Migraine is a common type of primary headache in children. It can significantly impact a child's life by decreasing school performance and causing social withdrawal. Migraine prevalence increases with age and is more common in females during adolescence. Migraines are classified into different types based on the presence of aura. Common childhood periodic syndromes like cyclic vomiting and abdominal migraine are often precursors to migraine. Treatment involves acute, preventive and behavioral strategies. Acute treatments include NSAIDs and triptans. Preventive medications include calcium channel blockers, antiepileptics and antidepressants. Biobehavioral therapy focuses on lifestyle modification. A thorough history and exam are important to rule out secondary causes and neuroimaging may be needed
- Migraine is a recurrent headache disorder that is one of the most common complaints in medicine. It is classified into migraine with aura and without aura.
- The pathophysiology involves complex vascular and neural mechanisms including cortical spreading depression, trigeminal nerve activation, and release of vasoactive substances. Genetic and environmental factors can also play a role in migraine triggers and risk.
- Diagnosis is based on criteria involving recurrent attacks of moderate to severe pulsating headache, photophobia, phonophobia, and possibly nausea. Physical exam is typically normal but may reveal associated neurological symptoms.
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 approaches to headache diagnosis and treatment. It defines different types of primary headaches like tension, migraine and cluster headaches. It also covers secondary headaches that can be caused by underlying conditions. The evaluation involves a thorough history, physical exam, and diagnostic tests depending on risk factors. Treatment differs based on whether the headache is primary or secondary, with the goal of identifying any serious underlying causes for secondary headaches.
Migraine its presentation and managementdrmohitmathur
This document summarizes information about migraines including what they are, common symptoms, triggers, types (aura vs without aura), overuse of medications leading to chronic migraines, management through lifestyle changes and medications, and resources for more information. Migraines involve recurrent attacks of moderate to severe headaches that can last hours to days, often accompanied by nausea, sensitivity to light/sound, and visual disturbances prior to pain for those with aura. Management focuses on avoiding triggers through lifestyle modifications, medications as directed by a doctor, and self-care techniques like rest, heat/ice, and biofeedback.
The document provides an overview of various headache types, including their causes, characteristics, treatments and related conditions. It discusses primary headache disorders like migraines and tension headaches, as well as secondary headaches that can indicate underlying issues. Evaluation of patient history is important for diagnosis. Treatment involves managing acute episodes and preventing recurrent headaches through lifestyle changes and medications.
Migraine is a neurological disorder characterized by recurrent headaches that are often severe and pulsating in nature. It is estimated to affect 10% of the worldwide population. There are two main types - migraine with aura, which involves neurological symptoms before or during the headache, and migraine without aura, which involves headaches without preceding neurological symptoms. Potential triggers include hormonal changes, stress, foods, and environmental factors like light and noise. Management involves lifestyle modifications and medications to abort acute attacks or prevent future attacks. Preventive medications include beta blockers, antidepressants, and anti-seizure drugs, while acute treatments include analgesics, triptans, and anti-nausea drugs.
The document discusses the management of migraines. Key points include:
- Migraines are a common cause of recurrent headaches affecting 10-20% of the population. They are often underdiagnosed and undertreated.
- Treatment involves both abortive and preventive therapies. Common abortive medications include NSAIDs, triptans, and ergot alkaloids. Preventive options include beta-blockers like propranolol, antidepressants, anti-seizure medications, and calcium channel blockers.
- Propranolol, especially the extended release formulation, is an effective and well-tolerated option for migraine prevention and reduces attack frequency, severity, and analgesic use
- Migraine is a recurrent headache disorder that is one of the most common complaints in medicine. It is classified into migraine with aura and without aura.
- The pathophysiology involves complex vascular and neural mechanisms including cortical spreading depression, trigeminal nerve activation, and release of vasoactive substances. Genetic and environmental factors can also play a role in migraine triggers and risk.
- Diagnosis is based on criteria involving recurrent attacks of moderate to severe pulsating headache, photophobia, phonophobia, and possibly nausea. Physical exam is typically normal but may reveal associated neurological symptoms.
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 approaches to headache diagnosis and treatment. It defines different types of primary headaches like tension, migraine and cluster headaches. It also covers secondary headaches that can be caused by underlying conditions. The evaluation involves a thorough history, physical exam, and diagnostic tests depending on risk factors. Treatment differs based on whether the headache is primary or secondary, with the goal of identifying any serious underlying causes for secondary headaches.
Migraine its presentation and managementdrmohitmathur
This document summarizes information about migraines including what they are, common symptoms, triggers, types (aura vs without aura), overuse of medications leading to chronic migraines, management through lifestyle changes and medications, and resources for more information. Migraines involve recurrent attacks of moderate to severe headaches that can last hours to days, often accompanied by nausea, sensitivity to light/sound, and visual disturbances prior to pain for those with aura. Management focuses on avoiding triggers through lifestyle modifications, medications as directed by a doctor, and self-care techniques like rest, heat/ice, and biofeedback.
The document provides an overview of various headache types, including their causes, characteristics, treatments and related conditions. It discusses primary headache disorders like migraines and tension headaches, as well as secondary headaches that can indicate underlying issues. Evaluation of patient history is important for diagnosis. Treatment involves managing acute episodes and preventing recurrent headaches through lifestyle changes and medications.
Migraine is a neurological disorder characterized by recurrent headaches that are often severe and pulsating in nature. It is estimated to affect 10% of the worldwide population. There are two main types - migraine with aura, which involves neurological symptoms before or during the headache, and migraine without aura, which involves headaches without preceding neurological symptoms. Potential triggers include hormonal changes, stress, foods, and environmental factors like light and noise. Management involves lifestyle modifications and medications to abort acute attacks or prevent future attacks. Preventive medications include beta blockers, antidepressants, and anti-seizure drugs, while acute treatments include analgesics, triptans, and anti-nausea drugs.
