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.
This document discusses different types of headaches. It defines headache and classifies headaches as primary or secondary. The main primary headaches are tension-type headaches, migraines, and cluster headaches. Tension-type headaches are the most common and feel like constant squeezing tightness. Migraines typically affect one side of the head and cause throbbing pain. Cluster headaches cause severe, stabbing pain around the eye and last 15-180 minutes. The document outlines symptoms, causes, diagnostic tests, and treatment for each type of primary headache. Nursing management includes comprehensive assessment, non-pharmacological therapies, avoiding triggers, and educating patients.
This document discusses various types of headaches including migraines, tension headaches, cluster headaches, and chronic daily headaches. It provides information on the prevalence, characteristics, and potential causes of different headache types. Diagnostic tests and classifications of headaches are outlined. Treatment options are also discussed, differentiating between abortive therapies used for acute headaches and prophylactic drugs prescribed for frequent or chronic headaches.
Headache in children -indexforpaediatrics.comdr-nagi
Headache is one of the commonest neurological symptoms in children and young people who are
referred to doctors. Headache refers to pain involving the orbits, forehead, scalp and temples but not
the face or neck. The primary headache includes chronic or recurrent headache and migraine. The
prevalence of chronic or recurrent headaches in children occur in 60-69% by the age of 7-9 years
and 75% by the age of 15 years. The prevalence of migraine in children is up to 28% of older
teenagers. The most serious cause of the secondary headache is brain tumor and the prevalence of
brain tumours in children is 3 per 100,000 per annum.
https://indexforpaediatrics.com
Pediatric headache by dr. milind bapatMilind Bapat
Headaches are common in children, affecting 39% by age 6 and 75% by age 15. Migraines, the most common type of primary headache in children, can cause school absences and impair academic performance. Evaluation of childhood headaches should consider secondary causes from infections, injuries, or intracranial pathology. For primary headaches like migraines, treatment involves acute abortive medications and lifestyle changes to prevent triggers as well as prophylactic medications if headaches are frequent or severe.
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.
This document discusses several key points about managing headaches and migraines:
- It describes a case of a 24-year-old woman experiencing episodic vertigo and asks what additional information would be useful to obtain.
- It then reviews treatment options for migraine-related vertigo and indicates that cinnarizine would be an appropriate initial treatment.
- Finally, it discusses the use of flunarizine for migraine prophylaxis, including its indications, contraindications, adverse effects, interactions, and evidence from clinical studies supporting its effectiveness in reducing migraine frequency and severity.
Headaches are a common complaint in children and adolescents, with prevalence increasing with age. There are primary headaches like migraines and tension-type headaches, as well as secondary headaches caused by conditions like infections, trauma, or masses. Migraines are the most common primary headache and their frequency increases in adolescence. Evaluation involves ruling out secondary causes through history and exam. For primary headaches, management includes acute treatment of attacks as well as preventive therapies and non-pharmacological methods. Frequent childhood headaches can negatively impact functioning and are associated with increased risk of future health problems.
A 35-year-old female patient has been experiencing recurrent severe headaches over the last 4 months, with unilateral pulsating pain lasting over 6 hours accompanied by nausea and sometimes vomiting. She prefers sitting in a dark room during attacks and is unable to be active. Migraine should be suspected in patients presenting with recurrent headaches that are unilateral, pulsating, long-lasting and inhibit daily activities, especially in women aged 20-50. Migraine is characterized by moderate to severe throbbing headache on one side of the head and can present with aura, nausea, photophobia, phonophobia, or other neurological symptoms. Treatment involves managing acute attacks and considering prophylaxis for frequent episodes.
This document discusses different types of headaches. It defines headache and classifies headaches as primary or secondary. The main primary headaches are tension-type headaches, migraines, and cluster headaches. Tension-type headaches are the most common and feel like constant squeezing tightness. Migraines typically affect one side of the head and cause throbbing pain. Cluster headaches cause severe, stabbing pain around the eye and last 15-180 minutes. The document outlines symptoms, causes, diagnostic tests, and treatment for each type of primary headache. Nursing management includes comprehensive assessment, non-pharmacological therapies, avoiding triggers, and educating patients.
This document discusses various types of headaches including migraines, tension headaches, cluster headaches, and chronic daily headaches. It provides information on the prevalence, characteristics, and potential causes of different headache types. Diagnostic tests and classifications of headaches are outlined. Treatment options are also discussed, differentiating between abortive therapies used for acute headaches and prophylactic drugs prescribed for frequent or chronic headaches.
Headache in children -indexforpaediatrics.comdr-nagi
Headache is one of the commonest neurological symptoms in children and young people who are
referred to doctors. Headache refers to pain involving the orbits, forehead, scalp and temples but not
the face or neck. The primary headache includes chronic or recurrent headache and migraine. The
prevalence of chronic or recurrent headaches in children occur in 60-69% by the age of 7-9 years
and 75% by the age of 15 years. The prevalence of migraine in children is up to 28% of older
teenagers. The most serious cause of the secondary headache is brain tumor and the prevalence of
brain tumours in children is 3 per 100,000 per annum.
https://indexforpaediatrics.com
Pediatric headache by dr. milind bapatMilind Bapat
Headaches are common in children, affecting 39% by age 6 and 75% by age 15. Migraines, the most common type of primary headache in children, can cause school absences and impair academic performance. Evaluation of childhood headaches should consider secondary causes from infections, injuries, or intracranial pathology. For primary headaches like migraines, treatment involves acute abortive medications and lifestyle changes to prevent triggers as well as prophylactic medications if headaches are frequent or severe.
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.
This document discusses several key points about managing headaches and migraines:
- It describes a case of a 24-year-old woman experiencing episodic vertigo and asks what additional information would be useful to obtain.
