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 PPT focuses on the diagnosis and treatment of the primary headache disorders, with special emphasis on migraine, the headache most likely to bring patients to physicians and pharmacists. warning signs of the ominous headache, which, although rare, can herald a life-threatening condition. Clinical characteristics of the primary headache types, migraine, tension-type headache, and cluster headache, are described
This PPT focuses on the diagnosis and treatment of the primary headache disorders, with special emphasis on migraine, the headache most likely to bring patients to physicians and pharmacists. warning signs of the ominous headache, which, although rare, can herald a life-threatening condition. Clinical characteristics of the primary headache types, migraine, tension-type headache, and cluster headache, are described
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
A talk covering epidemiology, diagnosis and management of primary headache disorders, common cases of secondary headache disorders and when to order brain imaging, lumbar puncture in headaches.
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 (type and pathophysiology ) in briefly.
helpful for beginning medical student.
there are many types but I talked about main types .
I hope you like it .
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
A talk covering epidemiology, diagnosis and management of primary headache disorders, common cases of secondary headache disorders and when to order brain imaging, lumbar puncture in headaches.
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 (type and pathophysiology ) in briefly.
helpful for beginning medical student.
there are many types but I talked about main types .
I hope you like it .
It is a brief presentation on headache disorders. My reference was mainly Medscape. I mentioned treatment in a concise way so you may want to read up more on that.
"Decoding Headaches: A Comprehensive Approach with Dr. Ganesh"
🌟 Greetings, everyone! Dr. Ganesh here, and today we're going to unravel the intricate world of headaches. Whether you're a healthcare professional refining your skills or someone seeking answers to those persistent head pains, this discussion is tailored just for you.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. Headaches in ChildrenHeadaches in Children
ObjectiveObjective
Learn the Causes of Headaches inLearn the Causes of Headaches in
Children.Children.
Learn common causes of chronicLearn common causes of chronic
headache and common causes of severeheadache and common causes of severe
headache.headache.
Learn to evaluate a patient withLearn to evaluate a patient with
headache.headache.
Understand parental concerns.Understand parental concerns.
3. INTRODUCTION
The term headache should encompass all
aches and pains located in the head, but in
practice its applications is restricted to
discomfort in the region of the cranial volt.
Headache, or cephalalgia, is defined as
diffuse pain in various parts of the head, with
the pain not confined to the area of
distribution of a nerve
Incidence of Chronic or recurrent headacheIncidence of Chronic or recurrent headache
40% by age 7 years.40% by age 7 years.
75% by age 15 years.75% by age 15 years.
Accounts for 10% referrals to NeurologistAccounts for 10% referrals to Neurologist..
5. 4.Miscellaneous headache not associated with
structural lesion:
Idiopathic stabbing headache.
Cold stimulus headache .
Benign cough headache .
Headache associated with sexual activity .
5.Headache associated with head trauma.
6.Headache associated with vascular disorder.
Acute ischaemic (CVD)
Intracranial haematoma .
SAH
Arteritis- Giant cell arteritis.
Venous thrombosis.
Arterial hypertension.
Classification contd..
6. 7. Headache associated with non vascular
intracranial disorder.
8. Headache associated with substances or their
withdrawal.
9. Headache associated with non
cephalic infection
10. Headache associated with
metabolic disorder.
11.Headache or facial pain associated
withdisorders of facial or cranial structures.
12.Cranial neuralgias ,nerve trunk
pain
13.Headache not classified
8. Case history 1Case history 1
7 year old boy with history of frequent7 year old boy with history of frequent
headaches for the last 4 monthsheadaches for the last 4 months
Not responding to paracetamole andNot responding to paracetamole and
Ibuprofen and CodeineIbuprofen and Codeine
Not associated with vomitingNot associated with vomiting
CNS , eye, ears, and systemic examinationCNS , eye, ears, and systemic examination
were normalwere normal
Cranial CTCranial CT
More anxietyMore anxiety
9. TENSION TYPE
HEADACHE
The word "tension" implies that this typeThe word "tension" implies that this type
of headache can be attributed entirely toof headache can be attributed entirely to
tension or stress, which may maketension or stress, which may make
people with this type of headachepeople with this type of headache
reluctant to consult a physician.reluctant to consult a physician.