The document discusses the management of migraines. Key points include:
- Migraines are a common cause of recurrent headaches affecting 10-20% of the population. They are often underdiagnosed and undertreated.
- Treatment involves both abortive and preventive therapies. Common abortive medications include NSAIDs, triptans, and ergot alkaloids. Preventive options include beta-blockers like propranolol, antidepressants, anti-seizure medications, and calcium channel blockers.
- Propranolol, especially the extended release formulation, is an effective and well-tolerated option for migraine prevention and reduces attack frequency, severity, and analgesic use
Migraine is a central nervous system disorder with a genetic basis. People with migraines have a hyperexcitable brain that is more sensitive to triggers. During migraine attacks, there is a wave of reduced blood flow called cortical spreading depression that starts in the occipital cortex and progresses forward. Repeated attacks can lead to changes in brain structures involved in pain processing like the periaqueductal gray, and an increased risk of white matter lesions. Preventive treatments aim to reduce central nervous system excitability underlying migraine while acute treatments target trigeminal pain pathways activated during attacks.
This document provides an overview of different types of headaches including their classification, epidemiology, clinical presentation, diagnosis, pathophysiology and treatment. It discusses primary headaches such as migraines, tension headaches and cluster headaches. It also covers secondary headaches which are symptomatic of underlying conditions. Key points include migraines affecting 10-15% of the population, being more common in women, and the importance of differentiating between primary and secondary headaches to guide treatment.
This document provides information on the management of migraines. It defines migraines and discusses their prevalence, burden, triggers, phases, and classification. It also covers the pathophysiology of migraines and outlines approaches to diagnosis, abortive treatment, and preventive treatment including medications like propranolol. Propranolol is positioned as the gold standard preventive treatment and its mechanisms of action, formulations, efficacy, dosage, and advantages over immediate-release versions are detailed.
This document summarizes several primary headache syndromes:
Tension type headache is the most common and involves gradual onset of bilateral dull pain that increases throughout the day. Migraine is the second most common and involves severe unilateral throbbing pain along with nausea, vomiting, and sensitivity to light and sound. Trigeminal neuralgia causes brief, severe facial pain triggered by activities like eating or shaving. Cluster headache is characterized by severe unilateral pain around the eye accompanied by redness, tearing and nasal congestion. These primary headache syndromes are differentiated based on their symptoms and pathophysiology.
The document discusses headaches, including:
- Headaches affect 75% of the population per year, with daily headaches affecting 4% and migraine alone accounting for 20 million lost work/school days.
- Headaches are classified as primary (migraine, tension-type, cluster) or secondary (caused by other conditions). Migraine is characterized by pulsatile pain lasting 4-72 hours with possible nausea and sensitivity to light/sound.
- Evaluation involves history and exam to identify concerning signs requiring further investigation or treatment of underlying causes. Diagnosis and management depends on headache type.
Headaches are one of the most common medical complaints. They can be classified as primary or secondary, with primary headaches like migraines occurring independently and secondary headaches resulting from another underlying condition. Migraines specifically involve recurrent attacks of moderate to severe throbbing head pain and other symptoms like sensitivity to light and sound. They can be further divided into migraines with aura, which include neurological symptoms before the headache, and migraines without aura. Potential triggers of migraines include certain foods, environmental factors, and behaviors.
Migraines are severe headaches often preceded by sensory warning signs like flashes of light and nausea. They have been documented for over 7,000 years and theories about their cause have evolved from humors rising in the body to increased blood flow in the brain. Migraines involve four phases - prodrome, aura, headache, and postdrome. Current theories suggest they are caused by cortical spreading depression leading to neurogenic inflammation and vascular changes in the brain. Treatment involves avoiding triggers, medications like triptans to abort attacks, and preventative medications like beta blockers, antidepressants, or anti-seizure drugs to reduce frequency.
This document provides information on evaluating and managing different types of headaches. It discusses taking a thorough history including red flags. Red flags for headaches include new onset headaches, worsening headaches, headaches associated with seizures, meningismus, or neurological deficits. It also summarizes migraine headaches, including diagnostic criteria, triggers, and acute and preventive treatment options. Additional headache types covered include tension headaches, cluster headaches, trigeminal neuralgia, glaucoma, medication overuse headaches, increased intracranial pressure, and acute sinusitis.
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.
This document discusses headache disorders and their evaluation and classification. It notes that headaches are among the most common neurological disorders, affecting around 47% of adults annually. The most common types of benign headaches are migraine, tension-type, and cluster headaches. A thorough patient history is the most important part of the evaluation, to help identify headache type and risk factors for underlying conditions. Physical examination may include neurological and general examination, with attention to danger signs in the history that suggest further investigation is needed.
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)
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 PowerPoint presentation discusses various types of headaches, their causes, symptoms, and treatments. It covers common headaches like tension headaches as well as more complex migraine types such as classic migraine, common migraine, basilar migraine, and cluster headaches. For migraines, it describes genetic and vascular theories of causation as well as the roles of serotonin and nitric oxide. Treatment approaches covered include acute medications for migraine attacks as well as various prophylactic drugs.
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.
1. Migraines can be classified as either primary or secondary headaches. Primary migraines include migraine without aura, migraine with aura, and tension-type headaches. Secondary migraines are caused by underlying structural or metabolic abnormalities.
