset is 10 - 30 years old

•   Familial

•   Unilateral > Bilateral

•   Lasts hours to days, onset usually gradual and worse at night
MIGRAINE CHARACTERISTICS
       THINK POUND
MIGRAINE CHARACTERISTICS
                      THINK POUND

• P: Pulsatile   Quality
MIGRAINE CHARACTERISTICS
                      THINK POUND

• P: Pulsatile   Quality

• O: duration    4-72 hOurs
MIGRAINE CHARACTERISTICS
                      THINK POUND

• P: Pulsatile   Quality

• O: duration    4-72 hOurs

• U: Unilateral
MIGRAINE CHARACTERISTICS
                      THINK POUND

• P: Pulsatile   Quality

• O: duration    4-72 hOurs

• U: Unilateral

• N: Nausea      & Vomiting
MIGRAINE CHARACTERISTICS
                      THINK POUND

• P: Pulsatile   Quality

• O: duration    4-72 hOurs

• U: Unilateral

• N: Nausea      & Vomiting

• D: Disabling    intensity
TENSION - TYPE
•   Two of the following pain characteristics:
       ✴   pressing or tightening (nonpulsating) quality
       ✴   mild to moderate intensity
       ✴   bilateral
•   Both of the following:
       ✴ no vomiting
       ✴ no more than one of the following (photophobia, phonophobia, nausea)

•   Lasting 30 mins to 7 days

•   At least 10 previous headache episodes with the above
    characteristics; less then 180 per year.
CLUSTER
•   Several unilateral, supraorbital, &/or temporal pain lasting 15 - 180
    mins (untreated)

•   Headache associated with at least ONE of:
       ✴   conjunctival injection or lacrimation
       ✴   nasal congestion/rhinorrhea
       ✴   miosis/ptosis
       ✴   eyelid edema
       ✴   a sense of restlessness or agitation

•   At least 5 attacks with above symptoms (can have up to 8 a day)
HEADACHE - DANGER
                SIGNALS
• First     and worst headache
• Association           with
    •   loss of consciousness or collapses
    •   non-migrainous visual disturbances or focal neurological signs
    •   fever or rash

•   Sudden headache with vomiting and/or loss of consciousness at
    onset

•   Neck stiffness

•   Jaw claudication (pts over 50)
HEADACHE - CONCERNING
              FEATURES
•   New onset headache after age 50
•   Genuinely increasing frequency and severity
•   Waking patient from sleep
•   Unresponsive to treatment
•   Always on same side
•   Following head trauma
•   Precipitated by exertion
•   New headache in patients:
    •   On anticoagulants
    •   With HIV or cancer
DIAGNOSIS
•   Careful history

    •   ask about BCP, look for warning signs

•   Examination

    •   to exclude focal neurological signs

    •   evidence of anxiety, tension or depression
INVESTIGATIONS
•   None may be necessary

•   Investigation of systemic disease if suspected

•   ESR & CRP if Temporal Arteritis (vasculitis)suspected

•   CT if:
    • new-onset headache (over 40!)
    • different/more severe (worst ever)
    • sudden onset (thunderclap)
    • associated with fever, meningismus, LOC change, focal neuro
      findings, recent head injury, optic disk edema, headache in morning
      associated with nausea or vomiting.
INVESTIGATIONS CONT.

•   LP urgently indicated when:

    •   clinical suspicion of subarachnoid hemorrhage in setting of negative
        or normal CT scan
           ✴   severe headache, N&V, nuchal rigidity, impaired LOC




    •   clinical suspicion of an infectious or inflammatory cause of
        headache
TREATMENT
           Begin timely appropriate treatment

• Glucocorticoid treatment should be instituted promptly
once the dx of TA is strongly suspected- often before it is
confirmed.

• In Meningitis antibiotic therapy should be initiated
immediately after the LP, or if CT than immediately after
blood cultures are drawn.

