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About Headaches and StimulationChef de Service de Neurochirurgie

CHU FORT DE FRANCE

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Occipital neuralgia

A . Paroxysmal stabbing pain ,with or

without persistent aching between

paroxysms , in the distribution(s) of thegreater , lesser and/or 3rd occipital nerves .

B . Tenderness over the affected nerve .

C . Pain is eased temporarily by anaestheticblock of the nerve

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Cervicogenic headaches

A- pain referred from a source in the neck and perceived in one or

more regions of the head or face fulfilling criteria C and D

B-evidence of lesion or disorder of the neck known to be avalid cause of headache

C-evidence that the pain can be attributed to the neck disorder

D-pain resolve after successful treatment of the causative lesion

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Primary headaches

Migraine

Tension-type headache

Cluster-headache and other trigeminal

autonomic cephalalgias

Other primary headaches

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Trigeminocervical complex

Is defined by its afferents :

Trigeminal nerve (face)

Upper three cervical nerves

(neck ; cerebral posterior fossa )

Is not defined by any distinctive cytoarchitectureor by any intrinsic boundaries

The pars caudalis of the spinal nucleus of the trigeminal nerveis continuous longitudinally with the outer laminae of the dorsal

horns of the upper 3 to 4 segments of the cervical spinal cord

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Trigemino-vascular system

Around meningeal vessels and veinous sinuses the nervous plexus

comes from 1-st branch of trigeminal nucleus with unilateral

distribution

Orthodromic conduction ,via the thalamus , to the cortex ,

is the way ot the conscious sensation of pain

Antidromic activation af amyelinic trigeminal fibers leads to

liberation of neuropeptides ..

NEUROGENIC INFLAMMATION

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Migraine without aura

A .At least 5 attacks fulfilling criteria

B . Headache lasting 472 h(untreated)

C . Headache has 2 of the following characteristics1 ; unilateral location

2 .pulsating quality

3 .moderate or severe pain intensity

4 .aggravation by or causing avoidance of routine physicalactivity

D . During headache 1 of the following :

1 .nausea and:or vomiting

2 .phono and photophobia

E . Not attributable to another disorder

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Chronic migraine

A-Headache fulfilling criteria C and D for

Migraine without aura on >15d/mofor>3mo

B-Not attributable to another disorder

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Cluster headache and other

trigeminal autonomic

cephalalgias Cluster headache

Paroxysmal hemicrania

Short lasting unilateral neuralgiform

headache attacks with conjunctival injection

and tearing (SUNCT)

Probable trigeminal autonomic cephalalgia

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Cluster headache

A -At least5 attacks fulfilling criteria c-d

B- severe or very severe unilateral orbital,supraorbital and/ortemporal pain lasting15-180 min if untreated

C-headache is accompagnied by >1 of the following: 1-ipsilateral conjunctival injection and/or lacrimation

2-ipsilateral nasal congestion and/or rhinorroea

3-ipsilateral eye lid oedema

4-ipsilateral forehead and facial sweating

5-ipsilateral miosis and/or ptosis 6-restlesness or agitation

D- frequency from1/2d to 8/d

E- not attributed to another disorder

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Primary headaches

Migraine

Tension-type headache

Cluster-headache and other trigeminal

autonomic cephalalgias

Other primary headaches

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Chronic Tension Type Headache

A-Headache >15d:mo(180d/y)and fulfilling criteria B-D

B-Headache lasts hours or may be continuous

C-Headache has>2of the following characteristics:

1-bilateral location

2-pressing/tightening (nonpulsating quality)

3-mild or moderate intensity

4-not aggravated by routine physical activity

D-Both of the following:

1-not>1of photophobia,phonophobia,mild nausea

2-neither moderate or severe nauseanor vomiting

E-Not attributed to another disorder

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BUT

Chronic migraine

Chronic TTH

Cervicogenic headache

ARE in some cases DIFFICULT to DISTINGUISH

!

(headache attributed to psychiatric disorder)

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And,as usual in headache

management

We have to know exactly

What is the type of the headache

What is actually the problem of this patient