2. Migraines can originate from extracranial or intracranial pain-sensitive structures. Common extracranial structures include the sinuses, eyes, ears, teeth, and blood vessels. Intracranial structures include arteries, dural veins and sinuses, and the meninges.
3. Migraines are treated either acutely to stop an attack or preventively to reduce frequency and severity. Acute treatments aim to rapidly relieve pain and associated
Migraine is a common type of episodic headache that is more prevalent in females than males. It typically onset before age 40 and is influenced by genetic and environmental factors like diet, stress, sleep patterns, and sensory stimuli. There are different clinical presentations including migraine without aura characterized by unilateral throbbing headaches without neurological symptoms, and migraine with aura where headaches are preceded by neurological symptoms like visual disturbances. Diagnosis is based on recurrent headaches lasting 4-72 hours with features like unilateral pain, throbbing, moderate to severe intensity, and sensitivity to movement. Management involves lifestyle modifications, acute symptomatic treatment with analgesics or triptans, and preventive medications for frequent episodes.
This document discusses several types of complicated migraine syndromes including hemiplegic migraine, alternating hemiplegia of childhood, migraine with brainstem aura, retinal migraine, ophthalmoplegic migraine, and Alice in Wonderland syndrome. It provides details on symptoms, diagnostic criteria, potential causes or genetic factors, differential diagnoses, and treatment approaches for each type.
This document discusses migraine, a neurological disorder characterized by recurrent headaches. It notes that migraines significantly impact quality of life, with over 25% missing at least a day of work/school and over 30% reducing household productivity. The text describes migraine symptoms like pulsating one-sided headaches along with sensitivity to light and sound. It explains that migraines originate in the brain and involve changes in nerve cell activity and blood flow that can cause visual disturbances and pain. Common types of migraines are also outlined.
This document summarizes information about migraines and other primary headaches. It begins by classifying headaches as either primary, meaning the headache itself is the disease, or secondary, meaning the headache is a symptom of an underlying condition. It then describes the characteristics and treatment approaches for primary versus secondary headaches. The bulk of the document focuses on describing migraines in particular, including the diagnostic criteria for migraine with and without aura, common symptoms and triggers, pathophysiology, treatment strategies including abortive and preventative options. It also briefly mentions some other less common primary headache types such as cluster headaches.
This document provides information on primary headache disorders, with a focus on migraine. It discusses the structures in the head that are sensitive to pain, and classifies headaches as either primary (having no underlying cause) or secondary (having an identifiable structural or metabolic cause). The primary headaches are further classified, with detailed descriptions and diagnostic criteria provided for migraine without aura, migraine with aura, and tension-type headache. Pathophysiology, epidemiology, triggers, management approaches including acute and preventive therapies are summarized for migraine. Botulinum toxin, triptans, ergot alkaloids, and other medication options are outlined for migraine treatment.
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.
This document discusses the management of headaches during pregnancy. It finds that 30% of pregnant women experience recurrent primary headaches, most commonly migraine without aura (64%) and tension-type headache (26%). Migraine often improves during pregnancy due to high estrogen levels but may recur postpartum. While migraine does not directly impact pregnancy outcomes, it may increase risks of hypertension and preeclampsia. Non-pharmacological treatments like rest, ice packs, acupuncture, and behavioral therapies are recommended. Pharmacological treatments require careful consideration of fetal risk.
Migraine is a central nervous system disorder with a genetic basis. People with migraines have a hyperexcitable brain that is more sensitive to triggers. During migraine attacks, there is a wave of reduced blood flow called cortical spreading depression that starts in the occipital cortex and progresses forward. Repeated attacks can lead to changes in brain structures involved in pain processing like the periaqueductal gray, and an increased risk of white matter lesions. Preventive treatments aim to reduce central nervous system excitability underlying migraine while acute treatments target trigeminal pain pathways activated during attacks.
This document provides an overview of different types of headaches including their classification, epidemiology, clinical presentation, diagnosis, pathophysiology and treatment. It discusses primary headaches such as migraines, tension headaches and cluster headaches. It also covers secondary headaches which are symptomatic of underlying conditions. Key points include migraines affecting 10-15% of the population, being more common in women, and the importance of differentiating between primary and secondary headaches to guide treatment.
This document provides information on the management of migraines. It defines migraines and discusses their prevalence, burden, triggers, phases, and classification. It also covers the pathophysiology of migraines and outlines approaches to diagnosis, abortive treatment, and preventive treatment including medications like propranolol. Propranolol is positioned as the gold standard preventive treatment and its mechanisms of action, formulations, efficacy, dosage, and advantages over immediate-release versions are detailed.
This document summarizes several primary headache syndromes:
Tension type headache is the most common and involves gradual onset of bilateral dull pain that increases throughout the day. Migraine is the second most common and involves severe unilateral throbbing pain along with nausea, vomiting, and sensitivity to light and sound. Trigeminal neuralgia causes brief, severe facial pain triggered by activities like eating or shaving. Cluster headache is characterized by severe unilateral pain around the eye accompanied by redness, tearing and nasal congestion. These primary headache syndromes are differentiated based on their symptoms and pathophysiology.
The document discusses headaches, including:
- Headaches affect 75% of the population per year, with daily headaches affecting 4% and migraine alone accounting for 20 million lost work/school days.
- Headaches are classified as primary (migraine, tension-type, cluster) or secondary (caused by other conditions). Migraine is characterized by pulsatile pain lasting 4-72 hours with possible nausea and sensitivity to light/sound.
- Evaluation involves history and exam to identify concerning signs requiring further investigation or treatment of underlying causes. Diagnosis and management depends on headache type.