- It then reviews treatment options for migraine-related vertigo and indicates that cinnarizine would be an appropriate initial treatment.
- Finally, it discusses the use of flunarizine for migraine prophylaxis, including its indications, contraindications, adverse effects, interactions, and evidence from clinical studies supporting its effectiveness in reducing migraine frequency and severity.
Headaches are a common complaint in children and adolescents, with prevalence increasing with age. There are primary headaches like migraines and tension-type headaches, as well as secondary headaches caused by conditions like infections, trauma, or masses. Migraines are the most common primary headache and their frequency increases in adolescence. Evaluation involves ruling out secondary causes through history and exam. For primary headaches, management includes acute treatment of attacks as well as preventive therapies and non-pharmacological methods. Frequent childhood headaches can negatively impact functioning and are associated with increased risk of future health problems.
A 35-year-old female patient has been experiencing recurrent severe headaches over the last 4 months, with unilateral pulsating pain lasting over 6 hours accompanied by nausea and sometimes vomiting. She prefers sitting in a dark room during attacks and is unable to be active. Migraine should be suspected in patients presenting with recurrent headaches that are unilateral, pulsating, long-lasting and inhibit daily activities, especially in women aged 20-50. Migraine is characterized by moderate to severe throbbing headache on one side of the head and can present with aura, nausea, photophobia, phonophobia, or other neurological symptoms. Treatment involves managing acute attacks and considering prophylaxis for frequent episodes.
Chronic daily headache is a debilitating condition affecting millions in the US. It involves headaches occurring more than 15 days per month for over 3 months. The document discusses the diagnosis and management of chronic daily headache. Key points include distinguishing between primary headache disorders like migraine from secondary disorders caused by other conditions. Treatment involves identifying medication overuse, treating any comorbid conditions, using preventive medications, and limiting the use of rescue medications to no more than 2 times per week to prevent rebound headaches.
Approach to headache family medicine case discussion 2010AR Muhamad Na'im
The document discusses a case of a 22-year-old female university student presenting with a week-long continuous headache. Her physical exam was unremarkable and she reported stress from her studies. Differential diagnoses for her headache include tension headache given her age, stressors, and normal exam. The document then reviews classification of headaches, pathophysiology, relevant history to obtain, red flags, management options including analgesics and stress counseling, and evidence on headache evaluation and treatment.
Migraine is a common neurological disorder characterized by severe headaches. Common triggers include diet, hormones, environment, and stress. Migraine attacks involve a headache phase with throbbing pain that worsens with activity along with symptoms like nausea and sensitivity to light/sound. Some people experience an aura phase before the headache with visual or sensory disturbances.
Treatment involves managing triggers, acute treatments like triptans to stop headaches, and preventive medications for those with frequent attacks. Preventive options include beta blockers, anti-seizure medications, and antidepressants, with the goal of reducing attack frequency and severity. Proper acute and preventive treatment along with lifestyle modifications can help manage migraine.
This document provides a summary of headache types including definitions, epidemiology, causes, evaluation, diagnosis, and management. It discusses common primary headache disorders like migraine and tension-type headache as well as secondary headaches that can be caused by conditions like sinusitis, pseudotumor cerebri, trigeminal neuralgia, and temporal arteritis. Key details are provided on symptoms, risk factors, diagnostic criteria and tests, and treatment approaches for each headache type. The document aims to educate medical students on conducting thorough evaluations and making accurate diagnoses to appropriately manage patients presenting with headaches.
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.
The document discusses sudden onset headaches, providing information on epidemiology, causes, evaluation, diagnosis, and management. It notes that sudden onset headaches can be caused by primary headache disorders like migraine or secondary causes like stroke, subarachnoid hemorrhage (SAH), and tumors. A thorough history and physical exam are important, and imaging like CT or MRI along with lumbar puncture may help diagnose conditions like SAH. Proper diagnosis is key as misdiagnosis can lead to worse outcomes.
Dr. Shafi Ullah Khan presents information on migraine including diagnostic criteria, clinical features, classification, pathophysiology, treatment approaches, and future treatment options. Key points include the diagnostic criteria of recurrent headache lasting 4-72 hours with features of nausea/vomiting/photophobia, classification into types such as migraine with and without aura, the trigeminovascular system pathway in migraine pathophysiology, treatment approaches including abortive medications and preventive medications/procedures, and novel emerging treatments under investigation.
This document discusses approaches to evaluating and diagnosing different types of headaches. It provides guidance on taking a thorough headache history, including questions about timing, characteristics, potential triggers and aggravating/relieving factors. Common headache types like migraine and tension headache are described. The document also outlines acute and preventive treatment strategies for migraine and tension headache, emphasizing the importance of empathy, shared decision making and monitoring response to treatment.
This document discusses headaches in children. It classifies headaches as either primary or secondary. The most common primary headaches in children are migraine, tension headache, and cluster headache. Migraines affect 3-23% of children and symptoms include throbbing pain, sensitivity to light/sound, and nausea. Tension headaches are caused by emotional or physical stress and eye strain. The document provides guidelines for evaluating and managing common childhood headaches.
The document discusses paediatric migraine. It notes that migraine commonly starts in childhood and adolescence. The prevalence increases throughout adolescence and there is a transition to a predominance in girls. Independent risk factors for migraine in children include older age, female sex, family history of migraine, and smoking in the household. The pathophysiology of migraine in children is presumed to be the same as in adults and involves genetic, biological, hormonal, and neurophysiological factors. A detailed history and neurological examination are important for evaluating paediatric migraine.
