The document discusses the approach to diagnosing and managing primary headache disorders. It begins with an introduction to headaches and classifications. 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 looking for red flags of secondary headaches, and potentially neuroimaging. Treatment involves both pharmacological options like triptans, NSAIDs, and preventive medications as well as non-pharmacological strategies depending on the specific primary headache disorder. The overall approach involves identifying the primary headache, treating acute episodes, and using preventive strategies as needed.
This document provides an overview of approaches to evaluating and treating different types of headaches. It discusses evaluating patients for primary headaches like migraines and cluster headaches versus secondary headaches that could indicate an underlying condition. The assessment involves taking a thorough history and performing a neurological exam to identify concerning symptoms. Red flags that warrant further investigation include new severe headaches or headaches in older patients. Imaging and lumbar puncture may be used to rule out conditions like hemorrhage or infection. Treatment differs based on the headache type but may include abortive medications, prophylaxis, oxygen for cluster headaches, and steroids.
This document discusses the approach to evaluating and diagnosing patients presenting with headache. It begins by distinguishing between primary and secondary headaches. Primary headaches include migraine, tension-type headache, and cluster headache, while secondary headaches are caused by underlying conditions like head trauma, vascular disorders, or infections. The document outlines diagnostic criteria for common headache types and recommends investigations and treatment approaches based on the presence of "red flags" or alarming symptoms.
This document provides information on evaluating and managing different types of headaches. It discusses taking a thorough history including red flags. Red flags for headaches include new onset headaches, worsening headaches, headaches associated with seizures, meningismus, or neurological deficits. It also summarizes migraine headaches, including diagnostic criteria, triggers, and acute and preventive treatment options. Additional headache types covered include tension headaches, cluster headaches, trigeminal neuralgia, glaucoma, medication overuse headaches, increased intracranial pressure, and acute sinusitis.
This document provides an overview of approaches to headache by Dr. Shivaom Chaurasia. It begins by defining headache and discussing common causes, which include primary headaches that often result in disability without an underlying organic disease, and secondary headaches that have a specific underlying cause like head trauma, vascular disorders, or nonvascular intracranial disorders. The document then examines the pathophysiology of headache, important aspects to cover in a headache history, potential investigations, management strategies for different headache types including migraine, tension, and cluster headaches, and indicators for referral to a neurologist.
This document provides an overview of headaches including migraine and tension headaches. It begins by defining headaches as pain in the head or neck region that originates from tissues surrounding the skull or brain. Headaches are then classified as either primary, which are benign and recurrent, or secondary, caused by underlying disease. Migraine is described as the most common primary headache, characterized by moderate to severe pulsating pain that worsens with activity and is often accompanied by nausea, sensitivity to light and sound. Diagnostic criteria for migraine with and without aura are outlined. Tension headaches are also common and involve mild to moderate pressing or tightening pain. Secondary headaches require further evaluation to identify their underlying cause.
This document discusses approaches to evaluating and treating headaches in children. It begins by outlining common causes of chronic and severe headaches in children, including tension-type headaches, cluster headaches, and migraines. It then provides details on evaluating patients with headaches and classifying different headache types based on international standards. The rest of the document elaborates on diagnostic criteria and treatment strategies for recurrent headache types like tension headaches, cluster headaches, and migraines. It describes treating acute migraine attacks with analgesics and triptans and providing migraine prophylaxis for frequent or disabling attacks.
This document provides an introduction to headaches, including their prevalence, origins, symptoms, pathophysiology, classification, and types. Some key points:
- Headaches are the most common neurological disorder and reason patients seek medical attention.
- Tension-type headaches are the most prevalent primary headache, affecting 69% of the population. Migraines affect 16%.
- Headaches can originate from extracranial structures like sinuses, eyes, teeth, and ears, or intracranial structures like arteries and dural veins.
- Pathophysiology involves stimulation of nociceptors and transmission of pain signals through small myelinated fibers to the thalamus.