Headaches are one of the most common medical complaints. They can be classified as primary or secondary, with primary headaches like migraines occurring independently and secondary headaches resulting from another underlying condition. Migraines specifically involve recurrent attacks of moderate to severe throbbing head pain and other symptoms like sensitivity to light and sound. They can be further divided into migraines with aura, which include neurological symptoms before the headache, and migraines without aura. Potential triggers of migraines include certain foods, environmental factors, and behaviors.
Migraines are severe headaches often preceded by sensory warning signs like flashes of light and nausea. They have been documented for over 7,000 years and theories about their cause have evolved from humors rising in the body to increased blood flow in the brain. Migraines involve four phases - prodrome, aura, headache, and postdrome. Current theories suggest they are caused by cortical spreading depression leading to neurogenic inflammation and vascular changes in the brain. Treatment involves avoiding triggers, medications like triptans to abort attacks, and preventative medications like beta blockers, antidepressants, or anti-seizure drugs to reduce frequency.
This document provides information on evaluating and managing different types of headaches. It discusses taking a thorough history including red flags. Red flags for headaches include new onset headaches, worsening headaches, headaches associated with seizures, meningismus, or neurological deficits. It also summarizes migraine headaches, including diagnostic criteria, triggers, and acute and preventive treatment options. Additional headache types covered include tension headaches, cluster headaches, trigeminal neuralgia, glaucoma, medication overuse headaches, increased intracranial pressure, and acute sinusitis.
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.
This document discusses headache disorders and their evaluation and classification. It notes that headaches are among the most common neurological disorders, affecting around 47% of adults annually. The most common types of benign headaches are migraine, tension-type, and cluster headaches. A thorough patient history is the most important part of the evaluation, to help identify headache type and risk factors for underlying conditions. Physical examination may include neurological and general examination, with attention to danger signs in the history that suggest further investigation is needed.
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)
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 PowerPoint presentation discusses various types of headaches, their causes, symptoms, and treatments. It covers common headaches like tension headaches as well as more complex migraine types such as classic migraine, common migraine, basilar migraine, and cluster headaches. For migraines, it describes genetic and vascular theories of causation as well as the roles of serotonin and nitric oxide. Treatment approaches covered include acute medications for migraine attacks as well as various prophylactic drugs.
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.
1. Migraines can be classified as either primary or secondary headaches. Primary migraines include migraine without aura, migraine with aura, and tension-type headaches. Secondary migraines are caused by underlying structural or metabolic abnormalities.
2. Migraines can originate from extracranial or intracranial pain-sensitive structures. Common extracranial structures include the sinuses, eyes, ears, teeth, and blood vessels. Intracranial structures include arteries, dural veins and sinuses, and the meninges.
3. Migraines are treated either acutely to stop an attack or preventively to reduce frequency and severity. Acute treatments aim to rapidly relieve pain and associated
Migraine is a common type of episodic headache that is more prevalent in females than males. It typically onset before age 40 and is influenced by genetic and environmental factors like diet, stress, sleep patterns, and sensory stimuli. There are different clinical presentations including migraine without aura characterized by unilateral throbbing headaches without neurological symptoms, and migraine with aura where headaches are preceded by neurological symptoms like visual disturbances. Diagnosis is based on recurrent headaches lasting 4-72 hours with features like unilateral pain, throbbing, moderate to severe intensity, and sensitivity to movement. Management involves lifestyle modifications, acute symptomatic treatment with analgesics or triptans, and preventive medications for frequent episodes.
This document discusses several types of complicated migraine syndromes including hemiplegic migraine, alternating hemiplegia of childhood, migraine with brainstem aura, retinal migraine, ophthalmoplegic migraine, and Alice in Wonderland syndrome. It provides details on symptoms, diagnostic criteria, potential causes or genetic factors, differential diagnoses, and treatment approaches for each type.
This document discusses migraine, a neurological disorder characterized by recurrent headaches. It notes that migraines significantly impact quality of life, with over 25% missing at least a day of work/school and over 30% reducing household productivity. The text describes migraine symptoms like pulsating one-sided headaches along with sensitivity to light and sound. It explains that migraines originate in the brain and involve changes in nerve cell activity and blood flow that can cause visual disturbances and pain. Common types of migraines are also outlined.
This document summarizes information about migraines and other primary headaches. It begins by classifying headaches as either primary, meaning the headache itself is the disease, or secondary, meaning the headache is a symptom of an underlying condition. It then describes the characteristics and treatment approaches for primary versus secondary headaches. The bulk of the document focuses on describing migraines in particular, including the diagnostic criteria for migraine with and without aura, common symptoms and triggers, pathophysiology, treatment strategies including abortive and preventative options. It also briefly mentions some other less common primary headache types such as cluster headaches.
This document provides information on primary headache disorders, with a focus on migraine. It discusses the structures in the head that are sensitive to pain, and classifies headaches as either primary (having no underlying cause) or secondary (having an identifiable structural or metabolic cause). The primary headaches are further classified, with detailed descriptions and diagnostic criteria provided for migraine without aura, migraine with aura, and tension-type headache. Pathophysiology, epidemiology, triggers, management approaches including acute and preventive therapies are summarized for migraine. Botulinum toxin, triptans, ergot alkaloids, and other medication options are outlined for migraine treatment.
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.
This document discusses the management of headaches during pregnancy. It finds that 30% of pregnant women experience recurrent primary headaches, most commonly migraine without aura (64%) and tension-type headache (26%). Migraine often improves during pregnancy due to high estrogen levels but may recur postpartum. While migraine does not directly impact pregnancy outcomes, it may increase risks of hypertension and preeclampsia. Non-pharmacological treatments like rest, ice packs, acupuncture, and behavioral therapies are recommended. Pharmacological treatments require careful consideration of fetal risk.