• SAH, stop antithrombotics, watch and try to control
elevation of intracranial pressure, CALL FOR HELP!
BENIGN HEADACHE
                  MANAGEMENT
•   Accurate diagnosis

•   Clear explanation

•   Discuss environmental factors

•   General advice
    •   diet, coffee, alcohol, lifestyle, use of analgesics
    •   Stress and anxiety management
    •   relaxation

•   Specific treatment
ACUTE ATTACKS OF MIGRAINE
•   Early analgesics - mild to moderate attacks
    •   Aspirin 650 - 1300mg po q4h (max 4g/24hrs)
    •   Ibuprofen 400 - 800mg (max 3.2g/24hrs)
    •   Combo (Tylenol #3)
    •   Butorphanol (rescue tx or when triptans ineffective or contraindicated)

•   Analgesics plus antiemetics
    •   Metoclopramide
    •   Buccastem

•   Triptans - first line in severe attacks
•   Ergots - first line in ultra severe attacks
PREVENTION OF MIGRAINE
•   Consider if 2 or more attacks per month
    •   Beta-blockers - 1st line treatment
    •   TCA’s - 1st line (if associated with depression, chronic pain, tension)
    •   CCB - reduce frequency but little effect on duration and intensity

    •   Anticonvulsants - 1st line for severe migraine
    •   5HT-2 - 2nd line, (Pizotifen)
    •   Erogots - 3rd line, (Methysergide)
MANAGEMENT OF TENSION-TYPE
             HEADACHE

• Lifestyle   issues            • Drugs
  • work-home-leisure balance     – limited simple
  • exercise                        analgesics
  • sleep                         – amitriptyline
                                  – SSRIs/TCA
• Physical    measures
                                  – Botox
  • relaxation
  • physio
  • self-help
MANAGEMENT OF CLUSTER
         HEADACHES

•   Acute Treatment: Subcutaneous sumatriptan and oxygen inhalation
    are the 1st line treatment. Also consider ergots, lidocaine and
    octreotide.

•   Preventive Treatment: start asap at the onset of a cluster episode.
    Verapamil is 1st line therapy. Also consider glucocorticoids, lithium,
    topiramate and methysergide.
REMEMBER


        Watch for RED FLAGS

    Avoid narcotic abuse/dependance

      Refer when you need HELP
“WOLCOTT’S INSTANT PAIN
    ANNIHILATOR”

More Related Content

What's hot (20)

Approach to a_case_of_headache
Approach to a_case_of_headacheApproach to a_case_of_headache
Approach to a_case_of_headache
 
Secondary headache
Secondary headacheSecondary headache
Secondary headache
 
HEADACHE - CLASSIFICATION
HEADACHE - CLASSIFICATIONHEADACHE - CLASSIFICATION
HEADACHE - CLASSIFICATION
 
Headache for post basic neuroscience course 2015
Headache for post basic neuroscience course 2015Headache for post basic neuroscience course 2015
Headache for post basic neuroscience course 2015
 
Approach to patient with headache
Approach to patient with headacheApproach to patient with headache
Approach to patient with headache
 
Migraine Headache
Migraine HeadacheMigraine Headache
Migraine Headache
 
Headache
Headache Headache
Headache
 
cluster headaches
 cluster headaches cluster headaches
cluster headaches
 
Migraine
MigraineMigraine
Migraine
 
Headache primary and secondary
Headache primary and secondaryHeadache primary and secondary
Headache primary and secondary
 
Headache
HeadacheHeadache
Headache
 
Headache (tension type headache, migraine)
Headache (tension type headache, migraine)Headache (tension type headache, migraine)
Headache (tension type headache, migraine)
 
HEADACHE
HEADACHEHEADACHE
HEADACHE
 
Headache
HeadacheHeadache
Headache
 
Headache
HeadacheHeadache
Headache
 
Migraine
MigraineMigraine
Migraine
 
Approach to headache
Approach to headacheApproach to headache
Approach to headache
 
Headache types & management
Headache types & managementHeadache types & management
Headache types & management
 