- Classification systems
Headaches are caused by pressure or irritation of the sensitive structures surrounding the brain, like blood vessels, cranial nerves, sinuses, and meninges, rather than direct stimulation of the brain itself which lacks pain receptors. There are two main types of headaches - primary headaches which include migraines, cluster, and tension headaches, and secondary headaches caused by underlying disorders like cervicogenic headaches or cranial neuralgias. Migraines are the most common primary headache, characterized by moderate to severe pulsating pain typically on one side of the head lasting 4 hours to 3 days along with symptoms like aura, nausea, vomiting, and sensitivity to light and smells. Cervicogenic headaches are referred pain in the head caused by issues
This document provides an overview of approaches to evaluating and treating different types of headaches. It discusses evaluating patients for primary headaches like migraines and cluster headaches versus secondary headaches that could indicate an underlying condition. The assessment involves taking a thorough history and performing a neurological exam to identify concerning symptoms. Red flags that warrant further investigation include new severe headaches or headaches in older patients. Imaging and lumbar puncture may be used to rule out conditions like hemorrhage or infection. Treatment differs based on the headache type but may include abortive medications, prophylaxis, oxygen for cluster headaches, and steroids.
This document discusses the approach to evaluating and diagnosing patients presenting with headache. It begins by distinguishing between primary and secondary headaches. Primary headaches include migraine, tension-type headache, and cluster headache, while secondary headaches are caused by underlying conditions like head trauma, vascular disorders, or infections. The document outlines diagnostic criteria for common headache types and recommends investigations and treatment approaches based on the presence of "red flags" or alarming symptoms.
This document provides information on evaluating and managing different types of headaches. It discusses taking a thorough history including red flags. Red flags for headaches include new onset headaches, worsening headaches, headaches associated with seizures, meningismus, or neurological deficits. It also summarizes migraine headaches, including diagnostic criteria, triggers, and acute and preventive treatment options. Additional headache types covered include tension headaches, cluster headaches, trigeminal neuralgia, glaucoma, medication overuse headaches, increased intracranial pressure, and acute sinusitis.
This document provides an overview of approaches to headache by Dr. Shivaom Chaurasia. It begins by defining headache and discussing common causes, which include primary headaches that often result in disability without an underlying organic disease, and secondary headaches that have a specific underlying cause like head trauma, vascular disorders, or nonvascular intracranial disorders. The document then examines the pathophysiology of headache, important aspects to cover in a headache history, potential investigations, management strategies for different headache types including migraine, tension, and cluster headaches, and indicators for referral to a neurologist.
This document provides an overview of headaches including migraine and tension headaches. It begins by defining headaches as pain in the head or neck region that originates from tissues surrounding the skull or brain. Headaches are then classified as either primary, which are benign and recurrent, or secondary, caused by underlying disease. Migraine is described as the most common primary headache, characterized by moderate to severe pulsating pain that worsens with activity and is often accompanied by nausea, sensitivity to light and sound. Diagnostic criteria for migraine with and without aura are outlined. Tension headaches are also common and involve mild to moderate pressing or tightening pain. Secondary headaches require further evaluation to identify their underlying cause.
This document discusses approaches to evaluating and treating headaches in children. It begins by outlining common causes of chronic and severe headaches in children, including tension-type headaches, cluster headaches, and migraines. It then provides details on evaluating patients with headaches and classifying different headache types based on international standards. The rest of the document elaborates on diagnostic criteria and treatment strategies for recurrent headache types like tension headaches, cluster headaches, and migraines. It describes treating acute migraine attacks with analgesics and triptans and providing migraine prophylaxis for frequent or disabling attacks.
This document provides an introduction to headaches, including their prevalence, origins, symptoms, pathophysiology, classification, and types. Some key points:
- Headaches are the most common neurological disorder and reason patients seek medical attention.
- Tension-type headaches are the most prevalent primary headache, affecting 69% of the population. Migraines affect 16%.
- Headaches can originate from extracranial structures like sinuses, eyes, teeth, and ears, or intracranial structures like arteries and dural veins.
- Pathophysiology involves stimulation of nociceptors and transmission of pain signals through small myelinated fibers to the thalamus.