The document provides tips for creating effective PowerPoint presentations. It recommends citing sources when using outside content, limiting information on each slide if on automatic timer, and using click to operate rather than automatic timing. Bullets and varying colors are suggested to make information more organized, readable from a distance, and understandable. Too much information or unorganized text on a slide makes it difficult to read and time.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise stimulates the production of endorphins in the brain which elevate mood and reduce stress levels.
Remove your obstacles and bring happiness and success in your life by offering Pooja to Lord Ganesha. Download Ganesha Pooja & Mantra App now for Free!
The document discusses the San Francisco Walk to End Alzheimer's event that will take place on September 20, 2014. The Alzheimer's Association advocates for Alzheimer's research and supports those with the disease. They host an annual Walk to End Alzheimer's in over 650 locations to raise funds and awareness for research and patient support programs. Scott Robarge, an entrepreneur involved with charitable organizations like the Alzheimer's Association, will participate in the upcoming San Francisco walk.
This document discusses Sukuk, which are Islamic financial certificates similar to bonds. It defines Sukuk and explains that they are structured around the securitization of various asset types. The document then categorizes different types of Sukuk and discusses the Sukuk market in Pakistan, providing examples like WAPDA Sukuk. It notes challenges for the Pakistani Sukuk market like a lack of short and long-term instruments and secondary market liquidity. The conclusion recommends the government establish an institution to support the Sukuk market and calls for concerted efforts across stakeholders to further develop it.
El documento presenta un resumen sobre mapas conceptuales realizado por Abigail Vazquez Cabrera para su clase de TIC's el 4 de diciembre de 2013. El resumen incluye la información de Abigail como autora, la materia y maestra a la que fue asignado, así como la fecha en la que fue elaborado.
This document outlines the recycling processes for various materials collected at Ricoh including paper/cardboard, food waste, PET bottles, glass, toner, hazardous waste, WEEE, wood, soft plastics, mixed metals, and general waste. The materials are collected, processed, and converted into new raw materials and products or used to generate energy. Key steps involve collection, sorting, baling, transportation to processing facilities, breaking down materials, and producing new items or putting energy back on the grid.
Scott Robarge founded Another8 in 2010 drawing from his nearly two decades of recruiting experience. As a talent acquisition firm, Another8 focuses on establishing relationships to ensure the right fit between companies in engineering, sales, and marketing roles in the San Francisco Bay area and qualified job candidates. Another8 offers customized recruiting services through exclusive, contained, or contingency searches based on factors like the number of openings, required skills, and level of urgency to help clients succeed through professionalism, trust, and passion.
This document summarizes Ed Davidson's presentation on fast tracking user acquisition. The presentation covered frameworks for media types and the customer journey. It also discussed choosing early-stage marketing channels like paid search, social media, and email marketing. Key metrics for optimization like CPA, LTV and ROI were explained. The presentation provided exercises for attendees to apply the concepts to their own businesses and identify potential marketing channels and strategies.
This document contains three lessons:
1. The first lesson discusses relative clauses, which provide additional information about something in a sentence. They can be essential or non-essential information.
2. The second lesson covers auxiliary verbs like "can", "could", "must", and "may" and their uses for ability, permission, requests, and possibility.
3. The third lesson explains the future form "going to", which is used to talk about plans and predictions based on present evidence, such as "I'm going to see him later today" or "It's going to rain soon."
In this workshop we will discuss the use of technology in the work of the humanities, also known as Digital Humanities (DH). We will discuss how faculty can us DH to archive historical documents, as well as how DH might be used to motivate students with different learning styles. For technologists, you will learn the tools many people are using to implement DH projects, and how you can help faculty think about historical data in the context of a DH project.
Professional recruitment entrepreneur Scott Robarge helps fast-growing technology companies find the skilled professionals they need for their continued success. When locating desired talent, Scott Robarge uses mobile-based technology and social media platforms such as Twitter.
The document summarizes key details about the September 11, 2001 terrorist attacks on the World Trade Center towers in New York City. It describes how two planes, Boeing 767 and 757 aircraft, crashed into each tower, with the first plane hitting the North Tower at 8:46 am and the second plane hitting the South Tower at 9:03 am. It notes that both towers collapsed, with the South Tower collapsing at 9:59 am and the North Tower collapsing at 10:28 am. Smoke from the towers could be seen from space. The attacks resulted in many casualties as people were crushed under rubble.
This document provides an overview of migraines in children and adolescents. Key points include:
- Migraines are the most common type of recurrent headache in children and incidence increases with age.
- Migraines are characterized by moderate to severe headaches that may be accompanied by nausea, light/sound sensitivity, etc.
- Up to 75% of children report having migraines by age 15.
- Diagnosis is based on diagnostic criteria including headache characteristics, triggers, and ruling out other causes.
- Treatment involves acute medications like NSAIDs and triptans for relief and prophylactic medications to reduce frequency.
This document discusses headaches, including red flags that indicate the need for evaluation of headaches, essential elements of a headache history, characteristics of migraine headaches, and cluster headaches. It provides details on the signs and symptoms, pathogenesis, diagnosis, and treatment of migraine headaches, including preventative and acute treatment options. It also covers potential complications of migraines and medication overuse headaches.
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 provides information on common primary headache types including migraine, tension-type headache, and cluster headache. It describes key characteristics such as localization of pain, duration, associated symptoms, treatments and prophylaxis for each type. Migraine is often unilateral with pulsating quality, nausea and sensitivity to light/sound. Tension-type headache is typically bilateral, pressing/tightening without nausea. Cluster headache is severe and unilateral with autonomic symptoms like tearing and nasal congestion lasting 15-180 minutes.
