The document discusses the approach to diagnosing and managing primary headache disorders. It begins with an introduction to headaches and classification. It then covers the diagnostic criteria and treatment approaches for common primary headaches like migraine, tension-type headache, and cluster headache. The diagnosis involves taking a thorough headache history, performing an exam, and considering red flags for secondary headaches. Treatment involves both pharmacological options like triptans, beta-blockers, and oxygen for cluster headaches as well as non-pharmacological strategies like lifestyle modifications and avoiding triggers. The overall approach involves classifying the primary headache disorder and then selecting appropriate treatment strategies.
Recent Migraine Headache Approach and Treatment.pptxSURENDRAKHOSYA2
A migraine is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It's often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so bad that it interferes with your daily activities.
For some people, a warning symptom known as an aura occurs before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty speaking.
Medications can help prevent some migraines and make them less painful. The right medicines, combined with self-help remedies and lifestyle changes, might help.
Migraines are often undiagnosed and untreated. If you regularly have signs and symptoms of migraine, keep a record of your attacks and how you treated them. Then make an appointment with your health care provider to discuss your headaches.
Even if you have a history of headaches, see your health care provider if the pattern changes or your headaches suddenly feel different.
if you have any of the following signs and symptoms, which could indicate a more serious medical problem:
An abrupt, severe headache like a thunderclap.
Headache with fever, stiff neck, confusion, seizures, double vision, numbness or weakness in any part of the body, which could be a sign of a stroke.
Headache after a head injury.
A chronic headache that is worse after coughing, exertion, straining or a sudden movement.
New headache pain after age 50.
getting too much sleep can trigger migraines in some people.
Physical strain. Intense physical exertion, including sexual activity, might provoke migraines.
Weather changes. A change of weather or barometric pressure can prompt a migraine.
Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.
Foods. Aged cheeses and salty and processed foods might trigger migraines. So might skipping meals.
Food additives. These include the sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods.
"Decoding Headaches: A Comprehensive Approach with Dr. Ganesh"
🌟 Greetings, everyone! Dr. Ganesh here, and today we're going to unravel the intricate world of headaches. Whether you're a healthcare professional refining your skills or someone seeking answers to those persistent head pains, this discussion is tailored just for you.
Recent Migraine Headache Approach and Treatment.pptxSURENDRAKHOSYA2
A migraine is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It's often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so bad that it interferes with your daily activities.
For some people, a warning symptom known as an aura occurs before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty speaking.
Medications can help prevent some migraines and make them less painful. The right medicines, combined with self-help remedies and lifestyle changes, might help.
Migraines are often undiagnosed and untreated. If you regularly have signs and symptoms of migraine, keep a record of your attacks and how you treated them. Then make an appointment with your health care provider to discuss your headaches.
Even if you have a history of headaches, see your health care provider if the pattern changes or your headaches suddenly feel different.
if you have any of the following signs and symptoms, which could indicate a more serious medical problem:
An abrupt, severe headache like a thunderclap.
Headache with fever, stiff neck, confusion, seizures, double vision, numbness or weakness in any part of the body, which could be a sign of a stroke.
Headache after a head injury.
A chronic headache that is worse after coughing, exertion, straining or a sudden movement.
New headache pain after age 50.
getting too much sleep can trigger migraines in some people.
Physical strain. Intense physical exertion, including sexual activity, might provoke migraines.
Weather changes. A change of weather or barometric pressure can prompt a migraine.
Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.
Foods. Aged cheeses and salty and processed foods might trigger migraines. So might skipping meals.
Food additives. These include the sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods.
