Headache Dr sadik al ghazawi - PowerPoint Presentation

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Headache

Dr

sadik

al

ghazawi

Associated

professer

Neurologist

Mrcp,frcp

uk

Accounts for 1

% to 2% of emergency department evaluations and up to 4% of medical office visits

Headache is caused by traction, displacement, inflammation, or distention of the pain-sensitive structures in the head or neck

Intracranial Pain-Sensitive Structures

Venous sinuses

Anterior

and middle meningeal

arteries

Dura

at the base of the

skull

Trigeminal

(V), glossopharyngeal (IX), and

vagus

(X)

nerves

Proximal

portions of the internal carotid artery and its branches near the circle of

Willis

Brainstem periaqueductal

gray

matter

Sensory

nuclei of the

thalamus

Venous sinuses

periaqueductal gray matter

Causes of headache

Primary

Migraine

Tension-type

Cluster

Paroxysmal

hemicrania

Trigeminal neuralgia

Chronic

daily headache

Secondary

Medication overuse (rebound)

head/neck trauma

Vascular disorder – SAH, AVM,

vasculitis,High

ICP / Low ICP

Tumor

Infection

CNS

Other infections

Red Flags in Hx

“Worst HA of my life”

New onset HA

Change in character of headache

Awakens him from sleep

Associated with focal symptoms

or fever

Worsening with bending, laying down, coughing or sneezing

Immunocompromised

h/o cancer

Migraine

Prevalence

12

%

More

than 90% before age 40

begins with visual or other

neurologic

symptoms in approximately 15% to 20% of patients (migraine with aura, or

classic migraine

)

In most

cases

no aura occurs (migraine without aura, or common migraine

Diagnostic Criteria:

A

. At least

5 attacks

fulfilling criteria

B through

D

B

. Headache attacks lasting 4 to 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 or causing avoidance of routine physical activity (eg, walking or climbing stairs)

D. During headache at least

one of the following

:

1. Nausea and/or vomiting

2. Photophobia and

phonophobia

E. Not attributed to another disorder

Management

Prophylactic

B Blocker prpronalol

Topamax

Antidepressant (

amytriptyline

)

Abortive

Analgesia

brufine

Sumatriptan

Ergot (

cafergot

,

Tension headache

A. At least

10 episodes

Fulfilling

criteria

B through D listed below

B

. Headache lasting from

30 minutes to 7

days

C

. Headache has at least two of the following pain characteristics: 1. Bilateral location2. Mild or moderate intensity (may inhibit but does not prohibit activity)3. Pressing/tightening (non-pulsating) quality4. No aggravation while climbing stairs or similar routine physical activity

D. Both of the following:

1. No nausea or vomiting (anorexia may still occur)

2. No more than one of photophobia and

phonophobia

E. Not attributed to another disorder

Cluster HA

A. At least

five attacks

fulfilling criteria

B through

D

B

. Severe or very severe unilateral orbital, supraorbital, and/or temporal pain

lasting

15 to 180 minutes

if

untreated

C

. Headache is accompanied by at least one of the following: 1. Ipsilateral conjunctival injection and/or lacrimation 2. Ipsilateral nasal congestion and/or rhinorrhea3. Ipsilateral eyelid edema4. Ipsilateral forehead and facial sweating 5. Ipsilateral miosis and/or ptosis 6. A sense of restlessness or agitation

D. Attacks have a frequency from

one every other day to eight per day

.

E. Not attributed to another disorder

Trigeminal neuralgia (tic

douloureux

)

1-In

many instances, the trigeminal (V) nerve roots are close to a

vascular

structure, and

microvascular

compression followed by demyelination of the

nerve

is believed to cause the disorder.

2-Second (V2) and third (V3) divisions of the trigeminal (V) nerve

3-Lightning-like

momentary (>1 second to approximately 2 minutes

)

4

-Trigger zones

about the cheek, nose, or mouth by touch, cold, wind, talking, or chewing can precipitate the pain.

5-

Young pts, bilateral symptoms or

abn

exam

r/o MS and brainstem

tumors

Medication-overuse HA

A. Headache

> or =

15

d/

mo

B. Regular overuse for

>3

months

of

> or = 1

acute/symptomatic treatment drugs:

1. Ergotamine,

triptans, opioids, or combination analgesic medications on > or = 10 d/month on a regular basis for >3 months 2. Simple analgesics or any combination of ergotamine, triptans, or analgesics opioids on > or = 15 d/month on a regular basis for >3 months without overuse of any single class alone C. Headache developed or markedly worsened during medication overuse