This document provides information on common primary headache types including migraine, tension-type headache, and cluster headache. It describes key characteristics such as localization of pain, duration, associated symptoms, treatments and prophylaxis for each type. Migraine is often unilateral with pulsating quality, nausea and sensitivity to light/sound. Tension-type headache is typically bilateral, pressing/tightening without nausea. Cluster headache is severe and unilateral with autonomic symptoms like tearing and nasal congestion lasting 15-180 minutes.
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.
- Headaches are a common neurological problem and migraine is the most frequent diagnosis in patients presenting with headache.
- Migraines affect 12-15% of the population and are characterized by distinct phases including prodrome, aura, headache, and postdrome. Common triggers include stress, hormones, sleep disturbances, and foods.
- Tension-type headaches are also very common and present as mild to moderate bilateral headaches without other symptoms. Treatment involves analgesics and behavioral therapies.
- Other primary headaches like cluster headaches and trigeminal autonomic cephalalgias present with short attacks of severe pain and autonomic symptoms. Emergency evaluation is needed for headaches with red flag symptoms.
This document 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 the classification and management of migraine headaches. It begins by outlining the International Classification of Headache Disorders criteria for classifying different types of migraines, including migraine without aura, migraine with aura, hemiplegic migraine, and chronic migraine. It then discusses the epidemiology, pathophysiology involving CGRP and other factors, and diagnostic criteria for some of the main migraine subtypes. The remainder of the document focuses on guidelines for managing acute migraines, preventing migraines, and treating refractory or chronic migraines, including in special populations like pregnancy and children. Treatment options discussed include triptans, CGRP antagonists, topiramate, valproate, and neurom
primary headche by smsmc.pptx jaipur rajasthandineshdandia
This document summarizes primary headache disorders. It discusses the classification of headaches and covers specific types like migraine, tension-type headache, and trigeminal autonomic cephalalgias. It describes the pain-sensitive structures in the head and pathways involved in headache pain. Key aspects of migraine like epidemiology, pathophysiology, triggers, diagnostic criteria, aura, and subtypes are defined. The International Classification of Headache Disorders criteria for diagnosing migraine and distinguishing primary from secondary headaches is also presented.
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.
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.
This document discusses different types of headaches including primary and secondary headaches. It describes the temporal patterns of headaches as acute, recurrent-episodic, chronic-progressive, and chronic-nonprogressive. The most common primary headaches are tension-type headaches and migraine headaches. Tension-type headaches are mild and lack severe symptoms while migraine headaches involve moderate to severe pain with associated symptoms like nausea and sensitivity to light and sound. Diagnostic testing is generally not needed but may include neuroimaging or lumbar puncture in some cases.
This document provides an overview of central vestibular disorders. It discusses how the vestibular system senses head motion and distributes signals to control eye movements, posture, and balance. Central vestibular disorders can cause pathological sensations of self-motion and conflicts between visual and vestibular inputs. Common causes include vascular issues like strokes, inflammation, tumors, inherited conditions, and migraines. Central vestigular disorders are challenging to diagnose but it is important to differentiate them from peripheral disorders due to their potential medical urgency and risk of long-term neurological effects.
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
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.
Mr. Y is a 40-year-old man who presented with a sudden onset throbbing right-sided headache that was 4/10 in severity, associated with blurry vision and worsened by light. On examination, he had neck tenderness but no other abnormalities. The features are consistent with a migraine without aura that was possibly triggered by sleep deprivation from caring for his infant the previous night.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
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DECLARATION OF HELSINKI - History and principlesanaghabharat01
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2. HEADACHE
• Headache is common complaint in children.
• Headaches often cause significant impact on life of child.
– Decreases school performance
– affects family interactions
– Causes social withdrawal
Most common type of primary headaches of childhood are
– Migraine
– Tension type headache
3. EPIDEMIOLOGY
• Up to 75% of children report having a
significant headache by the time they
are 15 years of age
• 10.6% of children between 5 to 15
years diagnosed as migraine.
4. Analysis of pediatric MIGRAINE
•
•
•
•
•
3-7 Years : (1.2% to 3.2% ) Slightly male
predominance
7-11 Yrs : 4–11% Equal male and female
predominance.
11- 15 years of age: 18–23% Female predominance
15 – 19 Yrs : 28% had migraine, Females, migraine
without aura common
90% of adolescents with migraine had a positive
family history.
5. According to international classification of headache disorder 2ND
edition migraine classified as:
Migraine without aura
Migraine with aura
Typical aura with migraine headache
Typical migraine with non migraine headache
Typical aura without headache
Familial hemiplegic migraine
Sporadic hemiplegic migraine
Basilar-type migraine
Childhood periodic syndromes that are commonly precursors of migraine
Cyclic vomiting
Abdominal migraine
Benign paroxysmal vertigo of childhood
Retinal migraine
Complications of migraine
Chronic migraine
Status migraine
Persistent aura without infarction
Migrainous infarction
6. Migraine without Aura
•
•
It is most common type of migraine.
Diagnostic criteria for migraine without aura by ICHD II
A. At least 5 attacks fulfilling criteria B-D
B. Headache attacks lasting 4-72 hours (untreated or unsuccessfully
treated)
C. Headache has at least two of the following characteristics:
– unilateral location
– pulsating quality
– moderate or severe pain intensity
– aggravation by routine physical activity (eg, walking or climbing
stairs)
D. During headache at least one of the following:
– nausea and/or vomiting
– photophobia and phonophobia
E. Not attributed to another disorder
7. Migraine with aura
• Aura is neurological warning that precedes headaches.