Dr.avs practice pearls in diagnosis and prophylaxis of migrainewebzforu
This document provides guidelines and recommendations for the diagnosis and prophylactic treatment of migraines. It begins with an overview of the International Headache Society criteria for diagnosing migraines based on the presence of head and non-headache symptoms. It then discusses taking a thorough patient history and performing a focused neurological examination to diagnose migraines and rule out secondary causes. Various migraine triggers and types are described. The document recommends candidates for migraine prevention based on monthly headache frequency and impairment. It reviews guidelines for successful prevention and duration of treatment. Potential mechanisms of preventive medications and common side effects of treatments like flunarizine, beta-blockers, and anti-epileptics are summarized. The progression of mig
1. The document discusses differentiating primary from secondary headaches and recognizing common childhood headaches like migraine and tension-type headaches.
2. Case examples are presented to demonstrate distinguishing features of different headache types based on history, examination, and diagnostic testing.
3. Management involves treatment of acute headaches, prevention strategies, and addressing triggers or comorbidities depending on the diagnosis.
A precise and general information on different types of headaches dealing with Symptoms, Precipitating Factors, Treatment and Prevention.
there are about 23 +/- different types of headaches mentioned according to ICD-10 and different medical sources.
some of them are
- Migraine
- Tension type headaches
- Cluster headaches
- Caffeine Withdrawal headaches
- Chronic Daily headaches
- Eyestrain headaches
- Hypertension headaches
- Sinus headaches
- TMJ headaches
- Ice Pick headaches
- Medication overuse headaches
- Children's headaches
there are different types of triggering factors of headaches, Diagnosis of headaches and Tests of headaches.
Hope this information may be helpful,
Regards,
SYED MASOOD AHMED QUADRI.
This document provides an overview of headaches other than migraines. It begins by defining headaches and outlining pain-sensitive and pain-insensitive cranial structures. It describes the mechanisms of referred pain and important aspects to cover in a headache history and examination. The document then discusses the diagnostic steps for headaches, including excluding secondary headaches and determining the primary headache type. Several primary headache types are defined in detail, including tension-type headache, cluster headache, and trigeminal autonomic cephalalgias such as cluster headache, paroxysmal hemicrania and SUNCT. Treatment approaches for various headache types are also summarized.
Migraine pathophysiology, diagnosis and treatmentsYung-Tsai Chu
Introduction of migraine, including symptoms, epidemiology, pathophysiology(neurotransmitter, neural network, channel, CGRP), diagnostic criteria and treatment (oral, intravenous therapy at ED and long-term prevention)
- Trigeminal neuralgia is characterized by sudden, severe facial pain that occurs in the areas of the face served by the trigeminal nerve. The pain is often triggered by light touch or other minor stimuli. Examination will reveal no sensory deficits. Treatment options include pharmacotherapy, microvascular decompression, or trigeminal ganglion block/radiofrequency ablation.
- Cluster headache is a severe headache occurring as multiple attacks and characterized by excruciating unilateral orbital, supraorbital, or temporal pain lasting 15-180 minutes if untreated. Attacks are associated with ipsilateral cranial autonomic features and a sense of restlessness. Treatment involves acute abortive therapy with oxygen or triptans and prevent
This document summarizes the pharmacotherapy of migraine. It outlines the pathophysiology including vascular, neurogenic, and neurovascular theories. It discusses acute treatment with non-specific medications like NSAIDs and specific treatments like triptans. Preventive treatment options are also covered including antidepressants, beta-blockers, anti-epileptics, calcium channel blockers, and newer targets such as CGRP antagonists and nitric oxide synthase inhibitors.
Topiramate has been shown to be an effective preventive treatment for migraine in multiple randomized controlled trials. It significantly reduced monthly migraine frequency compared to placebo at doses of 100mg and 200mg per day. Around 50% of patients achieved at least a 50% reduction in migraine days. The onset of efficacy was seen within the first month of treatment. Topiramate is generally well-tolerated, with dose titration helping to manage potential side effects. It offers an important additional option for preventing debilitating migraines.
MidAmerican Neuroscience Institute's physical therapist, Amy Nichols, DPT shares a presentation about her role in the Institutes Headache Center. She explains to a montly headache support group the evaluation and treatments that physical therapy provides for chronic daily migraine and other challenging headaches. The Institute has a high success rate with headaches with a integrated approach of neurology, physical therapy and sleep clinic coordinated at one location in the Kansas City area. www.neurokc.com
headache is one of the most common symptoms in the world, many people suffer from it. there are 150 different types of headache. there are red flags in patients with headache.there is algorithm for emergency management. you must know some information about it.
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.
Chronic daily headache is a debilitating condition affecting millions in the US. It involves headaches occurring more than 15 days per month for over 3 months. The document discusses the diagnosis and management of chronic daily headache. Key points include distinguishing between primary headache disorders like migraine from secondary disorders caused by other conditions. Treatment involves identifying medication overuse, treating any comorbid conditions, using preventive medications, and limiting the use of rescue medications to no more than 2 times per week to prevent rebound headaches.
Approach to headache family medicine case discussion 2010AR Muhamad Na'im
The document discusses a case of a 22-year-old female university student presenting with a week-long continuous headache. Her physical exam was unremarkable and she reported stress from her studies. Differential diagnoses for her headache include tension headache given her age, stressors, and normal exam. The document then reviews classification of headaches, pathophysiology, relevant history to obtain, red flags, management options including analgesics and stress counseling, and evidence on headache evaluation and treatment.
Migraine is a common neurological disorder characterized by severe headaches. Common triggers include diet, hormones, environment, and stress. Migraine attacks involve a headache phase with throbbing pain that worsens with activity along with symptoms like nausea and sensitivity to light/sound. Some people experience an aura phase before the headache with visual or sensory disturbances.