Headache
HeadacheHeadache
Headache
 
Headache
HeadacheHeadache
Headache
 

Viewers also liked

Viewers also liked (6)

att1_headache_mar07
att1_headache_mar07att1_headache_mar07
att1_headache_mar07
 
Primary headache kuliah fk uwks
Primary headache kuliah fk uwksPrimary headache kuliah fk uwks
Primary headache kuliah fk uwks
 
Primary headache
Primary headachePrimary headache
Primary headache
 
Primary headache
Primary headachePrimary headache
Primary headache
 
Primary Headache
Primary HeadachePrimary Headache
Primary Headache
 
Headache ppt
Headache pptHeadache ppt
Headache ppt
 

Similar to Headache Types, Causes, Symptoms and Treatment

Symptom analysis - HEADACHE
Symptom analysis - HEADACHESymptom analysis - HEADACHE
Symptom analysis - HEADACHEJyothi Reshma S
 
Approach to the diagnosis and management of primary headache disorders-GP-rec...
Approach to the diagnosis and management of primary headache disorders-GP-rec...Approach to the diagnosis and management of primary headache disorders-GP-rec...
Approach to the diagnosis and management of primary headache disorders-GP-rec...Adamu Mohammad
 
Approach to the diagnosis and management of primary headache disorders-GP-rec...
Approach to the diagnosis and management of primary headache disorders-GP-rec...Approach to the diagnosis and management of primary headache disorders-GP-rec...
Approach to the diagnosis and management of primary headache disorders-GP-rec...Adamu Mohammad
 
Sphenopalatine Neuralgia
Sphenopalatine NeuralgiaSphenopalatine Neuralgia
Sphenopalatine NeuralgiaShazeena Qaiser
 
Headaches and orthodontics 45° Sido International Congress
Headaches and orthodontics  45° Sido International CongressHeadaches and orthodontics  45° Sido International Congress
Headaches and orthodontics 45° Sido International CongressStudio Robotti
 
Chronic daily headache feb 13 photo
Chronic daily headache feb 13 photoChronic daily headache feb 13 photo
Chronic daily headache feb 13 photoNorton Healthcare
 
Anticonvulsives
AnticonvulsivesAnticonvulsives
AnticonvulsivesAmila17
 

Similar to Headache Types, Causes, Symptoms and Treatment (20)

Approach to Headache
Approach to HeadacheApproach to Headache
Approach to Headache
 
Headache
HeadacheHeadache
Headache
 
Headache hkl
Headache hklHeadache hkl
Headache hkl
 
Headace
HeadaceHeadace
Headace
 
Symptom analysis - HEADACHE
Symptom analysis - HEADACHESymptom analysis - HEADACHE
Symptom analysis - HEADACHE
 
Approach to the diagnosis and management of primary headache disorders-GP-rec...
Approach to the diagnosis and management of primary headache disorders-GP-rec...Approach to the diagnosis and management of primary headache disorders-GP-rec...
Approach to the diagnosis and management of primary headache disorders-GP-rec...
 
Approach to the diagnosis and management of primary headache disorders-GP-rec...
Approach to the diagnosis and management of primary headache disorders-GP-rec...Approach to the diagnosis and management of primary headache disorders-GP-rec...
Approach to the diagnosis and management of primary headache disorders-GP-rec...
 
HEADACHE GANTA-IMA.pptx
HEADACHE GANTA-IMA.pptxHEADACHE GANTA-IMA.pptx
HEADACHE GANTA-IMA.pptx
 
Sphenopalatine Neuralgia
Sphenopalatine NeuralgiaSphenopalatine Neuralgia
Sphenopalatine Neuralgia
 
Headaches and orthodontics 45° Sido International Congress
Headaches and orthodontics  45° Sido International CongressHeadaches and orthodontics  45° Sido International Congress
Headaches and orthodontics 45° Sido International Congress
 