- Classification systems
Headaches are caused by pressure or irritation of the sensitive structures surrounding the brain, like blood vessels, cranial nerves, sinuses, and meninges, rather than direct stimulation of the brain itself which lacks pain receptors. There are two main types of headaches - primary headaches which include migraines, cluster, and tension headaches, and secondary headaches caused by underlying disorders like cervicogenic headaches or cranial neuralgias. Migraines are the most common primary headache, characterized by moderate to severe pulsating pain typically on one side of the head lasting 4 hours to 3 days along with symptoms like aura, nausea, vomiting, and sensitivity to light and smells. Cervicogenic headaches are referred pain in the head caused by issues
This document discusses approaches to headache diagnosis and treatment. It defines different types of primary headaches like tension, migraine and cluster headaches. It also covers secondary headaches that can be caused by underlying conditions. The evaluation involves a thorough history, physical exam, and diagnostic tests depending on risk factors. Treatment differs based on whether the headache is primary or secondary, with the goal of identifying any serious underlying causes for secondary headaches.
This document provides an overview of Dr. Faisal Al Hadad's approach to evaluating and diagnosing headaches. It begins with definitions of headache and classifications of primary versus secondary headaches. It then discusses taking a thorough history, including onset, location, severity of pain, concurrent conditions, medications, and recent trauma. The physical exam focuses on identifying secondary causes, and red flags requiring further investigation are outlined. Diagnostic criteria for common primary headaches like migraines and cluster headaches are provided. Recommendations are given for imaging, lumbar puncture, and indications for neurology referral. The goal is to distinguish primary from secondary headaches and accurately diagnose the underlying condition.
Headache for post basic neuroscience course 2015Ahmad Shahir
This document provides information on different types of headaches, including migraine, tension-type headache, cluster headache, and medication overuse headache. It discusses the classification, symptoms, diagnosis, and management of various headaches. For diagnosis, it emphasizes taking a thorough history and physical exam. It outlines red flags that warrant further investigation. Treatment involves acute and preventative medications. The focus is on a personalized approach and lifestyle modifications like keeping a headache diary.
This document discusses various causes of headache including intracerebral bleeding from subdural hematoma or subarachnoid hemorrhage, intracerebral hemorrhage presenting with neurological deficits, tumors presenting with headache among other symptoms depending on location, obstructive hydrocephalus, idiopathic intracranial hypertension in young obese females, meningitis or encephalitis presenting with fever and neck stiffness, brain abscess with seizures and fever, temporal arteritis in those over 50 with fever and jaw claudication, referred pain from structures like the eye, post concussion headaches, headaches from conditions like hypertension and pheochromocytoma, and iatrogenic headaches from medications or procedures like lumbar punct
The document provides an overview of various headache types, including their causes, characteristics, treatments and related conditions. It discusses primary headache disorders like migraines and tension headaches, as well as secondary headaches that can indicate underlying issues. Evaluation of patient history is important for diagnosis. Treatment involves managing acute episodes and preventing recurrent headaches through lifestyle changes and medications.
This document discusses headache disorders and their evaluation and classification. It notes that headaches are among the most common neurological disorders, affecting around 47% of adults annually. The most common types of benign headaches are migraine, tension-type, and cluster headaches. A thorough patient history is the most important part of the evaluation, to help identify headache type and risk factors for underlying conditions. Physical examination may include neurological and general examination, with attention to danger signs in the history that suggest further investigation is needed.
Headaches can be caused by traction, inflammation, or vascular changes affecting pain-sensitive structures in the head or neck. Migraine headaches are frequently relieved by darkness, sleep, vomiting, or pressing on the ipsilateral temporal artery. They often diminish during pregnancy. Cluster headaches frequently awaken patients from sleep and can recur at the same time each day or night. Tension headaches are often maximal at the end of a workday and can be triggered by stressful situations.
Headache is a common reason patients seek medical attention and can be primary or secondary. Primary headaches include tension-type headaches, which cause bilateral tight band-like pain, and migraines, which often cause severe one-sided throbbing pain accompanied by sensitivity to light, sound, and nausea. Migraines are thought to involve neurovascular and serotonergic mechanisms. Cluster headaches are rare but cause excruciating unilateral orbital or temporal pain and may be associated with autonomic symptoms. Treatment involves acute abortive medications as well as preventive medications depending on headache type and frequency. Secondary headaches require evaluation for underlying causes such as infection, trauma, or vascular abnormalities.