Treatment involves managing triggers, acute treatments like triptans to stop headaches, and preventive medications for those with frequent attacks. Preventive options include beta blockers, anti-seizure medications, and antidepressants, with the goal of reducing attack frequency and severity. Proper acute and preventive treatment along with lifestyle modifications can help manage migraine.
This document provides a summary of headache types including definitions, epidemiology, causes, evaluation, diagnosis, and management. It discusses common primary headache disorders like migraine and tension-type headache as well as secondary headaches that can be caused by conditions like sinusitis, pseudotumor cerebri, trigeminal neuralgia, and temporal arteritis. Key details are provided on symptoms, risk factors, diagnostic criteria and tests, and treatment approaches for each headache type. The document aims to educate medical students on conducting thorough evaluations and making accurate diagnoses to appropriately manage patients presenting with headaches.
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.
The document discusses sudden onset headaches, providing information on epidemiology, causes, evaluation, diagnosis, and management. It notes that sudden onset headaches can be caused by primary headache disorders like migraine or secondary causes like stroke, subarachnoid hemorrhage (SAH), and tumors. A thorough history and physical exam are important, and imaging like CT or MRI along with lumbar puncture may help diagnose conditions like SAH. Proper diagnosis is key as misdiagnosis can lead to worse outcomes.
Dr. Shafi Ullah Khan presents information on migraine including diagnostic criteria, clinical features, classification, pathophysiology, treatment approaches, and future treatment options. Key points include the diagnostic criteria of recurrent headache lasting 4-72 hours with features of nausea/vomiting/photophobia, classification into types such as migraine with and without aura, the trigeminovascular system pathway in migraine pathophysiology, treatment approaches including abortive medications and preventive medications/procedures, and novel emerging treatments under investigation.
This document discusses approaches to evaluating and diagnosing different types of headaches. It provides guidance on taking a thorough headache history, including questions about timing, characteristics, potential triggers and aggravating/relieving factors. Common headache types like migraine and tension headache are described. The document also outlines acute and preventive treatment strategies for migraine and tension headache, emphasizing the importance of empathy, shared decision making and monitoring response to treatment.
This document discusses headaches in children. It classifies headaches as either primary or secondary. The most common primary headaches in children are migraine, tension headache, and cluster headache. Migraines affect 3-23% of children and symptoms include throbbing pain, sensitivity to light/sound, and nausea. Tension headaches are caused by emotional or physical stress and eye strain. The document provides guidelines for evaluating and managing common childhood headaches.
The document discusses paediatric migraine. It notes that migraine commonly starts in childhood and adolescence. The prevalence increases throughout adolescence and there is a transition to a predominance in girls. Independent risk factors for migraine in children include older age, female sex, family history of migraine, and smoking in the household. The pathophysiology of migraine in children is presumed to be the same as in adults and involves genetic, biological, hormonal, and neurophysiological factors. A detailed history and neurological examination are important for evaluating paediatric migraine.
Dr.avs practice pearls in diagnosis and prophylaxis of migrainewebzforu
This document provides guidelines and recommendations for the diagnosis and prophylactic treatment of migraines. It begins with an overview of the International Headache Society criteria for diagnosing migraines based on the presence of head and non-headache symptoms. It then discusses taking a thorough patient history and performing a focused neurological examination to diagnose migraines and rule out secondary causes. Various migraine triggers and types are described. The document recommends candidates for migraine prevention based on monthly headache frequency and impairment. It reviews guidelines for successful prevention and duration of treatment. Potential mechanisms of preventive medications and common side effects of treatments like flunarizine, beta-blockers, and anti-epileptics are summarized. The progression of mig
1. The document discusses differentiating primary from secondary headaches and recognizing common childhood headaches like migraine and tension-type headaches.
2. Case examples are presented to demonstrate distinguishing features of different headache types based on history, examination, and diagnostic testing.
3. Management involves treatment of acute headaches, prevention strategies, and addressing triggers or comorbidities depending on the diagnosis.
A precise and general information on different types of headaches dealing with Symptoms, Precipitating Factors, Treatment and Prevention.
there are about 23 +/- different types of headaches mentioned according to ICD-10 and different medical sources.
some of them are
- Migraine
- Tension type headaches
- Cluster headaches
- Caffeine Withdrawal headaches
- Chronic Daily headaches
- Eyestrain headaches
- Hypertension headaches
- Sinus headaches
- TMJ headaches
- Ice Pick headaches
- Medication overuse headaches
- Children's headaches
there are different types of triggering factors of headaches, Diagnosis of headaches and Tests of headaches.
Hope this information may be helpful,
Regards,
SYED MASOOD AHMED QUADRI.
This document provides an overview of headaches other than migraines. It begins by defining headaches and outlining pain-sensitive and pain-insensitive cranial structures. It describes the mechanisms of referred pain and important aspects to cover in a headache history and examination. The document then discusses the diagnostic steps for headaches, including excluding secondary headaches and determining the primary headache type. Several primary headache types are defined in detail, including tension-type headache, cluster headache, and trigeminal autonomic cephalalgias such as cluster headache, paroxysmal hemicrania and SUNCT. Treatment approaches for various headache types are also summarized.
Migraine pathophysiology, diagnosis and treatmentsYung-Tsai Chu
Introduction of migraine, including symptoms, epidemiology, pathophysiology(neurotransmitter, neural network, channel, CGRP), diagnostic criteria and treatment (oral, intravenous therapy at ED and long-term prevention)
- Trigeminal neuralgia is characterized by sudden, severe facial pain that occurs in the areas of the face served by the trigeminal nerve. The pain is often triggered by light touch or other minor stimuli. Examination will reveal no sensory deficits. Treatment options include pharmacotherapy, microvascular decompression, or trigeminal ganglion block/radiofrequency ablation.