• Typical aura can be visual, sensory or dysphasic lasting more
than 5 min and less than 60 min with headache starting within
60 min.
• Visual aura like photopsia is most common type of aura in
children and adolescents.
• Sensory aura occur unilaterally. children describe this
sensation as insect or worms crawling from their hand up to
face with numbness.
• Dysphasic auras it is least common type. It is an inability to
respond verbally.
8. Pathophysiology of Aura
• Cortical spreading depression is associated with migraine
aura
• CSD is depolarization wave that moves across cortex at
rate of 3 to 5 mm/ min.
• Alteration in neocortical function begins in occipital
region.
• Activation of trigeminal afferents, trigeminovascular
neurogenic inflammation, neuronal excitation in
trigeminal brainstem nuclear complex.
9. Continued…
•
•
•
Sensory information is subsequently transmitted to
thalamus, limbic and brainstem areas, nucleus raphe
magnus and reticular formation.
These areas are involved in regulation of autonomic,
endocrine, affective and motor function.
Their activation result in symptoms such as
photophobia, nausea, vertigo, dysphoria and fatigue.
10. ICHD-II diagnostic criteria for migraine with typical
aura
I. At least 2 Attacks fulfilling criteria II-IV
II. Aura consists of at least 1 of following but no motor weakness.
A. Fully reversible visual symptoms.
B. Fully reversible sensory symptoms.
C. Fully reversible dysphasic speech disturbance.
III. At least 2 of the following.
A. Homonymous visual symptoms and unilateral sensory
symptoms
B. At least 1 aura symptom develop gradually over >5 min
different aura symptoms occur in succession over >5 min.
C. each symptom lasts >5min and < 60 min.
IV. Headache lasting 4-72 hrs.
V. Not contributed to another disorder.
11. Familial hemiplegic migraine
• Autosomal dominant form of migraine with aura
• It is characterized by prolonged hemiplegia
accompanied by numbness, aphasia, and confusion.
Which precede, accompany, or follow the headache.
• Headache is usually contralateral to the hemiparesis
12. Typical migraine with non-migraine
headache
•
•
•
•
Typical aura consisting of visual or sensory or speech
symptoms.
At least one aura symptom develops gradually over ≥5
minutes and/or different aura symptoms occur in
succession over ≥5 minutes
each symptom lasts ≥5 and ≤60 minutes
This type of migraine Headache does not fulfil
criteria B-D for Migraine without aura. (B.
Headache attacks lasting 4-72 hours, D. During
headache at least one of the following: nausea and/or
vomiting, photophobia phonophobia )
13. Typical aura without headache
•
•
•
Typical aura consisting of visual or
sensory symptoms with or without
speech symptoms
Each symptom lasts ≥5 and ≤60 minutes
Headache does not occur during aura
nor follow aura within 60 minutes
14. Basilar migraine
•
It is migraine with aura symptoms clearly originating from the
brainstem and/or from both hemispheres simultaneously
affected, but no motor weakness.
•
Aura consisting of at least two of the following fully reversible
symptoms, but no motor weakness:
– Dysarthria
– Vertigo
– Tinnitus
– Diplopia
– Occipital headache
– visual symptoms simultaneously in both temporal and nasal
fields of both eyes
– ataxia
– simultaneously bilateral paraesthesias
15. Childhood Periodic Syndromes
• These are common precursors of migraine
1. Cyclic vomiting
2. Abdominal migraine
3. Benign paroxysmal vertigo of childhood.
16. Cyclic vomiting
• It is characterized by recurrent, sometimes monthly bouts of
severe vomiting that may be so intense that dehydration and
electrolyte abnormalities occur, particularly in infants.
• The vomiting may be projectile and persist for 1–5 days.
• After a period of deep sleep, the child awakens and resumes
normal play and eating habits as if the vomiting had not
occurred.
• Vomiting during attacks occurs at least 5 times/hr for at least 1
hr.
• Cyclic vomiting is treated with rectally administered or
injected antiemetics such as ondansetron and careful attention
to fluid replacement if the vomiting is excessive.
17. Abdominal migraine
• It is characterized by Recurrent mid-abdominal pain.
The pain may persist from 1 to 72 hr.
• To meet the criteria of abdominal migraine, the child
must complain at the time of the abdominal pain of at
least two of the following: anorexia, nausea,
vomiting.
• Mid-abdominal pain with pain-free periods between
each attack.
18. Benign paroxysmal vertigo of childhood
• The onset is usually between 2 and 8 years of age.
• symptoms are
-Repeated episodes of positional vertigo.
-Short duration (paroxysmal): Lasts only seconds to
minutes
-Positional in onset: Can only be induced by a change in
position.
-Nausea is often associated
-Associated with nystagmus
• Some children complain of vertigo or dizziness as an
initial feature of later migraine attacks.
• The vertigo becomes progressively less severe and may
disappear altogether.
19. Retinal migraine
• International Headache Society defines RM as “at least two
attacks of fully reversible monocular visual disturbance
(positive or negative), associated with migraine headache
within sixty minutes of the visual event”.
• The neuro-ophthalmic examination must be normal between
attacks and the visual events must not be attributable to
another disorder.
• visual disturbance like:
-flashing lights
-blind spots in your field of vision
-blindness in the eye
20. Complications of migraine
1. Chronic migraine
2. Status migraine
3. Persistent aura without infarction
4. Migrainous infarction
21. Chronic migraines
• The name "transformed migraine" is also used, since
chronic migraines can evolve (or transform) from
episodic to almost daily headaches.
• The symptoms of a chronic migraine are the same as a
"usual" migraine including unilateral headache that is
usually described as "throbbing," pain.
• Headache present more than 15 days out of the month for
at least 3 months.
22. Status migraine
• It is a severe form of migraine.
• Continuous headache for over 72 hours.
• In addition, patients must have at least one of the
following:
-Nausea and/or vomiting
-Photophobia and phonophobia
.
23. Persistent Aura without Infarction
• one or more of the aura symptoms last for longer than
a week, rather than disappearing after the migraine
starts.
• Most commonly visual aura are involved
-Zigzag lines
-Flashing lights
-Visual hallucinations
-Temporary blind spots
-Light sensitivity
24. Migrainous infarction
• According to the International Headache Society, it
consists of "one or more migrainous aura symptoms
associated with an ischemic brain lesion in appropriate
territory demonstrated by neuroimaging.“
• Migraine to fit the criteria for Migrainous Infarction, it
must include the following:
-The migraine must be associated with aura
-The migraine attack must be similar in intensity to
previous migraines
-The aura symptoms must last longer than 60 minutes
-The stroke must occur in the area of the brain that can
explain the aura symptoms
-The stroke cannot be caused by another medical
condition
25. Approach to case of headache
• A detailed history and medical examination is
most sensitive indicator of underlying etiology.
• The first step in evaluating a child with
headache is to rule out secondary causes
• Neuroimaging is done when neurological
examination is abnormal.
26. Detailed Headache History
•
•
•
•
•
•
•
•
•
Length of time the child has had headaches
Severity
Quality :Throbbing, pulsating, tightness.
Location :frontal, temporal, occipital, unilateral,
bilateral
Duration : number of minutes, hours, or days
Frequency : number per month, time interval
between headaches
The effect on the child’s quality of life and disability
Any aura before headaches
Presence of Nausea/ vomitting
27. History contd
• Time of onset: specific time of day, night-time waking,
relationship to particular activity.
• reliving factors: sleep, exercise, quiet, dark room
• Associated factors: photophobia, phonophobia
• Lifestyle factors: sleep pattern, exercise; diet.
• Prior treatment: response to past treatment, frequency of
use of medications.
• Activities; changes in school attendance or performance;
28. History contd
• Medical History : trauma, infection, allergies,
ventriculo-peritoneal (VP) shunt placement , epilepsy.
• Family History : headaches in first- and seconddegree relatives
• Social History : Changes or stressors in the home,
school, or outside should be obtained
29. Physical Exam
• Conducting a physical examination is
important, with an emphasis on the
neurological examination.
– Include a thorough search for potential sources of
secondary headache.
•
•
•
•
•
Increased intracranial pressure
Sinusitis
Dental disease
Abnormalities of the cervical spine
Tempo-mandibular joint disorders
30. Indications for Neuroimaging in a Child with
Headaches
• Abnormal neurological signs
• Recent school failure, behavioral change, fall-off in linear growth rate
• Headache awakens child during sleep; early morning headache, with
increase in frequency and severity
• Periodic headaches and seizures coincide, especially if seizure has a focal
onset
• Migraine and seizure occur in the same episode, and vascular symptoms
precede the seizure (20–50% risk of tumor or arteriovenous malformation)
• Headaches in child; <6 yr whose principal complaint is a headache. child
can not describe headache.
• Focal neurological symptoms or signs developing during a headache (i.e.,
complicated migraine)
• Focal neurological symptoms or signs develop during the aura, with fixed
laterality;
• Brief cough headache in a child or adolescent
31. MANAGEMENT
The American Academy of Neurology established useful practice
guidelines for the management of migraine as follows:
1. Reduction of headache frequency, severity, duration, and
disability
2. Reduction of reliance on poorly tolerated, ineffective, or
unwanted acute pharmacotherapy's
3. Improvement in quality of life
4. Avoidance of acute headache medication escalation
5. Education and enabling of patients to manage their disease to
enhance personal control of their migraine.
6. Reduction of headache-related distress and psychological
symptoms.
32. Three components are incorporated in treatment
plan
• Acute treatment strategy – for stopping headache
attacks
• Preventive treatment strategy – for frequent and
disabling headaches
• Biobehavioral therapy
33. Acute treatment strategy
• This mainly include 2 groups of medicines:
1. NSAIDS
Ibuprofen at dose of 7.5-10 mg/kg
over use needs to be avoided not more than 2-3 times a
week
2. Triptans
Almotriptan used for treatment of acute migraine.
Used for moderate to sever attacks, restricting use to 4-6 times per
month.
34. PREVENTIVE THERAPY
• IF HEADACHES ARE FREQUENT >1/WK AND
DISABLING.
• Prophylactic agent should be given for atleast 4-6
months and then weaned.
• Multiple preventive medications are used like:
-Calcium channel blockers like Flunarizine
-Antiepileptic drugs
-Antidepressants like amitriptyline most commonly
used
-Antihistamines like cyproheptadine
36. Biobehavioral therapy
• The patient and parents must understand that these objectives
are lifetime goals that can control the effect of migraines and
minimize the use of medication
• Essential for children to maintain a lifetime response to the
treatment and management of their headaches.
• Adequate fluid hydration, with limited use of caffeine
• Regular exercise
• Adequate nutrition through regular meals and a balanced diet
• Adequate sleep
• Lifestyle changes may result in an overall long-term
improvement in quality of life and may reverse any progressive
nature of the disease.
37. • References:
Nelson Textbook of Pediatrics
Rudolph`s pediatrics
IHS classification ICHD II
IAP Text book pediatrics