Headache gp
Headache gpHeadache gp
Headache gp
 
Unusual Headaches
Unusual Headaches Unusual Headaches
Unusual Headaches
 
Headache
HeadacheHeadache
Headache
 
MIGRAINE
MIGRAINEMIGRAINE
MIGRAINE
 
Week 1 Sec. 2 Pain .pptx
Week 1 Sec. 2 Pain .pptxWeek 1 Sec. 2 Pain .pptx
Week 1 Sec. 2 Pain .pptx
 
Migraine
MigraineMigraine
Migraine
 
Headache
HeadacheHeadache
Headache
 
Chronic daily headache feb 13 photo
Chronic daily headache feb 13 photoChronic daily headache feb 13 photo
Chronic daily headache feb 13 photo
 
Epilepsy
EpilepsyEpilepsy
Epilepsy
 
Anticonvulsives
AnticonvulsivesAnticonvulsives
Anticonvulsives
 

Recently uploaded

CEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand University
CEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand UniversityCEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand University
CEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand UniversityHarshChauhan475104
 
PERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptx
PERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptxPERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptx
PERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptxdrashraf369
 
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptxPresentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptxpdamico1
 
Giftedness: Understanding Everyday Neurobiology for Self-Knowledge
Giftedness: Understanding Everyday Neurobiology for Self-KnowledgeGiftedness: Understanding Everyday Neurobiology for Self-Knowledge
Giftedness: Understanding Everyday Neurobiology for Self-Knowledgeassessoriafabianodea
 
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...Wessex Health Partners
 
MedDRA-A-Comprehensive-Guide-to-Standardized-Medical-Terminology.pdf
MedDRA-A-Comprehensive-Guide-to-Standardized-Medical-Terminology.pdfMedDRA-A-Comprehensive-Guide-to-Standardized-Medical-Terminology.pdf
MedDRA-A-Comprehensive-Guide-to-Standardized-Medical-Terminology.pdfSasikiranMarri
 
COVID-19 (NOVEL CORONA VIRUS DISEASE PANDEMIC ).pptx
COVID-19  (NOVEL CORONA  VIRUS DISEASE PANDEMIC ).pptxCOVID-19  (NOVEL CORONA  VIRUS DISEASE PANDEMIC ).pptx
COVID-19 (NOVEL CORONA VIRUS DISEASE PANDEMIC ).pptxBibekananda shah
 
PNEUMOTHORAX AND ITS MANAGEMENTS.pdf
PNEUMOTHORAX   AND  ITS  MANAGEMENTS.pdfPNEUMOTHORAX   AND  ITS  MANAGEMENTS.pdf
PNEUMOTHORAX AND ITS MANAGEMENTS.pdfDolisha Warbi
 
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurMETHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurNavdeep Kaur
 
SGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdf
SGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdfSGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdf
SGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdfHongBiThi1
 
Measurement of Radiation and Dosimetric Procedure.pptx
Measurement of Radiation and Dosimetric Procedure.pptxMeasurement of Radiation and Dosimetric Procedure.pptx
Measurement of Radiation and Dosimetric Procedure.pptxDr. Dheeraj Kumar
 
Plant Fibres used as Surgical Dressings PDF.pdf
Plant Fibres used as Surgical Dressings PDF.pdfPlant Fibres used as Surgical Dressings PDF.pdf
Plant Fibres used as Surgical Dressings PDF.pdfDivya Kanojiya
 
Valproic Acid. (VPA). Antiseizure medication
Valproic Acid.  (VPA). Antiseizure medicationValproic Acid.  (VPA). Antiseizure medication
Valproic Acid. (VPA). Antiseizure medicationMohamadAlhes
 
Apiculture Chapter 1. Introduction 2.ppt
Apiculture Chapter 1. Introduction 2.pptApiculture Chapter 1. Introduction 2.ppt
Apiculture Chapter 1. Introduction 2.pptkedirjemalharun
 
Clinical Pharmacotherapy of Scabies Disease
Clinical Pharmacotherapy of Scabies DiseaseClinical Pharmacotherapy of Scabies Disease
Clinical Pharmacotherapy of Scabies DiseaseSreenivasa Reddy Thalla
 
Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...
Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...
Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...MehranMouzam
 
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara RajendranMusic Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara RajendranTara Rajendran
 
PHYSIOTHERAPY IN HEART TRANSPLANTATION..
PHYSIOTHERAPY IN HEART TRANSPLANTATION..PHYSIOTHERAPY IN HEART TRANSPLANTATION..
PHYSIOTHERAPY IN HEART TRANSPLANTATION..AneriPatwari
 
Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.Prerana Jadhav
 
systemic bacteriology (7)............pptx
systemic bacteriology (7)............pptxsystemic bacteriology (7)............pptx
systemic bacteriology (7)............pptxEyobAlemu11
 

Recently uploaded (20)

CEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand University
CEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand UniversityCEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand University
CEHPALOSPORINS.pptx By Harshvardhan Dev Bhoomi Uttarakhand University
 
PERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptx
PERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptxPERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptx
PERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptx
 
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptxPresentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
 
Giftedness: Understanding Everyday Neurobiology for Self-Knowledge
Giftedness: Understanding Everyday Neurobiology for Self-KnowledgeGiftedness: Understanding Everyday Neurobiology for Self-Knowledge
Giftedness: Understanding Everyday Neurobiology for Self-Knowledge
 
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
 
MedDRA-A-Comprehensive-Guide-to-Standardized-Medical-Terminology.pdf
MedDRA-A-Comprehensive-Guide-to-Standardized-Medical-Terminology.pdfMedDRA-A-Comprehensive-Guide-to-Standardized-Medical-Terminology.pdf
MedDRA-A-Comprehensive-Guide-to-Standardized-Medical-Terminology.pdf
 
COVID-19 (NOVEL CORONA VIRUS DISEASE PANDEMIC ).pptx
COVID-19  (NOVEL CORONA  VIRUS DISEASE PANDEMIC ).pptxCOVID-19  (NOVEL CORONA  VIRUS DISEASE PANDEMIC ).pptx
COVID-19 (NOVEL CORONA VIRUS DISEASE PANDEMIC ).pptx
 
PNEUMOTHORAX AND ITS MANAGEMENTS.pdf
PNEUMOTHORAX   AND  ITS  MANAGEMENTS.pdfPNEUMOTHORAX   AND  ITS  MANAGEMENTS.pdf
PNEUMOTHORAX AND ITS MANAGEMENTS.pdf
 
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurMETHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
 
SGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdf
SGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdfSGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdf
SGK HÓA SINH NĂNG LƯỢNG SINH HỌC 2006.pdf
 
Measurement of Radiation and Dosimetric Procedure.pptx
Measurement of Radiation and Dosimetric Procedure.pptxMeasurement of Radiation and Dosimetric Procedure.pptx
Measurement of Radiation and Dosimetric Procedure.pptx
 
Plant Fibres used as Surgical Dressings PDF.pdf
Plant Fibres used as Surgical Dressings PDF.pdfPlant Fibres used as Surgical Dressings PDF.pdf
Plant Fibres used as Surgical Dressings PDF.pdf
 
Valproic Acid. (VPA). Antiseizure medication
Valproic Acid.  (VPA). Antiseizure medicationValproic Acid.  (VPA). Antiseizure medication
Valproic Acid. (VPA). Antiseizure medication
 
Apiculture Chapter 1. Introduction 2.ppt
Apiculture Chapter 1. Introduction 2.pptApiculture Chapter 1. Introduction 2.ppt
Apiculture Chapter 1. Introduction 2.ppt
 
Clinical Pharmacotherapy of Scabies Disease
Clinical Pharmacotherapy of Scabies DiseaseClinical Pharmacotherapy of Scabies Disease
Clinical Pharmacotherapy of Scabies Disease
 
Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...
Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...
Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...
 