- Cluster headache is a severe headache occurring as multiple attacks and characterized by excruciating unilateral orbital, supraorbital, or temporal pain lasting 15-180 minutes if untreated. Attacks are associated with ipsilateral cranial autonomic features and a sense of restlessness. Treatment involves acute abortive therapy with oxygen or triptans and prevent
This document summarizes the pharmacotherapy of migraine. It outlines the pathophysiology including vascular, neurogenic, and neurovascular theories. It discusses acute treatment with non-specific medications like NSAIDs and specific treatments like triptans. Preventive treatment options are also covered including antidepressants, beta-blockers, anti-epileptics, calcium channel blockers, and newer targets such as CGRP antagonists and nitric oxide synthase inhibitors.
Topiramate has been shown to be an effective preventive treatment for migraine in multiple randomized controlled trials. It significantly reduced monthly migraine frequency compared to placebo at doses of 100mg and 200mg per day. Around 50% of patients achieved at least a 50% reduction in migraine days. The onset of efficacy was seen within the first month of treatment. Topiramate is generally well-tolerated, with dose titration helping to manage potential side effects. It offers an important additional option for preventing debilitating migraines.
MidAmerican Neuroscience Institute's physical therapist, Amy Nichols, DPT shares a presentation about her role in the Institutes Headache Center. She explains to a montly headache support group the evaluation and treatments that physical therapy provides for chronic daily migraine and other challenging headaches. The Institute has a high success rate with headaches with a integrated approach of neurology, physical therapy and sleep clinic coordinated at one location in the Kansas City area. www.neurokc.com
headache is one of the most common symptoms in the world, many people suffer from it. there are 150 different types of headache. there are red flags in patients with headache.there is algorithm for emergency management. you must know some information about it.
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.
UG Aug 2021 ppt neurology Headaache.pptxmanjujanhavi
The document discusses different types of primary headache syndromes including tension-type headache, migraine, medication overuse headache, cluster headache, and trigeminal neuralgia. It provides details on the pathophysiology, clinical features, and management of tension-type headache and migraine. For migraine specifically, it describes the theories of cortical spreading depression and activation of the trigeminovascular system in its pathogenesis.
- 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.
Migraine is a common type of headache disorder characterized by recurrent headaches that can cause severe throbbing pain, nausea, vomiting, and sensitivity to light and sound. It is believed to involve changes in brain activity and inflammation of the blood vessels around the brain. Migraines can be further classified based on whether an "aura" occurs before the headache, as well as other associated neurological symptoms. Common triggers include hormonal changes, stress, foods, and environmental factors. Treatment involves managing acute attacks with over-the-counter or prescription medications as well as lifestyle changes and preventive medications to reduce frequency and severity of migraines.
Clinical Approach to Migraine ward case.pptxDrMSajidNoor
Migraine is a type of headache characterized by recurrent moderate to severe throbbing pain on one side of the head lasting 4-72 hours. It is caused by activation of nerve fibers in brain blood vessels, and common symptoms include light/sound sensitivity, nausea, and vomiting. Risk factors include female sex, family history, depression/anxiety, and certain triggers like hormonal changes, stress, foods, and sleep changes. There are several types of migraine including those with and without aura, as well as menstrual, silent, vestibular, and abdominal migraines. Diagnosis involves history and tests to rule out other causes, while treatment depends on frequency and includes lifestyle changes, medications, and in rare cases surgery.
This document discusses headache syndromes and provides details on evaluating and diagnosing different types of headaches. It covers primary headaches like migraines and tension headaches. It also discusses secondary headache disorders and dangerous causes of sudden onset headaches like subarachnoid hemorrhage. Key factors for diagnosis are discussed like headache location, character, duration and associated symptoms. Diagnostic criteria for specific conditions like migraines are also provided.
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.
Approach to the diagnosis and management of primary headache disorders-GP-rec...Adamu Mohammad
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.
Approach to the diagnosis and management of primary headache disorders-GP-rec...Adamu Mohammad
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.
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.
Headache is one of the most common human complaints worldwide. There are two main types of headaches - primary and secondary. Primary headaches include migraines, tension headaches, and cluster headaches, which are caused by the condition itself rather than another cause. Migraines are severe headaches that can cause throbbing pain on one or both sides of the head along with nausea and sensitivity to light and sound. Tension headaches cause mild to moderate dull pain across both sides of the head that is often exacerbated by stress. Cluster headaches involve excruciating pain around one eye and are more common in men. Secondary headaches are caused by underlying conditions like infections, head injuries, or tumors. Diagnosis involves history and exams, while treatment
This document discusses different types of headaches including migraines, tension headaches, and cluster headaches. It describes the pathophysiology, clinical manifestations, diagnostic evaluation, and management of headaches. Migraines are caused by changes in serotonin levels and vasodilation/constriction and result in throbbing pain on one side of the head. Tension headaches cause steady pressure and are due to prolonged muscle contraction. Cluster headaches involve severe pain around the eye. Treatment involves medications to relieve pain or prevent headaches as well as lifestyle changes and relaxation techniques.
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 talk summarizes the definition, diagnosis and management strategies of migraine. It will be useful for general public as well as healthcare professionals.
This is more of a summary of recent evidence available on migraine management. It is easy to read and understand. Please post your queries and comments.
Sphenopalatine neuralgia, also known as cluster headaches, is a condition characterized by extremely painful attacks on one side of the head. Episodes typically occur in clusters, with periods of remission in between. Diagnosis is based on the pattern and symptoms of attacks. Treatment involves acute abortive therapies like oxygen and triptans to stop individual attacks, transitional therapies like steroids to control early episodes, and preventative medications like verapamil, lithium, and melatonin to suppress future attacks. While not life-threatening, cluster headaches can severely impact quality of life due to the intensity of pain.