"Decoding Headaches: A Comprehensive Approach with Dr. Ganesh"
🌟 Greetings, everyone! Dr. Ganesh here, and today we're going to unravel the intricate world of headaches. Whether you're a healthcare professional refining your skills or someone seeking answers to those persistent head pains, this discussion is tailored just for you.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Approach to the diagnosis and management of primary headache disorders-GP-rec2.pdf
1. Approach to the diagnosis
and management of
primary headache
disorders
PROF. FRANK OJINI
CMUL/LUTH
2. Introduction
Headache classification
Common primary headache disorders
Approach to the diagnosis of headaches (headache history, exam and inv)
Primary vs secondary headaches
Treatment of primary headache disorders
Approach to headache in the ER
Summary
3. INTRODUCTION
• Headache disorders are among the most common disorders of the nervous system
• Half to three-quarters of the adult population have had a headache at least once in the
last year
• Recurrent headaches are associated with personal and society burdens of pain, disability,
damaged quality of life, and financial cost
• Headache has been underestimated, under-recognized and under-treated throughout the
world
4. THE INTERNATIONAL CLASSIFICATION OF
HEADACHE DISORDERS - III
• Part one:The primary headaches
• Part two:The secondary headaches
• Part three: Painful cranial neuropathies, other facial pains and
other headaches
5. THE PRIMARY HEADACHES
1. Migraine
2. Tension-type headache (TTH)
3. Trigeminal autonomic cephalalgias (TACs)
4. Other primary headaches
6. THE SECONDARY HEADACHES
5. Headache attributed to head and/or neck trauma
6. Headache attributed to cranial or cervical vascular disorder
7. Headache attributed to non-vascular intracranial disorder
8. Headache attributed to a substance or its withdrawal
9. Headache attributed to infection
10. Headache attributed to disorder of homeostasis
11. Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth,
mouth, or other facial or cranial structures
12. Headache attributed to psychiatric disorder
7. MIGRAINE
• Migraine is a familial disorder characterized by recurrent attacks of headache,
widely variable in intensity, frequency, and duration
• Attacks are commonly unilateral and are usually associated with anorexia, nausea
and vomiting
• In some cases, they are preceded by or associated with neurologic and mood
disturbances
(World Federation of Neurology)
8. DIAGNOSTIC CRITERIA FOR MIGRAINE
• Headache attacks lasting 4-72 hrs
• Headache has at least 2 of the following characteristics:
Unilateral location
Pulsating quality
Moderate or severe pain intensity
Aggravation by routine physical activity
• During headache at least 1 of the following:
Nausea and/or vomiting
Photophobia and phonophobia
• Not better accounted for by another ICHD-3 diagnosis
9. TENSION-TYPE HEADACHE
• TTH is the most common form of headache (affects more than 40 percent of the adult
population worldwide)
• Characterized by bilateral mild to moderate pressure pain without other associated
symptoms (“featureless headache”)
• Pain is usually diffusely felt all over the head but may be located on the vertex or
forehead or the neck
• Experienced as a sense of pressure, feeling of tightness, or as a heavy weight pressing
down on the crown
10. DIAGNOSTIC CRITERIA FOR TTH
• Headache lasting from 30 mins to 7 days
• Headache has at least 2 of the following characteristics:
Bilateral location
Pressing/tightening (non-pulsating) quality
Mild or moderate intensity
Not aggravated by routine physical activity
• Both of the following:
No nausea or vomiting (anorexia may occur)
No more than one of photophobia or phonophobia
• Not better accounted for by another ICHD-3 diagnosis
11. TRIGEMINAL AUTONOMIC CEPHALALGIAS (TACs)
Strictly unilateral headaches accompanied by prominent cranial autonomic features,
which are lateralised and ipsilateral to the headache
• Cluster headache
• Paroxysmal hemicrania
• Short-lasting unilateral neuralgiform headache attacks
• SUNCT
• SUNA
• Hemicrania continua
12. CLUSTER HEADACHE
• Relatively rare, and characterized by brief episodes of severe head pain with associated autonomic symptoms
• Pain most commonly occurs in the retro-orbital area, followed by the temporal region, upper teeth, jaw, cheek,
lower teeth, and neck
• Ipsilateral autonomic symptoms such as eyelid edema, nasal congestion, lacrimation, or forehead sweating usually
accompany the pain
• There may be several (up to 8) episodes in the same day, with each episode lasting between 15 and 180 minutes
• Headache episodes occur daily for a number of weeks followed by a period of remission
• On average, a period of CH lasts 6 to 12 weeks, with remission lasting up to 12 months (Episodic CH)
• In Chronic CH episodes occur without significant periods of remission
13. DIAGNOSTIC CRITERIA FOR CLUSTER HEADACHE
• Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting
15-180 mins if untreated
• HD is accompanied by at least 1 of the following:
Ipsilateral conjunctival injection and/or lacrimation
Ipsilateral nasal congestion and/or rhinorrhoea
Ipsilateral eyelid oedema
Ipsilateral forehead and facial swelling
Ipsilateral miosis and/or ptosis
A sense of restlessness or agitation
• Attacks have a freq from 1 every other day to 8 per day
• Not better accounted for by another ICHD-3 diagnosis
14. STRUCTURED HEADACHE HISTORY: history is crucial to effective
diagnosis of primary headaches as the examination is essentially normal
“Time questions”
• Why consulting now?
• How recent in onset?
• How frequent, and what temporal pattern (distinguishing
between episodic and daily or unremitting)?
• How long lasting?
“Character questions”
• Nature and quality of pain
• Intensity of pain
• Site and spread of pain
• Associated symptoms
“Cause questions”
• Predisposing and/or trigger factors
• Aggravating and/or relieving factors
• Family history of similar headache
“Response questions”
• What does the patient do during the headache?