Headache Attributed to Nonvascular, Noninfectious
Intracranial Disorders
Headache Attributed to Trauma or Injury to the Head
and/or Neck
Headache Attributed to Infection
Headache Attributed to Cranial or Cervical Vascular
Disorders
Headache Associated with Disorders of Homeostasis
Headache Caused by Disorders of the Cranium, Neck,
Eyes, Ears, Nose, Sinuses, Teeth, Mouth, or Other
Facial or Cranial Structures
Headaches and the Cervical Spine
Migraine
Chronic Daily Headache
Cluster Headache
Other Trigeminal Autonomic Cephalalgias
Other Primary Headaches
This document provides an overview of evaluating and treating patients presenting with headache. It describes the approach of determining if the headache is due to a primary or secondary cause through history, physical exam, and diagnostic testing. Primary headaches include tension, migraine and cluster headaches and are treated differently than secondary headaches which require identifying and treating their underlying cause.
This document discusses different types of headaches including their causes, symptoms, and treatments. It covers primary headaches like migraines and tension headaches as well as secondary headaches caused by underlying conditions. Migraines are characterized by severe throbbing pain and can include aura. Tension headaches feel like a band around the head. Cluster headaches occur in clusters with severe orbital pain. Temporal arteritis is inflammation of the temporal arteries seen in older adults. Treatment depends on the type but may include medications, relaxation, and lifestyle changes.
This document discusses chronic daily headache (CDH), defined as a headache occurring on 15 or more days per month for more than 3 months. It describes the classification of primary and secondary CDH according to the International Headache Society. Primary CDH includes chronic migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua. Secondary CDH is caused by underlying head/neck issues, vascular disorders, infections, or psychiatric disorders. Risk factors, pathophysiology, treatment approaches including medication overuse management, and lifestyle modifications are summarized.
Vertigo is a common complaint that requires differentiating between central and peripheral causes. A thorough history and physical exam, including HINTS testing, is needed. Peripheral vertigo is often benign and can be treated with repositioning maneuvers like Epley's or Sermont's for conditions like BPPV. Central vertigo requires imaging to rule out serious conditions like stroke. Short term medication may help peripheral symptoms but definitive treatment is repositioning or management of underlying disorders. Proper evaluation is key to differentiating benign from potentially life-threatening causes of vertigo.
This document provides an overview of pediatric and adult headaches. It begins by classifying headaches as acute, subacute, or chronic. For pediatric headaches, it outlines the important aspects of history taking and danger signs that warrant further evaluation. It describes migraine headaches in children in detail. For adult headaches, it discusses mechanisms, classification, precipitating factors, and characteristics. It provides guidance on evaluation, management, and when to refer or admit patients with headaches.
1. Identify the difference between vertigo, disequilibrium,, near-syncope, and Undifferentiated dizziness.
2. Identify helpful tests to distinguish peripheral from central vertigo.
3. Understand how to treat different kinds of vertigo
Headaches are one of the most common medical complaints. They can be classified as primary or secondary, with primary headaches like migraines occurring independently and secondary headaches resulting from another underlying condition. Migraines specifically involve recurrent attacks of moderate to severe throbbing head pain and other symptoms like sensitivity to light and sound. They can be further divided into migraines with aura, which include neurological symptoms before the headache, and migraines without aura. Potential triggers of migraines include certain foods, environmental factors, and behaviors.
This document provides an overview of headache management in family practice. It discusses evaluating and treating common headache types like migraine, tension headache, and cluster headache. It covers diagnostic testing, acute and preventive treatment options, and considerations for headache in special populations like pregnancy, menopause, and the elderly.
This document outlines the approach to evaluating a patient presenting with dizziness. It discusses the overview, epidemiology, major etiologies including vertigo, disequilibrium, syncope, and nonspecific dizziness. For each etiology, the summary includes defining the condition, taking a relevant history, performing a physical exam including special maneuvers, generating a differential diagnosis, ordering appropriate investigations, management, identifying red flags, providing health education, follow up, and the role of family medicine. The approach emphasizes taking a thorough history to determine the type and characteristics of dizziness and using physical exam findings to distinguish peripheral from central causes of vertigo.