1.Ocular headache and the causes of raised ocular pressureBARNABASMUGABI
This document provides an overview of headache evaluation and management for ophthalmologists. It begins by classifying headaches as either primary or secondary, with the primary types including migraine, tension-type headache, and trigeminal autonomic cephalgias. For evaluation, it recommends taking a thorough history and performing ocular, neurological, and laboratory exams. It describes features that warrant neuroimaging using the "SNOOP" mnemonic. Treatment approaches for migraine and tension-type headaches include acute symptomatic relief as well as prophylactic management. Specific headache syndromes like cluster headache and SUNCT are also outlined. Secondary headaches can result from ocular, orbital, vascular, or intracranial pathology.
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 provides an overview of migraines including:
- Classification of primary headaches including migraines, tension-type, and cluster headaches
- Symptoms of migraines such as pulsating pain, nausea, sensitivity to light/sound, visual aura
- Common triggers of migraines like food, environmental factors, sleep patterns, and stress
- Diagnosis involves evaluating symptoms, neurological exam, and ruling out other causes
- Treatment includes non-pharmacological options like avoiding triggers, pharmacologic options like triptans, ergotamines, and NSAIDs.
Enteric (typhoid) fever is caused by Salmonella typhi and Salmonella paratyphi bacteria, transmitted through contaminated food or water. It causes systemic infection characterized by fever and abdominal symptoms. If left untreated, it can lead to severe complications involving multiple organ systems. Diagnosis involves blood culture early and stool culture later. Treatment requires antibiotics like fluoroquinolones or cephalosporins for at least 10 days. Prevention involves vaccination and improved sanitation.
Balance requires input from sensory systems like vision and vestibular, processing in the cerebellum and brainstem, and motor output. Disorders can occur from problems with input, processing, or motor function. A careful history is needed to determine the exact nature and location of dizziness or vertigo. Physical exam may reveal sensory issues, eye movement abnormalities, or weakness depending on the site of lesion. Common causes of vertigo include vestibular disorders like acute vestibular failure, benign paroxysmal positional vertigo, and Meniere's disease.
- Seizures are caused by abnormal excessive neuronal activity in the brain. Epilepsy is defined as a tendency to have recurrent unprovoked seizures.
- Seizures can be focal, starting in one area of the brain, or generalized, involving both hemispheres. Common seizure types include tonic-clonic, absence, and complex partial seizures.
- Epilepsy has no cure but can often be controlled with anti-seizure medications or surgery. Lifestyle advice is also important to reduce risks. Prognosis depends on seizure type, cause, and response to treatment.
This document discusses trigeminal neuralgia and facial palsy. It describes trigeminal neuralgia as unilateral facial pain involving the second and third divisions of the trigeminal nerve, usually in patients over 50. Common causes include vascular compression or demyelination. Facial palsy or Bell's palsy is also discussed, describing it as a lower motor neuron lesion of the 7th cranial nerve causing unilateral facial weakness, often preceded by ear pain. Most patients recover spontaneously within 12 weeks, while a minority are left with facial disfigurement.
This document provides information on meningitis and encephalitis. It defines meningitis as inflammation of the meninges, and encephalitis as inflammation of the brain parenchyma. It describes the typical presentation and causes of viral and bacterial meningitis. Investigations may include lumbar puncture and CSF analysis. Treatment depends on the causative organism but may include antibiotics, antivirals, corticosteroids and supportive care. Complications are also discussed for different types of meningitis and encephalitis.
This document provides an overview of cerebrovascular disease and stroke. It discusses the anatomy and physiology of cerebral blood flow, the definition and classifications of stroke, common clinical presentations, investigations including imaging and vascular studies, and management approaches including thrombolysis, aspirin, risk factor modification, and carotid interventions. Stroke is a leading cause of death and disability that requires rapid diagnosis and treatment to minimize brain damage.
Hepatitis C is a major global public health problem that infects approximately 180 million people worldwide. It is a leading cause of liver disease and death, with more than 350,000-500,000 people dying each year from hepatitis C related liver disease. The virus predominantly causes chronic infection in 70-85% of cases and can lead to cirrhosis, liver failure, and hepatocellular carcinoma over time if left untreated. New direct acting antiviral regimens have revolutionized treatment and now offer cure rates over 95% with shorter, better tolerated courses of therapy.
Biological therapies are drugs derived from living organisms that are used to treat various medical conditions. Common biological therapies include monoclonal antibodies, cytokines, and growth factors. These agents are used to treat diseases like cancer, arthritis, and inflammatory bowel disease. While effective, biological therapies can have significant side effects like increased risk of infection and autoimmune disorders. Ongoing research continues to develop new biological agents and dosing strategies to maximize benefits and minimize risks.
The document discusses diseases of the aorta, including congenital anomalies, aortic aneurysms, and aortic dissections. It describes the structure and function of the aorta and risk factors for diseases like smoking and hypertension. Symptoms, investigations, and treatments are outlined for different aortic conditions such as thoracic and abdominal aortic aneurysms. Surgical and endovascular repair options are discussed for larger aneurysms at higher risk of rupture.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. • Headache is among the most common reasons to seek medical attention, and
responsible for more disability than any other neurologic problem
• Common and causes considerable worry, but rarely represents sinister disease
• Causes may be Primary (benign) or Secondary, and most have primary
syndromes
• Tempo of evolution is critical; Sudden-onset headache, maximal immediately,
is always a ‘red flag’ and prompt rapid assessment for possible subarachnoid
hemorrhage or other sinister causes, even only 10–25% serious pathology
• Evolves over hours to days is much less likely to be sinister
3. • The tempo of evolution of headache is critical; sudden-onset headache,
maximal immediately, is always a ‘red flag’ (Box 26.11) and should
prompt rapid assessment in hospital for possible subarachnoid
hemorrhage or other sinister causes, even though only 10–25% of
patients harbor serious pathology
• Clues to other possible causes (e.g. rash in meningitis) should be sought
(p. 1201)
• Headache that evolves over hours to days is much less likely to be
sinister
4.
