Headaches can have many causes and present with varying symptoms. Primary headaches include tension, cluster, and migraine headaches which originate from structures surrounding the brain. Secondary headaches are caused by underlying conditions and can be life-threatening. A thorough history and physical exam is important to determine the type and cause of headache and appropriate treatment.
2. What is a headache?
• a pain arising from the head or upper neck of the body.
• pain originates from the tissues and structures that surround the
brain because the brain itself has no nerves that give rise to the
sensation of pain
• The periosteum that surrounds bones
• muscles that encase the skull
• sinuses
• eyes, and ears
• meninges that cover the surface of the brain
• spinal cord, arteries, veins, and nerves, all can become inflamed or
irritated to cause headache
• pain may be a dull ache, sharp, throbbing, constant, mild, or intense
3. What u feel during attack
• Nausea
• Vomiting
• Diarrhea
• Sweating
• Cold hands
• Light sensitivity
• Dizziness
• Neck pain
• Sensitivity to sound
• Scalp tenderness
• Pale complexion
• Pulsating temple
• Pressure pain
• Vertigo
• Difficulty thinking
4. Causes of headaches.
1. Traction or dilatation of intracranial or extracranial
arteries.
2. Traction of large extracranial veins
3. Compression, traction or inflammation of cranial and
spinal nerves
4. Spasm and trauma to cranial and cervical muscles.
5. Meningeal irritation and raised intracranial pressure
6. Disturbance of intracerebral serotonergic projections
6. Hypertensive Encephalopathy
• Associated with high blood pressure, nausea,
vomiting and blurred vision
• Usually associated with blood pressures of
200/130.
• Headache diffuse and worse in the morning
and subsides during the day.
7. Meningitis:useful signs and symptoms.
• The absence of fever, neck stiffness and altered
mental status in a patient with a headache virtually
eliminates the diagnosis of meningitis.
• In multiple studies the presence of neck stiffness on
examination has a pooled sensitivity of 70%.
10. Tension headaches
• most common type of primary headache
• women >men
• Due to contraction of the muscles that cover the skull.
• When the muscles covering the skull are stressed, they may
become inflamed, go into spasm, and cause pain.
• Common sites include the base of the skull where the
trapezius muscles of the neck insert, the temples where
muscles that move the jaw are located, and the forehead.
• because of physical or emotional stress
• difficult and prolonged manual labor
• sitting at a desk or computer for long periods of time
concentrating.
11. Causes of TTH( tension type headache)
• Some evidence that like migraine caused by
serotonin imbalance but to a lesser extent
than migraine.
• This would indicate that similar treatments
would work.
12. Symptoms of tension h’ache
• Pain that begins in the back of the head and upper
neck and is described as a band-like tightness or
pressure. It may spread to encircle the head.
• The most intense pressure may be felt at the temples
or over the eyebrows.
• usually is bilateral
• not associated with an aura , nausea, vomiting, or
sensitivity to light and sound.
• sporadically (infrequently and without a pattern) but
can occur frequently and even daily in some people.
• allows most people to function normally, despite the
headache.
13. Episodic Tension Type Headache.
IHS Criteria
• Tension type headaches < 15 per month.
• Lasts 30 mins to 7 days
• No nausea or vomiting
• No photophobia and phonophobia (1 ok)
• Headache has at least 2 of the following criteria:
a. pressing/tightening
b. Bilateral
c. Mild-moderate
d. Not aggravated by physical activity.
14. Chronic Daily Headache
• Affects 4-5% of the population.
• Definiton: head pain for at least 4 hours for more
than 15 days/month.
• Often develops from an episodic headache disorder
either migraine or episodic tension type headache
• Includes chronic tension type headache(CTTH) and
chronic daily migraine
15. Prevention of CTTH
• Tricyclic antidepressants.
• Stress management
• Tizanidine
• SSRIs:prozac
• Anticonvulsants:gabapentin and topiramate.
• Acupuncture
16. Dx of tension h’ache
• History
• pain is mild-to-moderate
• Bilateral
• described as a tightness that is not throbbing
• not made worse with activity
• no associated symptoms like nausea,
vomiting, or light sensitivity.