10. .. International Headache SocietyInternational Headache Society
diagnostic criteria for tension-typediagnostic criteria for tension-type
headacheheadache
Primary diagnosisPrimary diagnosis
1.1. Headache hasHeadache has at leastat least two of the followingtwo of the following
characteristicscharacteristics::
Bilateral painBilateral pain
PressurePressure
Mild to moderate painMild to moderate pain
No increased pain with physical exertionNo increased pain with physical exertion
2.2. AndAnd no more than one of the following:no more than one of the following:
Sensitivity to lightSensitivity to light
Sensitivity to soundSensitivity to sound
3.3. AndAnd neither of the following*:neither of the following*:
NauseaNausea
VomitingVomiting
4.4. AndAnd duration of 30 minutes to 7 daysduration of 30 minutes to 7 days
11. Subdivision diagnosisSubdivision diagnosis
1.1. Episodic (<15 days/mo)Episodic (<15 days/mo) oror chronic (chronic (>>1515
days/mo for >6 mo)days/mo for >6 mo)
2.2. Associated withAssociated with oror not associated withnot associated with
coexisting pericranial muscle tenderness**coexisting pericranial muscle tenderness**
**Chronic tension-type headache may include oneChronic tension-type headache may include one
of these symptoms.of these symptoms.
**Diagnosed by manual palpation or**Diagnosed by manual palpation or
electromyographic studies.electromyographic studies.
Adapted from Headache Classification Committee of the InternationalAdapted from Headache Classification Committee of the International
Headache Society (2).Headache Society (2).
12. Synonym:
Raeder’s syndrome, Histamine cephalalgia, Red
migraine, paroxysmal nocturnal cephalagia.
Age – 20 to 50 yrs.
Sex – men are affected 7 to 8 times more than
women.
The pain begins without warnings & reaches a
crescendo within 5 minutes. Each attack last for
30 min to 2 hours.
1 – 3 short-lived attacks/day over a 4 – 8 weeks
period, followed by a pain free interval that
average one year.
CLUSTER HEADACHE
13. CLUSTER HEADACHE
Almost always the same orbit is involved
during attacks.
The pain is excruciating in intensity &
deep, non-fluctuating and explosive in
quality.
Associated with - homolateral
lacrimation, red eye, miosis, lid ptosis, nasal
stuffiness & nausea.
Onset is nocturnal is about 50% of the
cases & then pain usually awakens the
patients within 2 hours of falling asleep.
14. Diagnostic Criteria for ClusterDiagnostic Criteria for Cluster
HeadacheHeadache
A At least five attacks fulfilling criteria B through DA At least five attacks fulfilling criteria B through D
B Severe unilateral orbital, supraorbital and/orB Severe unilateral orbital, supraorbital and/or
temporal pain lasting 15 to 180 minutes (untreated)temporal pain lasting 15 to 180 minutes (untreated)
C .Headache associated with at least one of theC .Headache associated with at least one of the
following signs on the pain side:following signs on the pain side:
ConjunctivalConjunctival
injectioninjection
LacrimationLacrimation
Nasal congestionNasal congestion
RhinorrheaRhinorrhea
Forehead and facialForehead and facial
sweatingsweating
MiosisMiosis
PtosisPtosis
Eyelid edemaEyelid edema
D. Frequency of attacks: one attack every otherD. Frequency of attacks: one attack every other
day to eight attacksday to eight attacks
16. Case history 2Case history 2
A 10 year old boy with history of headache for 4A 10 year old boy with history of headache for 4
weeksweeks
Started as funny feeling inside his abdomenStarted as funny feeling inside his abdomen
Pain round the right eyePain round the right eye
Pain spread all over his headPain spread all over his head
VomitVomit
PhotophobiaPhotophobia
Fatigue, lethargic and want to sleepFatigue, lethargic and want to sleep
17. MIGRAINE
Periodic, commonly unilateral, often pulsatile headache,
begins in childhood, adolescence, or early adult life & recur
with diminishing frequency during advancing years.
Associated with nausea, vomiting and/or other symptoms
of neurological dysfunction of varying admixture.
The attacks cease during pregnancy in 75-80% of women.
18. Migraine: contd.
Some patients link their attacks to certain dietary
items – chocolate, cheese, fatty foods, orange,
tomatoes, onions.
In others headache are consistently induced by –
exposure to glare or other strong sensory stimuli
– worry.
Sudden jarring of the head.
Rapid change in barometric pressure.
Lack of sleep.
19. Migraine with aura:
Premonitory symptoms:
Changes in mood (surge of energy & feeling of well
being), appetite (hunger or anorexia).
Aura:
Visual disturbance – Unformed flashes of white or
multicoloured light (Photopsia), An enlarging blind spot
with a shimmering edge (scintillating scotoma), formation
of dazzling zigzag lines-, (fortification spectra), blurred or
cloudy vision.
