Headache Dr. Mansour Al Moallem
Headache related to etiology… Vascular… Migraine Muscle contraction… Tension headache Inflammatory… Giant cell artritis meningitis Distortion… ● Brain tumor Idiopathic… Trigeminal neuralgia
Pain sensitive structure invovle in headache
Migraine… Common migraine Classical migraine “ with aura” Complicated migraine Cluster headache “more in male”
Migraine…Pathogenesis…
Migraine…Symptoms…
Migraine…Symptoms…
Migraine…Cont… Affect…. 20% of female & 10-12% of male Started at age 5-30 yrs peak at puberty 70% with family history It might trigger by different factors… Stress Sleep disturbance Drugs food
Migraine…Cont… Treatment… For acute symptoms… Prophylactic… Analgesia Ergotamine Serotonin agonist Antiemetic Prophylactic… Tricyclic antidepressant Beta blocker Some antiepileptic drugs
Tension headache The most common headache Mostly related to stress & emotional conflict 40% May have family history More in female It might associated with migraine Described as non throbbing , diffuse, tightness trigger point may be found
Giant cell artritis Affect external branches of carotid artery mostly temporal artery. Segmented inflammation with lymphocyte, plasma cell & multi nucleated giant cells. Affect patients >50 yrs. Male : female 2:3 Subacute sever pain at temporal region. Mainly unilateral Examination at temporal region …tenderness , diminish or pulseless, tortious course If not treated… loss of vision 50% or other such as…MI
Giant cell artritis…cont Investigations… ESR Doppler Biopsy Treatment… steroid
Trigeminal neuralgia Pain at distribution at 5th cranial nerve mainly at V2 or V3 or both More in female “3:2” above 50 yrs Commonly unilateral May be trigger by special maneuver e.g. laughing , shaving , brushing teeth …. Many they respond to medical treatment …if not or develop major side effect ….consider surgery
Headache due to raise intracranial pressure etiology Is variable 20% headache is the initial symptom More early if in posterior fossa Usually is intermittent, Increase during sleep & immediately after wakeup Increase with cough & strain May associate with nausea & projectile vomiting Mid line tumor may cause intermittent 3rd ventricle obstruction tumor in 4th ventricle may cause sever emesis & neck rigidity Conscious may altered Neurological sign(s) according to site of the lesion Papilloedema is common
Benign raise intracranial pressure (BIH) Idiopathic Almost in female … peak at 3rd decade Associated with… Obesity Drugs…e.g. steroid , Vit A… Symptoms…. Headache Double vision Blured vision
Benign raise intracranial pressure (BIH) Consider other diagnosis such as… ”Cerebral venous/sinus thrombosis” If patint pesent with… sizure Focal neurological deficit Finding… Bilateral papiloedema +/- 6th nerve Normal MRI/MRV Increase CSF pressure Normal CSF analysis
Others… Meningitis Sinus thrombosis Paranasal sinus Hemorrhage Subdural hematoma Subarachnoid hemorrhage Ineracerbral hemorrhage
Approach to patient with headache History Age Onset Duration Character of headache Associate symptoms Examination Full neurological examination including for papilledema
Approach to patient with headache When consider headache as emergency acute headache Change of character altered consciousness Seizure in examination… Neurological deficit Papilledema Neck rigidity fever
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