5.
6.
7.
8. • Establish whether the headache comes and goes, with periods of no
headache in between (usually migraine), or present almost all the time
• Associated symptoms, such as preceding visual symptoms,
nausea/vomiting or photophobia/ phonophobia, support a diagnosis of
migraine, but progressive focal symptoms or constitutional upset like
weight loss or fever, may suggest a more sinister cause (e.g. cancer or
meningitis)
• Migraine patients typically retire to bed to sleep in a dark room, whereas
cluster headache often agitated and restless
9. • Headaches present for months or years are almost never sinister (although
paradoxically worry patients), whereas new-onset especially in elderly, more of
concern
• Over 60 years pain localised to one or both temples, temporal arteritis should be
considered, especially if temporal pulses are absent and/or arteries are enlarged and
tender
• Most outpatients will have migraine (intermittent, lasting a few hours, associated with
migrainous symptoms) or chronic daily headache syndrome (often present for months
to years, without associated symptoms and refractory to analgesia)
• Easy to recognise but patients are often worried, so elicit such concerns and explain
why sinister disease is unlikely and investigation is rarely required
• Sinusitis, ‘eye strain’, food allergies and uncomplicated hypertension are never the
explanation for persistent headache
10. CLINICAL EVALUATION OF ACUTE, NEW-
ONSET HEADACHE
• New, severe headache has a differential diagnosis that is quite different from
recurrent headaches over many years
• Have probability of finding a potentially serious cause is considerably greater
• Require prompt evaluation and appropriate treatment
• Serious causes include meningitis, subarachnoid hemorrhage, epidural or
subdural hematoma, glaucoma, tumor, and purulent sinusitis
11. • Careful neurologic examination is an essential first step
• Patients with an abnormal examination or a history of recent-onset headache
should be evaluated by a computed tomography (CT) or magnetic resonance
imaging (MRI) study of the brain
• As an initial screening procedure CT and MRI methods appear to be equally
sensitive
• In some LP is also required, unless a benign etiology can be otherwise
established.
12. • Evaluation include cranial arteries by palpation; cervical spine by the
effect of passive movement of the head and by imaging;
• Investigation of cardiovascular and renal status by blood pressure
monitoring and urine examination;
• Eyes by funduscopy, intraocular pressure measurement, and refraction
13. • Psychological state should also be evaluated because a relationship exists between head
pain, depression, and anxiety
• To identify comorbidity rather than explanation for the headache, because troublesome
headache is seldom simply caused by mood change
• Medicines with antidepressant actions are also effective in the preventive treatment of
both tension-type headache and migraine, each symptom must be treated optimally
• Recurrent headache disorders may be activated by pain that follows otologic or
endodontic surgical procedures
• Treatment of the headache is largely ineffective until the cause of the primary problem
is addressed
• Brain tumor is a rare cause of headache and even less commonly a cause of severe pain
14. Tension-type headache
• Most common type and is experienced to some degree by the majority
of the population
• Pathophysiology
• Incompletely understood
• Emotions and anxiety are common precipitants and sometimes
associated depressive illness
• Anxiety about the headache itself may lead to continuation
15. • Patients often become convinced of a serious underlying condition
• Muscular spasms may worsen this in some patients
16. Clinical features
• Characterized as ‘dull’, ‘tight’ or like a ‘pressure’, and there may be
sensation of a band round the head or pressure at the vertex
• Constant and generalised, but often radiates forwards from the
occipital region
• Pain can remain unabated for weeks or months without interruption,
although the severity may vary, and there is no associated vomiting or
photophobia
17. • Activities are usually continued and pain may be less noticeable when the
patient is occupied
• Less severe in the early part of the day, becoming more troublesome as the
day goes on
• Tenderness may be present over skull vault or in occiput but easily
distinguished from the triggered pains of trigeminal neuralgia and the
exquisite tenderness of temporal arteritis
• Analgesics may be taken with chronic regularity despite little effect, and may
serve to perpetuate the symptoms
18. Management
• Provide careful assessment, followed by discussion of likely precipitants
and reassurance that the prognosis is good
• Excessive use of analgesia, particularly containing codeine, may maintain
and exacerbate the headache
19. • Physiotherapy (with muscle relaxation and stress management) may help and
low-dose amitriptyline can provide benefit
• Evidence that patients benefit from a perception that their problem has been
taken seriously and rigorously assessed
• Investigation contribute to such reassurance, especially if concerns about
underlying lesion are strong, but should understand the purpose and likely
outcome of such imaging
20. Migraine
• Usually appears before middle age; affects about 20% of females and
6% of males at some point in life
• Some assume that migraine is a term encompassing any severe
headache but has a characteristic presentation
21. Pathophysiology
• Cause is unknown but increasing evidence that aura is due to dysfunction of
ion channels causing a spreading front of cortical depolarisation (excitation)
followed by hyperpolarization (depression of activity)
• Spreads over the cortex at a rate of about 3 mm/minute, corresponding to the
aura’s symptomatic spread
• The headache phase is associated with vasodilatation of extracranial vessels
and may be relayed by hypothalamic activity
22. • Activation of the trigemino vascular system is probably important
• Genetic contribution is implied by frequently positive family history, and
similar phenomena occurring in disorders such as CADASIL
• Female preponderance and the frequency of attacks at certain points in
menstrual cycle also suggest hormonal influences
• Oestrogen-containing oral contraception sometimes exacerbates migraine, and
increases the small risk of stroke in patients who suffer from migraine with
aura
• When psychological factors contribute, attack often occurs after a period of
stress, being more likely on Friday evening at the end of the working week or
at the beginning of a holiday
23. Clinical features
• Some report a prodrome of malaise, irritability or behavioural change for some hours or days
• Around 20% experience an aura, and are said to have migraine with aura (previously known
as classical migraine)
• Aura is most often visual, consisting of fortification spectra, which are shimmering, silvery
zigzag lines that march across the visual fields for up to 40 minutes, sometimes leaving a trail
of temporary visual field loss (scotoma)
• In some sensory aura of tingling followed by numbness, spreading over 20–30 minutes, from
one part of the body to another
• Dominant hemisphere involvement may cause transient speech disturbance
• 80% with characteristic headache but no ‘aura’ are said to have migraine without aura
24. • Usually severe and throbbing, with photophobia, phonophobia and vomiting
lasting from 4 to 72 hours
• Movement makes the pain worse, and patients prefer to lie in a quiet, dark room
• Caution should be taken when limb weakness or isolated aura without headache
to migraine
• In such cases, structural disorders of the brain, or even focal epilepsy, considered
• In some aura do not resolve, leaving more permanent neurological disturbance
• This persistent migrainous aura may occur with or without evidence of brain
infarction
25.