The document discusses headaches, including:
- Headaches affect 75% of the population per year, with daily headaches affecting 4% and migraine alone accounting for 20 million lost work/school days.
- Headaches are classified as primary (migraine, tension-type, cluster) or secondary (caused by other conditions). Migraine is characterized by pulsatile pain lasting 4-72 hours with possible nausea and sensitivity to light/sound.
- Evaluation involves history and exam to identify concerning signs requiring further investigation or treatment of underlying causes. Diagnosis and management depends on headache type.
The document provides information on diagnosing and classifying different types of headaches. It discusses:
1) The importance of taking a thorough history and using diagnostic criteria to determine if a headache is primary or secondary in nature.
2) Common primary headache disorders like migraines, tension headaches, and cluster headaches and how to recognize the characteristics of each.
3) Red flags that could indicate an underlying medical condition causing the headache and the need for further investigation.
This document discusses approaches to headache diagnosis and treatment. It defines different types of primary headaches like tension, migraine and cluster headaches. It also covers secondary headaches that can be caused by underlying conditions. The evaluation involves a thorough history, physical exam, and diagnostic tests depending on risk factors. Treatment differs based on whether the headache is primary or secondary, with the goal of identifying any serious underlying causes for secondary headaches.
This document provides an overview of Dr. Faisal Al Hadad's approach to evaluating and diagnosing headaches. It begins with definitions of headache and classifications of primary versus secondary headaches. It then discusses taking a thorough history, including onset, location, severity of pain, concurrent conditions, medications, and recent trauma. The physical exam focuses on identifying secondary causes, and red flags requiring further investigation are outlined. Diagnostic criteria for common primary headaches like migraines and cluster headaches are provided. Recommendations are given for imaging, lumbar puncture, and indications for neurology referral. The goal is to distinguish primary from secondary headaches and accurately diagnose the underlying condition.
Headache for post basic neuroscience course 2015Ahmad Shahir
This document provides information on different types of headaches, including migraine, tension-type headache, cluster headache, and medication overuse headache. It discusses the classification, symptoms, diagnosis, and management of various headaches. For diagnosis, it emphasizes taking a thorough history and physical exam. It outlines red flags that warrant further investigation. Treatment involves acute and preventative medications. The focus is on a personalized approach and lifestyle modifications like keeping a headache diary.
This document discusses various causes of headache including intracerebral bleeding from subdural hematoma or subarachnoid hemorrhage, intracerebral hemorrhage presenting with neurological deficits, tumors presenting with headache among other symptoms depending on location, obstructive hydrocephalus, idiopathic intracranial hypertension in young obese females, meningitis or encephalitis presenting with fever and neck stiffness, brain abscess with seizures and fever, temporal arteritis in those over 50 with fever and jaw claudication, referred pain from structures like the eye, post concussion headaches, headaches from conditions like hypertension and pheochromocytoma, and iatrogenic headaches from medications or procedures like lumbar punct
The document provides an overview of various headache types, including their causes, characteristics, treatments and related conditions. It discusses primary headache disorders like migraines and tension headaches, as well as secondary headaches that can indicate underlying issues. Evaluation of patient history is important for diagnosis. Treatment involves managing acute episodes and preventing recurrent headaches through lifestyle changes and medications.
This document discusses headache disorders and their evaluation and classification. It notes that headaches are among the most common neurological disorders, affecting around 47% of adults annually. The most common types of benign headaches are migraine, tension-type, and cluster headaches. A thorough patient history is the most important part of the evaluation, to help identify headache type and risk factors for underlying conditions. Physical examination may include neurological and general examination, with attention to danger signs in the history that suggest further investigation is needed.
Headaches can be caused by traction, inflammation, or vascular changes affecting pain-sensitive structures in the head or neck. Migraine headaches are frequently relieved by darkness, sleep, vomiting, or pressing on the ipsilateral temporal artery. They often diminish during pregnancy. Cluster headaches frequently awaken patients from sleep and can recur at the same time each day or night. Tension headaches are often maximal at the end of a workday and can be triggered by stressful situations.
