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Headache: When to see a physician Morris Levin, MD Section of Neurology Dartmouth Medical School.

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Presentation on theme: "Headache: When to see a physician Morris Levin, MD Section of Neurology Dartmouth Medical School."— Presentation transcript:

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2 Headache: When to see a physician Morris Levin, MD Section of Neurology Dartmouth Medical School

3 Head Pain - sources Meninges Brain veins and arteries Pain nerves Periosteum Scalp Scalp muscles Scalp blood vessels Sinuses Eyes Ears Teeth, TMJ Arteries of the neck Neck spine Neck muscles

4 IHS Classification IHS Primary HA 1. Migraine 2. Tension-type 3. Cluster 4. Exertional Secondary HA 5. Post-traumatic 6. Blood vessel disease 7. Brain tumor 8. Substances 9. Infection 10. Medical problems 11. Neck, Eyes, SInuses 12. Psychiatric 13. Neuralgias

5 Primary Headaches Migraine –severe, one-sided, –nausea Tension-Type –milder, more diffuse, – –no nauseaCluster –brief, around the eye, –occurs in cycles

6 Warning Signs in Headache Warning Signs in Headache  Sudden  Brought on by exertion  New kind of headache, or change in pattern  Onset in middle age or later  Fever  Change in behavior or thinking  Changes in sensation, strength  Setting of systemic disease - eg Cancer, AIDS

7 Medical Evaluation of Headaches History of the HA problem General medical history General examination Diagnostic testing

8 Medical Evaluation History –Where, When –What Triggers, what helps –What other symptoms –Family history –Medical problems and medications

9 Medical Evaluation Examination –Head and Neck –General exam –Neurological exam Mental function Vision Motor function SensationCoordination

10 Options: Blood tests X-rays MRI, CT Lumbar Puncture Testing Testing Medical Evaluation MRI

11 Brain Tumors and HA 50% of Brain neoplasms present with HA <.1% of HA sufferers have brain neoplasm

12 Vascular problems Arteriovenous malformation aneurysm

13 Infections Brain abscess Cysticercosis

14 IHS Classification IHS Primary HA 1. Migraine 2. Tension-type 3. Cluster 4. Exertional Secondary HA 5. Post-traumatic 6. Blood vessel disease 7. Brain tumor 8. Substances 9. Infection 10. Medical problems 11. Neck, Eyes, SInuses 12. Psychiatric 13. Neuralgias However – Recurring headaches are usually primary (migraine or tension-type headache)

15 Headache - When to see a Physician Conclusions Headache can be a warning sign of serious illness Most correctable causes of headache can be found Most headache problems are due to “primary headache”


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