HEADACHENeurology session.

Done by ahmed jabbar

headache

Caused by traction,displacement inflammation and vascular spasm or distention of pain sensitive structures in the head or neck.

Pain sensitive structures include: venous sinus,arteries,dura,v,ix,x cranial nerves and periostium

Lines

1.TypesA.Primary.

headache.migraine,tension,trigeminal autonomic cephalagia(TACs),primary thunderclap,hemicraine and continua

B.Secondary.Meningitis,intracranial

hemorrhage,brain tumor and temporal arteritis

approaches

1 .location of pain: unilateral (migraine)

,bilateral(tension)and paranasal(sinusitis)

2.characteristics: pulsating(migraine),tight or pressure(tension),dull(mass) and sharp(trigeminal neuralgia)

3.presipitating factors: stressmfatigue,menses,hunger,choclate and tyramine

Approaches

4.relieving factors: darkness,sleep and vomiting

5.associated symptoms :wt.loss fever nausea, photophobia,

phonophobia etc…6.time7.aura.

Migraine

is a chronic neurological disease characterized by recurrent moderate to severe headaches often in association with a number of autonomic nervous system symptoms

*migraine is sensitive to sound,light and movement

Types

1.common migraine(without aura):recurrent lasting 4-72 hours

2.classic migraine (with aura)aura is a transient focal neurological

phenomenon that occurs before or during the headache

Consist of visual,sensory and speech

Diagnostic criteria

1.The diagnosis of migraine without aura#Five or more attacks—for migraine with aura, two attacks are

sufficient for diagnosis#Four hours to three days in duratio

#Two or more of the following:Unilateral (affecting half the head);Pulsating;Moderate or severe pain intensity

#One or more of the following:Nausea and/or vomiting;

Sensitivity to both light (photophobia) and sound( phonophobia)

.

Diagnostic criteria

2 .The diagnosis of migraine with aura

#at least 2 attcks#aura.reversible

#2 of the following Visual symptoms and \or unilateral sensory symptoms.At least one aura

Managment

1.Nonpharmalogical: lifestyle change2.pharmalogical:

AnalgesicsTriptansErgotaminesNSAIDsDopamine antagonist

3.PreventionAntiepileptic drugAntidepressantBeta blockersCCBantiserotonine

Tension headache

is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes, or other muscle groups in the body. Tension-type headaches account for nearly 90% of all headaches.

Clinical features

DiffuseNot aggravated by activity

Not severeNo nausea and vomiting

Photophobia or phonophobia

Management

LifestylePhysical

Pharmacological:Acetaminophen

AspirinIbuprofen

Preventive:Amitriptyline(antidepressant)

Cluster headache

  neurological disorder characterized by recurrent, severe headaches on one side of the head, typically around the eye. There are often accompanying autonomic symptoms during the headache such as eye watering, nasal congestion and swelling around the eye, typically confined to the side of the head with the pain.

Lasting 15 min to 2 hours

Treatment

Sumatriptan nasal spray Prevention:

Short term: prednisoneLong term: verapamil

Secondary headache

Temporal arteritisIdiopathic intracranial hypertensionTrigeminal neuralgia

Temporal arteritis

is an inflammatory disease of blood vessels most commonly involving large and medium arteries of the head, predominantly the branches of the external carotid artery.

Associated with malaise,myalgia,wt loss,arthralgia and fever

Pain during chewing(jaw claudication)Involvement of ophthalmic artery lead to

visual loss

Dx &Rx

Dilated and tenderBiopsy: thick wall

High ESRRx:

High dose of prednisone

Idiopathic intracranial hypertension

sometimes called by the older names benign intracranial hypertension

 is a neurological disorder that is characterized by increased intracranial pressure  in the absence of a tumor or other diseases .

  double vision and other visual symptoms. If untreated, it may lead to swelling of the optic disc(papilledema) in the eye ,

which can progress to  vision loss.

Dx

Dandy criteria1.Increased i.c

pressure(headache and papillidema)

2 .6th nerve palsy3.Normal neuroimage

4.Elevated opening pressure more than 250 mm\H2O

Treatment

Removal of 20-40 ml of csf

Diuretics:Acetazolamide

furesamide

Trigeminal neuralgia

is a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve. The clinical association between TN and hemifacial spasm is the so-called tic douloureux.

No more than few seconds or minutesSensory loss can not be demonstrated

on examination.Common.

treatment

Carbamazepine.Baclofen.

Gasserian ganglian ablation.Radio-surgery.

Thundreclap headache

Causes1.Subarachnoid or intracerebral hg

2.cervico-cephalic arterial dissection3.Cerebral venous thrombosis

4.Acute hypertension5.Acute low csf pressure