Headache is a common reason patients seek medical attention and can be primary or secondary. Primary headaches include tension-type headaches, which cause bilateral tight band-like pain, and migraines, which often cause severe one-sided throbbing pain accompanied by sensitivity to light, sound, and nausea. Migraines are thought to involve neurovascular and serotonergic mechanisms. Cluster headaches are rare but cause excruciating unilateral orbital or temporal pain and may be associated with autonomic symptoms. Treatment involves acute abortive medications as well as preventive medications depending on headache type and frequency. Secondary headaches require evaluation for underlying causes such as infection, trauma, or vascular abnormalities.
Headache Attributed to Nonvascular, Noninfectious
Intracranial Disorders
Headache Attributed to Trauma or Injury to the Head
and/or Neck
Headache Attributed to Infection
Headache Attributed to Cranial or Cervical Vascular
Disorders
Headache Associated with Disorders of Homeostasis
Headache Caused by Disorders of the Cranium, Neck,
Eyes, Ears, Nose, Sinuses, Teeth, Mouth, or Other
Facial or Cranial Structures
Headaches and the Cervical Spine
Migraine
Chronic Daily Headache
Cluster Headache
Other Trigeminal Autonomic Cephalalgias
Other Primary Headaches
This document provides an overview of evaluating and treating patients presenting with headache. It describes the approach of determining if the headache is due to a primary or secondary cause through history, physical exam, and diagnostic testing. Primary headaches include tension, migraine and cluster headaches and are treated differently than secondary headaches which require identifying and treating their underlying cause.
This document discusses different types of headaches including their causes, symptoms, and treatments. It covers primary headaches like migraines and tension headaches as well as secondary headaches caused by underlying conditions. Migraines are characterized by severe throbbing pain and can include aura. Tension headaches feel like a band around the head. Cluster headaches occur in clusters with severe orbital pain. Temporal arteritis is inflammation of the temporal arteries seen in older adults. Treatment depends on the type but may include medications, relaxation, and lifestyle changes.
This document discusses chronic daily headache (CDH), defined as a headache occurring on 15 or more days per month for more than 3 months. It describes the classification of primary and secondary CDH according to the International Headache Society. Primary CDH includes chronic migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua. Secondary CDH is caused by underlying head/neck issues, vascular disorders, infections, or psychiatric disorders. Risk factors, pathophysiology, treatment approaches including medication overuse management, and lifestyle modifications are summarized.
Vertigo is a common complaint that requires differentiating between central and peripheral causes. A thorough history and physical exam, including HINTS testing, is needed. Peripheral vertigo is often benign and can be treated with repositioning maneuvers like Epley's or Sermont's for conditions like BPPV. Central vertigo requires imaging to rule out serious conditions like stroke. Short term medication may help peripheral symptoms but definitive treatment is repositioning or management of underlying disorders. Proper evaluation is key to differentiating benign from potentially life-threatening causes of vertigo.
This document provides an overview of pediatric and adult headaches. It begins by classifying headaches as acute, subacute, or chronic. For pediatric headaches, it outlines the important aspects of history taking and danger signs that warrant further evaluation. It describes migraine headaches in children in detail. For adult headaches, it discusses mechanisms, classification, precipitating factors, and characteristics. It provides guidance on evaluation, management, and when to refer or admit patients with headaches.
1. Identify the difference between vertigo, disequilibrium,, near-syncope, and Undifferentiated dizziness.
2. Identify helpful tests to distinguish peripheral from central vertigo.
3. Understand how to treat different kinds of vertigo
Headaches are one of the most common medical complaints. They can be classified as primary or secondary, with primary headaches like migraines occurring independently and secondary headaches resulting from another underlying condition. Migraines specifically involve recurrent attacks of moderate to severe throbbing head pain and other symptoms like sensitivity to light and sound. They can be further divided into migraines with aura, which include neurological symptoms before the headache, and migraines without aura. Potential triggers of migraines include certain foods, environmental factors, and behaviors.
This document provides an overview of headache management in family practice. It discusses evaluating and treating common headache types like migraine, tension headache, and cluster headache. It covers diagnostic testing, acute and preventive treatment options, and considerations for headache in special populations like pregnancy, menopause, and the elderly.