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara RajendranMusic Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
 
PHYSIOTHERAPY IN HEART TRANSPLANTATION..
PHYSIOTHERAPY IN HEART TRANSPLANTATION..PHYSIOTHERAPY IN HEART TRANSPLANTATION..
PHYSIOTHERAPY IN HEART TRANSPLANTATION..
 
Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.
 
systemic bacteriology (7)............pptx
systemic bacteriology (7)............pptxsystemic bacteriology (7)............pptx
systemic bacteriology (7)............pptx
 

Headache Types, Causes, Symptoms and Treatment

  • 3. HEADACHE • Headache affects 75% of population per year (45 million people) and 25% of Neurology OP referrals
  • 4. HEADACHE • Headache affects 75% of population per year (45 million people) and 25% of Neurology OP referrals • Daily headache affects 4% of population
  • 5. HEADACHE • Headache affects 75% of population per year (45 million people) and 25% of Neurology OP referrals • Daily headache affects 4% of population • Onany day 90,000 people are absent from work or school because of headache
  • 6. HEADACHE • Headache affects 75% of population per year (45 million people) and 25% of Neurology OP referrals • Daily headache affects 4% of population • Onany day 90,000 people are absent from work or school because of headache • Migrainealone accounts for 20 million lost work or school days per year
  • 7. CLASSIFICATION OF HEADACHE 1. PRIMARY HEADACHE (FROM IHS 2003) (must have characteristic or benign features without abnormal neurological signs) 1. Migraine 2. Tension-type headache 3. Cluster
  • 8. CLASSIFICATION OF HEADACHE 2. SECONDARY HEADACHE (FROM IHS 2003) 4. Head or neck trauma  5. Cranial or cervical vascular disorders (Temporal Arteritis) 6. Non-vascular intracranial disorders (tumor, IIH,) 7. Substances or their withdrawal 8. Infection (meningitis) 9. Disorder of homeostasis (bleed)
  • 9. MIGRAINE • Age of onset is 10 - 30 years old • Familial • Unilateral > Bilateral • Lasts hours to days, onset usually gradual and worse at night
  • 11. MIGRAINE CHARACTERISTICS THINK POUND • P: Pulsatile Quality
  • 12. MIGRAINE CHARACTERISTICS THINK POUND • P: Pulsatile Quality • O: duration 4-72 hOurs
  • 13. MIGRAINE CHARACTERISTICS THINK POUND • P: Pulsatile Quality • O: duration 4-72 hOurs • U: Unilateral
  • 14. MIGRAINE CHARACTERISTICS THINK POUND • P: Pulsatile Quality • O: duration 4-72 hOurs • U: Unilateral • N: Nausea & Vomiting
  • 15. MIGRAINE CHARACTERISTICS THINK POUND • P: Pulsatile Quality • O: duration 4-72 hOurs • U: Unilateral • N: Nausea & Vomiting • D: Disabling intensity
  • 16. TENSION - TYPE • Two of the following pain characteristics: ✴ pressing or tightening (nonpulsating) quality ✴ mild to moderate intensity ✴ bilateral • Both of the following: ✴ no vomiting ✴ no more than one of the following (photophobia, phonophobia, nausea) • Lasting 30 mins to 7 days • At least 10 previous headache episodes with the above characteristics; less then 180 per year.
  • 17. CLUSTER • Several unilateral, supraorbital, &/or temporal pain lasting 15 - 180 mins (untreated) • Headache associated with at least ONE of: ✴ conjunctival injection or lacrimation ✴ nasal congestion/rhinorrhea ✴ miosis/ptosis ✴ eyelid edema ✴ a sense of restlessness or agitation • At least 5 attacks with above symptoms (can have up to 8 a day)
  • 18. HEADACHE - DANGER SIGNALS • First and worst headache • Association with • loss of consciousness or collapses • non-migrainous visual disturbances or focal neurological signs • fever or rash • Sudden headache with vomiting and/or loss of consciousness at onset • Neck stiffness • Jaw claudication (pts over 50)