• How much is activity (function) limited or prevented?
• What medication has been and is used, and in what manner?
State of health between attacks
• Completely well, or residual or persisting symptoms?
• Concerns, anxieties, fears about the HD
15. PRIMARY HEADACHES vs SECONDARY HEADACHES
• In evaluating a patient with headache, the first task is to determine whether the headache is primary in origin or reflects
underlying neurologic or systemic disease (ie, secondary headache)
• Distinguishing dangerous headaches from benign or low-risk headaches is a significant challenge because the symptoms can
overlap
• Done by eliciting any warning features (red flags) in the history
• A high index of suspicion exists for secondary headache
✓ headache reaches full intensity rapidly
✓ associated with abnormal neurologic signs
✓ progressive in intensity and duration over time
✓ increased by Valsalva maneuver
✓ worse upon standing
✓ develops after the age of 50 years
✓ coexisting systemic and neurologic disorders
16. RED FLAGS IN PATIENTS PRESENTING WITH
HEADACHE
SNOOP4 can act as a useful aide-memoire in remembering the red-flag features
Systemic symptoms/signs: fever, weight loss (infection, malignancy)
Neurologic symptoms/signs: stroke, SOL, intracranial infection
Onset sudden (thunderclap): SAH, RCVS
Older age of onset (>50yrs): temporal arteritis, glaucoma, SOL
Papilloedema: raised ICP
Positional: relief when supine (intracranial hypotension); relief when up-right (SOL)
Precipitated byValsalva, cough, bending forward: SOL
Progressive headache or change in headache pattern: any secondary cause
(Pregnancy)
17. MIGRAINE vs TTH
• A positive response to the presence of the following symptoms can ‘‘PIN’’ the diagnosis
of migraine:
Photophobia: Does light bother you when you have a headache?
Impairment: Do you experience headaches that impair your ability to function?
Nausea: Do you feel nauseated when you experience a headache?
A positive answer to two or three of these three questions results in a 93% and 98%,
respectively, positive predictive value for a diagnosis of migraine
18. CLUSTER HEADACHE vs MIGRAINE
• Cluster headache is uncommon and often misdiagnosed
Only 25 percent of patients with cluster headaches are diagnosed correctly within one year of
symptom onset, and more than 40 percent report a delay in diagnosis of five years or longer
The most common incorrect diagnoses reported in one study were migraine (34 percent), sinusitis
(21 percent), and allergies (6 percent)
• A useful point to distinguish between migraine and CH is that patients with migraine typically
lie down or sit still (often in a dark room), whereas patients with a CH are often agitated and
pace around the room, often at night when headaches occur
19. NEUROLOGICAL EXAMINATION
• It is unnecessary to check every aspect of neurological function (a brief neurological screen
should take no more than 5-10 min)
• Particular attention should be paid to examination of the cranial nerves, tendon reflexes, and
optic discs
• If the history suggests that there is a more sinister cause for the headache, a full neurological
examination is necessary
• It is of great comfort to patients when told that the findings are ‘‘normal’’
When time is short, a minimum examination should include blood pressure and
examination of the optic fundi
20. INVESTIGATIONS
• Investigations rarely contribute to the diagnosis of headache when the history and examination have not
suggested an underlying cause
• The only role for neuroimaging (preferably MRI) in the diagnosis of headache is to confirm or exclude
causes of secondary headache that are suspected on the basis of red flags in the medical history and/or
physical examination
• Neuroimaging for reassurance is not recommended and can lead to harmful and unnecessary
investigations and treatment
• MRI can reveal clinically insignificant abnormalities (e.g, white matter lesions, arachnoid cysts), which can
alarm the patient and lead to further unnecessary testing
All patients with suspected trigeminal autonomic cephalalgia (e.g. cluster headache) should have neuroimaging
21. ACUTETREATMENT OF MIGRAINE
Drug class Drug Dosage and route Contraindications
First line medication
NSAIDs ASA
Ibuprofen
Diclofenac Potasium
900-1000 mg oral
400-600 mg oral
50 mg oral (soluble)
GI bleeding, HF
Other simple analgesics
(if NSAIDs are
contraindicated)
PCM 1000 mg oral Hepatic disease, renal
failure
Anti-emetics (when
necessary)
Domperidone
Metoclopramide
10 mg oral or
suppository
10 mg oral
GI bleeding, epilepsy,
renal failure
PD, epilepsy, mechanical
ileus
22. ACUTETREATMENT OF MIGRAINE ii