26. Management
• Avoidance of identified triggers or exacerbating factors (chocolate, cheese,
redwine, combined contraceptive pill) may prevent attacks
• Treatment of acute attack consists of simple analgesia with aspirin, paracetamol or
non-steroidal anti-inflammatory agents
• Nausea may require an antiemetic such as metoclopramide or domperidone
• Severe attacks can be aborted by one of the increasing number of ‘triptans’ (e.g.
sumatriptan), which are potent 5-hydroxytryptamine (5-HT) agonists
• These can be administered orally, by subcutaneous injection or by nasal spray
27. • Avoid accelerating use
• Overuse of analgesia, including triptans, contribute to medication
overuse headache
• If frequent (more than 3–4 per month), prophylaxis considered
• Vasoactive drugs (calcium channel blockers and β-adrenoceptor
antagonists (β-blockers)), antidepressants (amitriptyline, dosulepin) and
anti-epileptic drugs (valproate, topiramate)
• Women with aura should avoid oestrogen treatment for either oral
contraception or hormone replacement, although the increased risk of
ischaemic stroke is minimal
28. Medication overuse headache
• With increasing availability of over-the-counter medication, headache
syndromes perpetuated by analgesia intake are becoming common
• Can complicate any other headache syndrome, especially associated
with migraine and tension headache
• Most common culprits are compound analgesia (particularly codeine
and other opiate-containing preparations) and triptans, and MOH is
usually associated with use on more than 10–15 days per month
29. Management
• Withdrawal of responsible analgesics
• Migraine prophylactics may be helpful in reducing the rebound
headaches
• In severe cases, hospital admission with or without a course of
corticosteroids may be helpful
30. Cluster headache
• Cluster headaches (also known as migrainous neuralgia) are much less
common than migraine
• 5 : 1 male predominance and onset is usually in the third decade
31. Pathophysiology
• Cause unknown, but differs from migraine in its character, lack of
genetic predisposition, lack of provoking dietary factors, opposing
gender imbalance and different drug effect
• Functional imaging studies have suggested abnormal hypothalamic
activity
• Patients are more often smokers with a higher than average alcohol
consumption
32. Clinical features
• Cluster headache is strikingly periodic, featuring runs of identical
headaches beginning at the same hour for weeks at a time (the
eponymous ‘cluster’)
• Patients may experience either one or several attacks within a 24-hour
period
• Severe, unilateral periorbital pain with autonomic features, such as
unilateral lacrimation, nasal congestion and conjunctival injection
(occasionally with the other features of Horner’s syndrome)
33. • Severe, is characteristically brief (30–90 minutes)
• Patients are often highly agitated during the headache phase
• Cluster period is typically a few weeks, followed by remission for
months to years, but a small proportion do not experience remission
34. Management
• Acute attacks: Subcutaneous injections of sumatriptan or inhalation of
100% oxygen
• Brevity of the attack probably prevents other migraine therapies from being
effective
• Migraine prophylaxis is often ineffective too but can be prevented in some
by sodium valproate, verapamil, methysergide or short courses of oral
corticosteroids
• Severe debilitating clusters can be helped with lithium therapy, although
this requires monitoring
35. Headaches associated with
specific activities
• These usually affect men in their thirties and forties
• Patients develop a sudden, severe headache with exertion, including sexual
activity
• Usually no vomiting and no neck stiffness, and the headache lasts less than
10–15 minutes, though a less severe dullness may persist for some hours
• Subarachnoid haemorrhage needs to be excluded by CT and/or CSF
examination after a first event
36. • The pathogenesis of these headaches is unknown
• Although frightening, attacks are usually brief and patients may only
need reassurance and simple analgesia for the residual headache
• The syndrome may recur, and prevention may be necessary with
propranolol or indomethacin
37. Other headache syndromes
• A number of rare headache syndromes produce pains about the eye
similar to cluster headaches
• These include chronic paroxysmal hemicrania and SUNCT (short-
lasting unilateral neuralgiform headaches with conjunctival injection
and tearing)
• The recognition of these syndromes is useful since they often respond
to specific treatments such as indomethacin.