common cause for headache

1. Dr. K. Vasantha M.S., F.R.C.S.
Director RIO Chennai Rtd

2.  Females in the age group 15 to 44 years
 Obese females esp. those with recent weight gain
 Men in similar age group or slightly older also may be
affected. Incidence of sleep apnea is more in these
patients

3.  Papilledema
 Elevated intracranial pressure
 No abnormalities in CSF
 No space occupying lesions
 No abnormalities in the brain parenchyma
 No hydrocephalus

4. Sometimes
 Empty sella
 Flattening of posterior part of globe
 Distension of perioptic subarachnoid space
 Tortuous optic nerve
 Transverse venous sinus stenosis

5. Venous abnormalities like
 Cerebral venous sinus thrombosis
 Arteriovenous fistula
 Jugular vein obstruction – thrombosis or ligation
 Defective absorption of CSF
 Hypercoagulable state
 Superior vena cava thrombosis

6.  Tetracycline, doxycycline, minocycline
 Growth hormone – it increases the level of insulin like
growth factor which increases CSF secretion
 Steroid withdrawal – more in children
 Lithium

7.  Hypervitaminosis – more in children on all-trans retinoic
acid treatment
 Females who are on treatment for acne with tetracycline
and isotretinoin may be affected

8.  Middle ear or mastoid infection – contiguous infection
causing vessel wall infection and thrombophlebitis
 Sleep apnea
 Anemia - ? Due to hypoxia leading on to increased
capillary permeability or abnormalities in hemodynamics
due to high flow
 Renal failure, uremia

9.  Down syndrome
 Turner syndrome
 Addison’s disease
 Hypoparathyroidism
 Systemic lupus erythymatosis
 Also increased right heart pressure
 Respiratory diseases – hypercapnea induced cerebral
vasodilatation

10.  ? Due to decreased CSF absorption
 ? Elevated intra abdominal pressure due to obesity
leading on to increased pleural pressure and cardiac
filling pressure. This can cause intra cranial venous
pressure and increased intra cranial tension
 Narrowing of transverse sinus

11.  Headache
 Neck stiffness
 Retro bulbar pain
 Transient visual obscurations, gaze evoked amaurosis
 Diplopia
 Decrease in vision
 Tinnitus
 Rarely ophthalmoplegia and hemi facial spasm

12.  Visual loss – insidious, peripheral field loss
 Rarely acute loss due optic nerve ischemia or retinal
artery occlusion
 Functional visual loss
 Fields – enlargement of blind spot and loss due to nerve
fiber bundle defects

13.  Stage 1- normal optic disc
 Stage 2- C shaped halo on the nasal side with normal
temporal side
 Stage 2- halo all round. Optic cup will not be obliterated
 Stage 3- Partial obscuration of one or more segments of
blood vessels at the disc margin

14.  Stage 4- Almost complete obscuration of major blood
vessels on the disc
 Stage 5- partial or total obscuration of blood vessels on
the surface of optic disc

15.  CT and MRI must be done to rule out other causes for
papilledema
 Empty sella, arachnoid membrane herniating in to the
pituitary fossa
 Dilated tortuous optic nerve
 Elevation of optic disc head
 Slit like ventricles

16.  Lumbar puncture is done to assess the intra cranial
pressure
 CSF analysis will be normal

17.  No visual loss- treatment of headache with analgesics
 Anti depressants, reduction of weight and acetazolamide
if needed
 Mild loss- Acetazolamide, furosimide, weight reduction.
Topiramate is also given as it has acetazolamide like
action along with reduction in appetite

18. If the headache is very severe
 Medical decompression with mannitol
 If still intractable – surgical decompression with
craniotomy

19.  Intra venous steroids and acetazolamide
 Lumbo peritonial shunt or ventriculo peritonial shunt
 Optic nerve sheath decompression. This is now a days
done from the medial side, either trans conjunctivally or
through medial end of lid crease to avoid damage to
posterior choroidal artery. That will cause ischemia of
macula and severe visual loss