  • 19. HEADACHE - CONCERNING FEATURES • New onset headache after age 50 • Genuinely increasing frequency and severity • Waking patient from sleep • Unresponsive to treatment • Always on same side • Following head trauma • Precipitated by exertion • New headache in patients: • On anticoagulants • With HIV or cancer
  • 20. DIAGNOSIS • Careful history • ask about BCP, look for warning signs • Examination • to exclude focal neurological signs • evidence of anxiety, tension or depression
  • 21. INVESTIGATIONS • None may be necessary • Investigation of systemic disease if suspected • ESR & CRP if Temporal Arteritis (vasculitis)suspected • CT if: • new-onset headache (over 40!) • different/more severe (worst ever) • sudden onset (thunderclap) • associated with fever, meningismus, LOC change, focal neuro findings, recent head injury, optic disk edema, headache in morning associated with nausea or vomiting.
  • 22. INVESTIGATIONS CONT. • LP urgently indicated when: • clinical suspicion of subarachnoid hemorrhage in setting of negative or normal CT scan ✴ severe headache, N&V, nuchal rigidity, impaired LOC • clinical suspicion of an infectious or inflammatory cause of headache
  • 23. TREATMENT Begin timely appropriate treatment • Glucocorticoid treatment should be instituted promptly once the dx of TA is strongly suspected- often before it is confirmed. • In Meningitis antibiotic therapy should be initiated immediately after the LP, or if CT than immediately after blood cultures are drawn. • SAH, stop antithrombotics, watch and try to control elevation of intracranial pressure, CALL FOR HELP!
  • 24. BENIGN HEADACHE MANAGEMENT • Accurate diagnosis • Clear explanation • Discuss environmental factors • General advice • diet, coffee, alcohol, lifestyle, use of analgesics • Stress and anxiety management • relaxation • Specific treatment
  • 25. ACUTE ATTACKS OF MIGRAINE • Early analgesics - mild to moderate attacks • Aspirin 650 - 1300mg po q4h (max 4g/24hrs) • Ibuprofen 400 - 800mg (max 3.2g/24hrs) • Combo (Tylenol #3) • Butorphanol (rescue tx or when triptans ineffective or contraindicated) • Analgesics plus antiemetics • Metoclopramide • Buccastem • Triptans - first line in severe attacks • Ergots - first line in ultra severe attacks
  • 26. PREVENTION OF MIGRAINE • Consider if 2 or more attacks per month • Beta-blockers - 1st line treatment • TCA’s - 1st line (if associated with depression, chronic pain, tension) • CCB - reduce frequency but little effect on duration and intensity • Anticonvulsants - 1st line for severe migraine • 5HT-2 - 2nd line, (Pizotifen) • Erogots - 3rd line, (Methysergide)
  • 27. MANAGEMENT OF TENSION-TYPE HEADACHE • Lifestyle issues • Drugs • work-home-leisure balance – limited simple • exercise analgesics • sleep – amitriptyline – SSRIs/TCA • Physical measures – Botox • relaxation • physio • self-help
  • 28. MANAGEMENT OF CLUSTER HEADACHES • Acute Treatment: Subcutaneous sumatriptan and oxygen inhalation are the 1st line treatment. Also consider ergots, lidocaine and octreotide. • Preventive Treatment: start asap at the onset of a cluster episode. Verapamil is 1st line therapy. Also consider glucocorticoids, lithium, topiramate and methysergide.
  • 29. REMEMBER Watch for RED FLAGS Avoid narcotic abuse/dependance Refer when you need HELP
  • 30. “WOLCOTT’S INSTANT PAIN ANNIHILATOR”

Editor's Notes

  1. \n
  2. \n
  3. \n
  4. \n
  5. \n
  6. \n
  7. \n
  8. \n
  9. \n
  10. \n
  11. \n
  12. \n
  13. \n
  14. \n
  15. \n
  16. \n
  17. \n
  18. \n
  19. \n
  20. \n
  21. \n
  22. \n
  23. \n
  24. \n
  25. \n
  26. \n
  27. \n
  28. \n