Sensory disturbance – Numbness & tingling of the lips
face & hand.
Motor disturbance – Weakness of an arm or leg, mild
aphasia or dysarthria.
20. Migraine Variants:
Ophtlamoplegic migraine :
Recurrent unilateral associated with weakness of the
extra ocular muscle – A transient 3rd or 6th nerve palsy.
More common in children.
Retinal migraine:
Headache associated with monocular blindness due to
retinal or ant. optic nerve ischaemia.
Basilar migraine:
The patient first develop total blindness which is
accompanied by admixture of – vertigo, ataxia,
dysarthria, tinnitus, & distal or perioral paresthesia.
The neurological symptoms are followed by throbbing
occipital headache.
21. Hemiplegic migraine:
Childhood periodic syndrome:
Instead of complaining of headache, the child appears
limp & pale & complains of abdominal pain. Vomiting is
more common than in the adult..
Complicated migraine:
Migraine with dramatic transient focal neurologic
features. Or, migraine attack that leaves a persisting
residual neurologic deficit.
Status migrainosus:
Migraine patient who lapses into a condition of daily or
virtually continuous migraine.
22. Modified Diagnostic Criteria for Migraine
Episodic attacks of headache lasting 4-72hr
With two of the following symptoms:
•Unilateral pains
•Throbbing/pulsating
•Aggravation on movement.
•Pain of moderate or severe intensity.
And one of the following symptoms:
•Nausea or vomiting.
•Photophobia or Phonophobia.
23. Diagnostic Criteria for MigraineDiagnostic Criteria for Migraine Migraine without auraMigraine without aura
At least five attacks fulfilling criteria B through DAt least five attacks fulfilling criteria B through D
Headache lasting 4 to 72 hours (untreated or unsuccessfully treated)Headache lasting 4 to 72 hours (untreated or unsuccessfully treated)
At least two of the following pain characteristics:At least two of the following pain characteristics:
Unilateral locationUnilateral location
Pulsating qualityPulsating quality
Moderate or severe intensityModerate or severe intensity
Aggravation by walking stairs or similar physical activityAggravation by walking stairs or similar physical activity
During headache, at least one of the following:During headache, at least one of the following:
Nausea and/or vomitingNausea and/or vomiting
Photophobia and phonophobiaPhotophobia and phonophobia
Migraine with auraMigraine with aura
At least two attacks fulfilling criterion BAt least two attacks fulfilling criterion B
At least three of the following characteristics:At least three of the following characteristics:
One or more fully reversible aura symptoms indicating focal cerebral corticalOne or more fully reversible aura symptoms indicating focal cerebral cortical
and/or brain-stem dysfunctionand/or brain-stem dysfunction
At least one aura symptom develops gradually over more than 4 minutes, or twoAt least one aura symptom develops gradually over more than 4 minutes, or two
or more symptoms occur in succession.or more symptoms occur in succession.
No aura symptom lasts more than 60 minutes; if more than one aura symptom isNo aura symptom lasts more than 60 minutes; if more than one aura symptom is
present, accepted duration is proportionally increased.present, accepted duration is proportionally increased.
Headache follows aura, with a free interval of less than 60 minutes (headacheHeadache follows aura, with a free interval of less than 60 minutes (headache
may also begin before or simultaneously with aura).may also begin before or simultaneously with aura).
24. B. Pharmacologic therapy:
Staged approach to migraine
pharmacotherapy:
StageStage DiagnosisDiagnosis TherapiesTherapies
MildMild • Occasional throbbingOccasional throbbing
headache (less than oneheadache (less than one
attack per month)attack per month)
• No major impairment ofNo major impairment of
functioningfunctioning..
• Control of migraineControl of migraine
attacks –attacks –
ModerateModerate • Some impairment of function.Some impairment of function.
• Moderate or severeModerate or severe
headache (1-3 attacks perheadache (1-3 attacks per
month)month)
• Nausea commonNausea common
• Control of migraineControl of migraine
attacks –attacks –
SevereSevere • Severe headache (>3 attacksSevere headache (>3 attacks
per month)per month)
• Marked nausea and/orMarked nausea and/or
vomiting.vomiting.
• Significant functionalSignificant functional
impairment.impairment.
• Control of migraineControl of migraine
attacksattacks
• ProphylacticProphylactic
medicationmedication
25. Control of acute migraine attacks:
The drugs should be taken as soon as the headache
component of the attack is recognized.
Drugs used in the control of migraine attacks are
Analgesics
Combination analgesics
5HT agonist (Oral, Nasal, SC, IM, or IV)
Dopamine antagonists (Oral, IM or IV).