This document outlines the approach to evaluating a patient presenting with dizziness. It discusses the overview, epidemiology, major etiologies including vertigo, disequilibrium, syncope, and nonspecific dizziness. For each etiology, the summary includes defining the condition, taking a relevant history, performing a physical exam including special maneuvers, generating a differential diagnosis, ordering appropriate investigations, management, identifying red flags, providing health education, follow up, and the role of family medicine. The approach emphasizes taking a thorough history to determine the type and characteristics of dizziness and using physical exam findings to distinguish peripheral from central causes of vertigo.
The document discusses headaches, including:
- Headaches affect 75% of the population per year, with daily headaches affecting 4% and migraine alone accounting for 20 million lost work/school days.
- Headaches are classified as primary (migraine, tension-type, cluster) or secondary (caused by other conditions). Migraine is characterized by pulsatile pain lasting 4-72 hours with possible nausea and sensitivity to light/sound.
- Evaluation involves history and exam to identify concerning signs requiring further investigation or treatment of underlying causes. Diagnosis and management depends on headache type.
The document provides information on diagnosing and classifying different types of headaches. It discusses:
1) The importance of taking a thorough history and using diagnostic criteria to determine if a headache is primary or secondary in nature.
2) Common primary headache disorders like migraines, tension headaches, and cluster headaches and how to recognize the characteristics of each.
3) Red flags that could indicate an underlying medical condition causing the headache and the need for further investigation.
- Headaches are a common neurological problem and migraine is the most frequent diagnosis in patients presenting with headache.
- Migraines affect 12-15% of the population and are characterized by distinct phases including prodrome, aura, headache, and postdrome. Common triggers include stress, hormones, sleep disturbances, and foods.
- Tension-type headaches are also very common and present as mild to moderate bilateral headaches without other symptoms. Treatment involves analgesics and behavioral therapies.
- Other primary headaches like cluster headaches and trigeminal autonomic cephalalgias present with short attacks of severe pain and autonomic symptoms. Emergency evaluation is needed for headaches with red flag symptoms.
This document provides an overview of headaches for optometrists. It discusses the prevalence and burden of common headaches like migraines and tension-type headaches. Migraines affect 12-15% of the population, especially women during their working lives, and cause significant disability. Tension-type headaches are also very common. The document reviews potential visual or ocular symptoms associated with different headache types and lists red flags that could indicate more serious underlying causes. It provides guidance on evaluating headaches, making a diagnosis, explaining the condition to the patient, and discussing appropriate management and treatment goals.
Headache is a common symptom in children and adolescents, with up to 75% experiencing a significant headache by age 15. Headaches can be primary, such as migraines or tension-type headaches, or secondary to other conditions such as viral infections. A thorough history and physical exam are usually sufficient for diagnosis, though imaging may be required if symptoms suggest increased intracranial pressure. Treatment involves acute medication to stop attacks as well as preventive medication and lifestyle modifications if headaches are frequent or disabling.
The document provides guidelines for doctors on diagnosing and managing migraine and tension-type headache. It discusses the prevalence and burden of headache disorders in the UK. Diagnosis involves taking a thorough headache history. Treatment involves identifying and avoiding triggers, acute medications in a stepwise approach, and prophylactic drugs. Non-drug interventions like stress management and exercise are also recommended. Regular audit is needed to assess the effectiveness of the guidelines.
Headaches are among the most common reasons patients seek medical attention. They can be primary, caused by conditions like migraines and tension-type headaches, or secondary, caused by underlying organic diseases. The International Headache Society classifies primary headaches into categories like migraines, tension-type, and cluster headaches. Secondary headaches have identifiable causes such as head trauma, vascular disorders, or brain tumors. Treatment involves managing symptoms for primary headaches or treating the underlying cause for secondary headaches.
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.
Headaches can be caused by many factors and require evaluation to determine the cause. Sudden, severe headaches require prompt evaluation to rule out serious underlying issues. Migraines typically involve throbbing pain and associated symptoms like nausea while tension headaches feel like pressure across the entire head. Treatment depends on the identified cause but may include medications, lifestyle changes, and reassurance when risks of serious conditions are low.
