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Presentation on theme: "Headache."— Presentation transcript:

1 Headache


3 Headaches-overview Primary headaches -Migraine -tension type
-cluster headache/cephalgias -Others

4 Headache classification
Secondary headaches- Trauma Cranial/ cervical vascular disorder Substance or its withdrawl Infection Homeostasis related Neck , sinuses,eyes,nose, teeth Anxiety/somatisation

5 Headache classification
Neuralgias/other headaches Eg cranial neralgias, trigeminal neuralgia, atypical facial pain

6 Headaches Affect 40% of UK population Migraine- 15% of population.
Females:males 3:1 Tension headaches- 80% of population Cluster headache 1 in 200


8 Migraine

9 Migraine management Look at predisposing factors
-stress, fatigue,depression,anxiety,menstruation, menopause, head/neck trauma. -trigger factors-dietary (20%), relaxation, travel, missing meals/sleep, bright lights, noise, strenuous exercise, mensruation.

10 Migraine Duration (hours3 days)
Without aura in 2/3rd -unilateral, pulsating, moderate/severe intensity, aggravated by exercise, nausea/vomiting. Photophonophobia With aura in 1/3rd- spreading scintillating scotoma, unilateral paraesthesia, dysphasia

11 Migraine-drug intervention
Step one- simple analgesic+/- antiemetic Eg aspirin mg +buccastem 3-6mgbd Step two – rectal analgesic +/- antiemetic Eg diclofenac suppositaries+domperidone suppositaries Step three – triptans-use at onset of pain, not aura. Some rebound of symptoms in 20-50% of patients within 48 hours.

12 Triptans Sumatriptan 50-100mg
Zolmitriptan 2.5mg then rpt after 2 hours (not children) Rizatriptan 10mg (equiv sumatriptan 100mg) Almotritan 12.5mg-HIGH EFFICACY. COST EFFECTIVE

13 Migraine prophylaxis Ineffective for medication overuse headaches
Use for 4-6 months-taper off over 2-3 weeks. Agents: betablockers, TCAD, pizotifen, gabapentin, lisinopril Other agents-topiramate, sodium valproate, clonidine Non drug therapies

14 Tension headache

15 Tension headaches Chronic tension type headache:-
-more than 15 days per month - often daily -often stress/lifestyle related

16 Tension headaches Episodic tension-type headache-
-may be unilateral but tend to be generalised - pressure/tightness - often spreads from neck -stress related or related to cervical/cranial musculoskeletal anomalies

17 Tension headache management
Lifestyle changes Regular exercise Drug treatments-acute-aspirin mg, ibuprofen 600mg, naproxen mg, paracetamol 500mg-1g Prophylaxis-amitriptyline, nortriptyline, propranolol, SSRIs

18 Medication overuse headaches
Affects 1 in 50 adults Females:males 5:1 First noted with phenacetin/ergotamine More common with aspirin/ NSAIDs/paracetamol/codeine/DF118 Can take several weeks to resolve after medication withdrawl Key feature-pre-emptive use of analgesia

19 Medication overuse headaches-cont.
Low doses daily carry larger risk than higher doses weekly Esp common if using simple analgesia more days than not per month Using triptans, codeine >10days per month Worse on awakening in the morning Worse after physical exertion

20 Medication withdrawl headache-treatment
Stage one-abrupt withdrawl most effective-Sx will worsen in days 3-7. Stage 2-recovery from MOH Stage 3- review and assess the underlying primary headache disorder Stage 4- prevent relapse Failure to withdraw- naproxen 250mgtds/500mg bd, tcad.

21 References Mentor/GP notebook
BASH (British Association for the Study of Headaches)-guidelines. Neurological Differential diagnoses. Batten, J. 2nd edition.

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