18. Cluster h’ache
intro
• occur daily for periods of a week or more
• with long periods of time, months to
years, with no headache symptoms.
• occur at the same time of day, often
waking the patient in the middle of the
night.
• due to a sudden release of the chemicals
histamine and serotonin in the brain
• The hypothalamus, an area located at the
base of the brain, is responsible for the
body's biologic clock and may be the
location that is the source for this type of
headache.
causes
• tend to run in
families
• triggered by
changes in sleep
patterns
• By Rx - NTG for
heart disease
• smoking, alcohol,
chocolate and foods
high in nitrites like
smoked meat are
responsible
19. Symptoms of cluster h’ache
• headaches that come in groups (clusters) separated by pain-free periods
of months or years.
• A patient may experience a headache on a daily basis for weeks or
months and then be pain free for years.
• begins in adolescence but can extend to those in middle age.
• pain typically occurs once or twice daily
• Each episode of pain lasts from 30 to 90 minutes.
• occur at the same time every day
• awaken the patient at night from a sound sleep.
• around or behind one eye.
• patients describe the pain as feeling like a hot poker in the eye
• The affected eye may become red, inflamed, and watery.
• The nose on the affected side may become congested and runny.
• patients with cluster headaches tend to be restless
• They often pace the floor, bang their heads against a wall, can do suicide
20. Dx of cluster h’ache
• History
• description of the pain
• clock-like recurrence
• If examined in the midst of an attack, the patient
usually is in a painful crisis and may have the eye
and nose watering as described previously.
• If the patient is seen when the pain is not
present, the physical examination is normal and
the diagnosis will depends upon the history.
21. Rx of cluster h’ache
• very difficult to treat
• headache recurs daily, there are two treatment needs. The pain of
the first episode needs to be controlled, and the following
headaches need to be prevented.
• Initial treatment options may include one or more of the following:
• inhalation of high concentrations of oxygen
• injection of triptan medications, like, sumatriptan (Imitrex),
zolmitriptan (Zomig), and rizatriptan (Maxalt) which are common
migraine medications;
• injection of lidocaine into the nostril;
• dihydroergotamine (DHE, Migranal), a medication that causes blood
vessels to constrict; and
• caffeine.
22. Prevention of the next cluster h’ache
• CCBs – verapamil , diltiazem
• prednisone
• antidepressant medications - lithium
• antiseizure rx - valproic acid, topiramate
• Life style modification
• Avoid smoking /alcohol
23. Migraine headaches
• are the second most common type of primary
headache.
• affect children as well as adults.
• Before puberty - boys and girls are affected
equally
• after puberty - women > men
24. Cluster headaches
• are a rare type of primary headache.
• It more commonly affects men in their late
20s
• though women and children can also suffer
25. secondary headaches
• due to an underlying structural problem in the head or
neck.
• broad group of medical conditions ranging from dental
pain from infected teeth to pain from an infected sinus,
to life-threatening conditions like bleeding in the brain
or infections like encephalitis or meningitis
• Traumatic headaches fall into this category including
post-concussion headaches.
• also includes headaches associated with substance
abuse and excess use of medications used for
headache
26. Secondary headache
1. Head and neck trauma
• Subdural hemorrhage
• Epidural hemorrhage
• Subarachnoid hemorrhage
• Concussions
2. Bl vessel problem in Head and neck
• Stroke, TIA, temporal arteritis, arteriovenous
malformation-AVM
27. Sec h’ache
3. Non bl vessel problem in brain
• Tumor
• Seizure
• > ICT
4. Drugs
discontinuing analgesics
5. Infections
meningitis, encephalitis, HIV, influenza, pneumonia
28. Sec headache
6. Change in body enviornment
HTN, DM, renal dialysis, dehydration
7. Psychiatric diseases
8. ENT diseases
9. Ophthalmic disease
10. Teeth disease
35. cranial neuralgias, facial pain, and
other headaches?
• Neuralgia -neur= nerve + algia =pain
• Cranial neuralgia describes inflammation of
one of the 12 nerves that supply the motor
and sensation function of the head and neck
• eg. trigeminal neuralgia which affects cranial
nerve V (the trigeminal nerve) and can cause
intense facial pain.