Drug class Drug Dosage and route Contraindications
Second-line medication
Triptans Sumatriptan 50 or 100 mg oral or 6
mg subcutaneous or 10
or 20 mg intranasal
Cardiovascular or
cerebrovascular disease,
uncontrolled
hypertension, hemiplegic
migraine, migraine with
brainstem aura
Zolmitriptan 2.5 or 5 mg oral or 5 mg
intranasal
Almotriptan 12.5 mg oral
Elitriptan 20, 40 or 80 mg oral
Frovatriptan 2.5 mg oral
Naratriptan 2.5 mg oral
Rizatriptan 10 mg oral tablet or
mouth-dispersible wafers
23. ACUTETREATMENT OF MIGRAINE iii
Drug class Drug Dosage and route Contraindications
Third-line medication
Gepants Ubrogepants 50 mg, 100 mg oral Co-administration with
strong CYP3A4
inhibitors
Rimegepants 75 mg oral Hypersensitivity, hepatic
impairment
Ditans Lasmiditan 50, 100 or 200 mg oral Pregnancy, concomitant
use with drugs that are
P-glycoprotein
substrates
26. PROPHYLACTIC TREATMENT OF MIGRAINE iii
Third-line preventive medications
Botulinum toxin OnabotulinumtoxinA 155–195 units to 31–39 sites
every 12 weeks
Calcitonin gene-related peptide
(CGRP) monoclonal antibodies
Erenumab
Fremanezumab
Galcanezumab
Eptinezumab
70 or 140 mg subcutaneous
once monthly
225 mg subcutaneous once
monthly or 675 mg
subcutaneous once quarterly
240 mg subcutaneous, then 120
mg subcutaneous once monthly
100 or 300 mg intravenous
quarterly
27. NON-PHARMACOLOGICAL MANAGEMENT OF
MIGRAINE
• Includes lifestyle modification and identifying the triggers and avoiding or managing them
• Physical activity and sports have a protective effect in patients with migraine
• No evidence-based dietary recommendations available for patients with migraine,
however unhealthy food habits possibly a risk factor
• The chronification of migraine and the number of migraine attacks can be prevented by
improving sleep quality or treating sleep disorder if present
28. MANAGEMENT OFTTH
• Tension-type headaches are rarely disabling
• OTC analgesics such as ASA and NSAIDs (ibuprofen, naproxen) are effective treatment for
infrequent episodes
PCM has been shown to be less effective, but can be considered in those intolerant of NSAIDs
• For chronic or frequently occurring TTH, a low-doseTCA such as amitriptyline is the
treatment choice
• Care must be taken to educate patients on use of analgesics to prevent progression to
medication overuse
SSRIs, benzodiazepines, codeine, dihydrocodeine not recommended
29. NON-PHARMACOLOGICAL MANAGEMENT OFTTH
• The initial step is to provide reassurance to the non-harmful, self-limiting nature of the
condition
• Chronic TTH can be associated with depression which should be managed as appropriate to
prevent treatment failure
• General exercise is recommended alongside referral for physiotherapy for patients with
musculoskeletal neck pain
• Yoga and meditation could be suggested for stress management
• Acupuncture and osteopathy have some evidence of benefit in chronic TTH
• Medication overuse should be sought for and treated, if present
30. MANAGEMENT OF CLUSTER HEADACHE
• An acute cluster attack responds well to sumatriptan 6 mg SC (intranasal sumatriptan and zolmitriptan can be used but not
as effective)
• Oxygen 100% 10–15 L per minute through a special mask can terminate a cluster attack in 10–20 minutes
• Prophylactic treatment should be commenced early in a CH with verapamil 80mgTDS
This should be gradually uptitrated (up to 960 mg)
A baseline ECG should be obtained prior to commencement, as verapamil can lead to bradyarrhythmia
• A rapid and effective remission can be achieved in some cases with a short course of a high-dose steroid for a few days
(allows the preventive treatment with verapamil to take effect)
Prednisolone 60 mg per day for 5 days with a reduction of 5–10 mg every day
• Lithium and methysergide may be effective second line for cluster headache
• Other drugs with some indication of efficacy include topiramate, gabapentin,melatonin and pizotifen
31. Approach to the diagnosis and management of
primary headache disorders
Step 1: History and Examination
Step 2: Identify red flags for secondary headache
Step 3: Neuroimaging (if secondary headache is considered) ± other invs
Step 4: Categorise the primary headache disorder
Step 5: Treatment strategies (pharmacological and nonpharmacological)
32. SMART Headache Management
Sleep Regular and sufficient sleep
Meals Regular and sufficient meals, including
breakfast and good hydration
Activity Regular (but not excessive) exercise
Relaxation Relaxation and stress reduction
Trigger avoidance Avoid identified triggers (stress, sleep
deprivation, excessive caffeine, etc)
33. Approach to the diagnosis
and management of
primary headache
disorders
END OF LECTURE
QUESTIONS??