26. The vast majority of migraine attacks can be treated solely
with mild analgesics such as –
•Acetaminophen –
•Aspirin -
• Other NSAIDs –
Ibuprofen –
Naproxen.
Indomethacin -.
Combination analgesics:
•The combination of Acetaminophen, Aspirin & Caffeine has
been approved for use by the FDA for the treatment of mild
to moderate migraine.
•The combination of Acetaminophen, Dichloral phenazone
& Isometheptene has been classified by the FDA as
“possibly” effective in the treatment of migraine.
27. 5HT agonist (Oral, Nasal, SC, IM, or IV):
Ergot derivatives –
Ergotamine & Dihydro ergotamine (DHE)
Ergot preparation can be taken – Orally,
Sublingually, Rectally, IM, IV, Inhalers.
29. Duration of prophylactic therapy
The optimum duration of prophylactic therapy is uncertain
The approach is to treat for 6-12 months and then taper
over the course of several weeks.
Data are limited on the effectiveness of preventive agents
in children
30. DRUGS USED FOR PROPHYLAXIS OF MIGRAINEDRUGS USED FOR PROPHYLAXIS OF MIGRAINE
Propranolol.Propranolol.
Timolol.Timolol.
Sodium valproateSodium valproate
Methyserzide.Methyserzide.
These drugs are approved by FDA, USA.These drugs are approved by FDA, USA.
Others:Others:
Amitryptyline, Nortryptilline.Amitryptyline, Nortryptilline.
Phenelzine, Cyproheptadine.Phenelzine, Cyproheptadine.
Under research:Under research:
GabapentineGabapentine
TopiramateTopiramate
31. •Accurate history taking is fundamental
•Need for further investigation is
determined by red flag symptoms
•Or symptoms that do not corresponding
to a recognised primary headache pattern
DIAGNOSIS
32. HISTORY TAKING:
1.Age, sex, occupation:
Migraine headache – more frequent in teenagers &
young adults, higher occurrence in female.
Cluster headache – almost exclusively in males.
Cranial arteritis – more frequently in late middle age & in
elderly.
2. Duration:
Tension headache -often has long duration.
Headache due to expanding of intracranial disease –
usually short duration.
Headache due to meningeal cause – acute in onset.
Migraine headache – recur over a long period of time,
with symptoms free interval between attacks
33. DIAGNOSTIC APPROACH: Contd..
3. Location of headache:
As a general rule localized headache is of greater
significance than diffuse headache.
Tension headache – typically generalized, band
like or bioccipital.
Migraine with aura – often unilateral & frequently
more prominent interiorly.
Migraine without aura – frequently bilateral.
Cluster headache – invariably limited to the same
side of the head in any given attacks & usually
periorbital.
34. APPROACH: Contd
8. Frequency, duration & diurnal variation:
Tension headache – often persist & may worsen as the day
progress.
Migraine headache – the frequency is variable & unpredictable.
Although usual variation is from 4 - 72 hrs, they may persist for
days.
Cluster headache – occur repetitively over a period of weeks or
months. Often there are 1 or 2 attacks daily. The headache
typically nocturnal & of brief duration (30 min to a few hours).
9. Family history:
Migraine headache – strong family history.
Cluster headache – are not familial.
35. Red flag for secondary headache - Silberstein SD et al
Flag Descriptios/example
Systemic symptoms or secondary
risk factors
Fever,W. Loss,or known cancer,HIV,
immunosupression or thrombotic risks
Nerological symptoms or
abnormal signs
Confusion,impaired alertness/drowsy,
persistent focal signs> 1 H
onset First and worst headache,sudden abrupt
from sleep, or progressively worsening
older New onset and progressive-Giant cell
arteritis
Previous headache history Significant change in features, freq. or
severity
Triggered headache By valsalva, exertion, sexual intercourse
36. When to scan a patient withWhen to scan a patient with
headacheheadache
First or worst headache, particularly if of suddenFirst or worst headache, particularly if of sudden
onset.onset.
Headache of increasing frequency or severity.Headache of increasing frequency or severity.
Increased frequency of vomiting and headache onIncreased frequency of vomiting and headache on
waking.waking.
Headache triggered by coughing, straining orHeadache triggered by coughing, straining or
postural changes.postural changes.
Persistent physical symptoms or signs after attackPersistent physical symptoms or signs after attack
(neurological or endocrine)(neurological or endocrine)
Meningism, confusion,impairment ofMeningism, confusion,impairment of
consciousness or seizures.consciousness or seizures.