| ID | 104 |
|---|---|
| Name | HEADACHE |
| Cause | |
| Signs Symptoms | |
| Diagnosis | Diagnosis of headache: 1. Careful history taking. 2. Clinical presentations & examinations. 3. Blood count & serological test. 4. Lumbar puncture & CSF test. 5. Plain X-ray of the skull and paranasal sinuses. 6. EEG 7. CT scan or MRI of brain. 8. Ophthalmic exam (visual acuity in specific cases). |
| Investigations | |
| Management | |
| Introduction | Headache is a common neurological symptom characterised by pain or discomfort over the cranial vault including forehead and sub occipital region. In the most cases of headache, underlying structural lesions are usually not present, but a careful history of the nature of onset, intensity, duration & site of pain may provide some clues to the suspected underlying cause. On the contrary, headache due to primary neurologicl disoders can easily be identified by applying different invasive^ non-invasive diagnostic procedures, such as CT scan, MRI, EEG, lumbar puncture etc. |
| History | |
| Etiology | Aetiological types & associated causes of headache: 1. Traumatic headache Head injury, injury to the upper cervical spine or its associated soft parts. 2. Inflammatory headache Meningitis, sinusitis.jnastoiditis, febrile systemic illnesses. 3. Tumour headache Associated with primary or metastatic tumours of the head and neck or intracranial heamatoma. 4. Vascular headache Migraine, intracranial aneurysm, essential hypertension and syncope. 5. Metabolic headache Hypothyroidism, ovarian dysfunction, anemia and boold dyscrasias etc. 6. Emotional headache Anxiety pain, conversion neurosis etc. 7. Miscellaneous Neuralgias, ocular disorders e.g glaucoma. |
| Clinical Features | |
| Preventions | |
| Treatment | Treatment: General treatment- 1. Headache of short duration requires no treatment, but in chronic psychpgenic or post-traumatic headache- reassurance helps greatly to the patient: 2. In chronic headache e.g psychogenic or post traumatic headache-paracetamol 500mg 4 times daily or aspirin 300mg-600mg 4 times daily is usually effective. 3. Mild sedation- diazepam 2-5mg 3 times daily or phenobarbitone 30mg orally once daily may be helpful. Specific treatment- Underlying cause of the headache must be find out and specific treatment should be given accordingly. |
| Complications | |
| Prognosis | |
| Types | Clinical types: 1. Tension headache 2. Depression headache 3. Migraine 4. Cluster headache 5. Idiopathic intracranial hypertension (IIH) 6. Benign paroxysmal headache 7. Facial pain (trigeminal neuralgia) 8. Atypical facial pain 9. Post-herpetic neuralgia 10. Giant cell (temporal or cranial) arteritis |
| Classification | