Date post: | 03-Jul-2015 |
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Diagnosing
headache
Elizabeth Vargas Rodríguez
OBJECTIVE
• Identify the different types and subtypes of
headache, comparing the characteristics
of them.
• Establish a diagnosis based in the range of
the International Classification of
Headache Disorders .
Primary headache
• The diagnosis of a primary headache
requires that all other identifiable and
probable conditions that can secondarily
cause headache be excluded.
• For this crucial diagnostic step to take
place, the clinician must be familiar with
the typical features of each headache
type, carried out a competent physical
examination, and selected the
appropriate special investigations (CT).
Secondary Headache
• This type have an important
consideration, not only because of the
potential danger inherent in some, even
also because of their prevalence.
According to lifetime prevalence studies of
headache:
-Primary and secondary tension type headache
are the most common (69%)
-Headache from systemic infection is second in
frequency (63%)
- Migraine is next (16%)
- Headache after head injury (4%)
- Exertional headache (1%)
- Vascular disorders (1%)
- Sub-arachnoid hemorrhage (<1%)
- Brain tumors (0.1%).
Diagnosis of primary headache
syndromes
• Frequency: low to moderate
frecuency, episodic headache and high
frecuency.
• Attack duration: more than 4 hours and
those that last less than 4 hours.
Clinical features
Migraine is a unilateral, moderate to severe
throbbing headache – often frontal in
location. It is aggravated by positional
change and exercise.
Tension type headache is not so severe
usually bilateral, described as ‘tight,
pressing or aching’. It is not generally
aggravated by positional change.
Cluster headache is acute, unilateral,
located behind one eye, boring in
character and not affected adversely by
exercise or position.
Patient behavior and
appearance during attack
• In typical migraine attacks, the patient
chooses silence, tries to sleep (often finding
that sleep relieves the headache), and does
not want to be disturbed.
• But in cluster headache the opposite occurs.
• Unfortunately, this signs are similar in patients
with meningitis, encephalitis or subarachoid
hemorrhage.
Duration
• Untreated or unsuccessfully treated
migraines last 4–72 hours.
• Cluster headaches are shorter, having
a duration range of 15–180 minutes.
• Episodic tension type headache has a
duration of 30 minutes to 7 days.
Conclusion
• Is very important for the
clinician be able to classify
the different types of
cephaleas, based in their
etiology, signs-symptoms
and therefore create a
treatment plan for the
patient.
Bibliography
• Joubert, D. J. (August, 2005). Diagnosis of
headache. Headache • THEME, 621-
625.Recovered in July 27; from:
http://www.racgp.org.au/Content/Naviga
tionMenu/Publications/AustralianFamilyPh
ys/2005Issues/AugustHeadache/200508jou
bert.pdf