Headache with Special Reference to MigraineAbinayaa Arasu
Headache is a common pain problem that can have various causes. The document discusses the main types of headaches including those due to vasodilation, traction, inflammation, muscle spasm, referred pain, and psychogenic factors. It then focuses on migraine headaches, providing details on characteristics, pathogenesis, diagnostic criteria, treatment and variants. Tension-type headaches and cluster headaches are also summarized, with the key points being their recurrent but mild-moderate pain, and the severe unilateral pain of cluster headaches that occurs in bouts. A headache diary and red flag signs are important for properly evaluating the type and cause of a patient's headaches.
- Approximately half of adults worldwide suffer from headache disorders. The International Headache Society classification helps doctors differentiate primary headaches from secondary headaches caused by underlying conditions.
- A thorough history and physical exam, focusing on features of primary headaches, can often determine the headache type and reduce unnecessary tests.
- The document provides diagnostic criteria and recommendations for evaluating and testing various headache types like migraines, tension headaches, and cluster headaches. Danger signs require further investigation through tests like neuroimaging, lumbar puncture, or blood tests to rule out secondary causes.
This document provides information on Dr. Ganta Rajasekhar's academic qualifications and areas of interest in neurology. It then discusses approaches to evaluating headache, classifications of primary and secondary headache disorders, migraine pathogenesis and management, tension-type headache, and trigeminal autonomic cephalalgias. Evaluation and treatment strategies for acute migraine, preventive migraine therapy, medication overuse headache, and special headache conditions are covered. Common questions in headache management are also addressed.
This document provides information on evaluating and managing headaches in children and adolescents. It begins with epidemiology data showing headaches are very common in this age group. The document then reviews tools for taking a thorough headache history and differentiating primary from secondary headaches. It describes the major primary headache disorders - migraine, tension-type headache, and others. Treatment approaches are also discussed, including lifestyle modifications, acute pharmacologic options, and concerns around medication overuse headache. The goal is to identify headaches, formulate appropriate treatment plans, and prevent disease progression or medication overuse issues.
This document provides an overview of common types of headaches, including migraine, tension-type headache, cluster headache, and medication overuse headache. It discusses the signs, symptoms, diagnostic approach, and management strategies for each type. The diagnostic approach involves taking a thorough history, performing a physical examination, and ordering imaging tests only if indicated. Management involves both acute and preventative treatment depending on the headache type. The document emphasizes the importance of making an accurate diagnosis and reassuring patients that other pathology has been excluded.
This document provides information on common primary headache types including migraine, tension-type headache, and cluster headache. It describes key characteristics such as localization of pain, duration, associated symptoms, treatments and prophylaxis for each type. Migraine is often unilateral with pulsating quality, nausea and sensitivity to light/sound. Tension-type headache is typically bilateral, pressing/tightening without nausea. Cluster headache is severe and unilateral with autonomic symptoms like tearing and nasal congestion lasting 15-180 minutes.
This document provides information on common primary headache types including migraine, tension-type headache, and cluster headache. It describes key characteristics such as localization of pain, duration, associated symptoms, treatments and prophylaxis for each type. Migraine is often unilateral with pulsating quality, nausea and sensitivity to light/sound. Tension-type headache is typically bilateral, pressing/tightening without nausea. Cluster headache is severe and unilateral with autonomic symptoms like tearing and nasal congestion lasting 15-180 minutes.
Headaches and orthodontics 45° Sido International CongressStudio Robotti
1) Headaches are among the most common and disabling health problems, affecting nearly 10% of the global population. Proper classification of headaches is important for uniformity, research, and treatment guidelines.
2) The first consultation for a patient with headaches should gather information on frequency, duration, triggers, and previous treatments to classify the headache type according to the International Classification of Headache Disorders.
3) Migraines are a common primary headache type characterized by pulsating pain that worsens with activity along with nausea and sensitivity to light/sound. Early recognition and treatment are key to effective migraine management.
Headaches can have many causes and present with varying symptoms. Primary headaches include tension, cluster, and migraine headaches which originate from structures surrounding the brain. Secondary headaches are caused by underlying conditions and can be life-threatening. A thorough history and physical exam is important to determine the type and cause of headache and appropriate treatment.
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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??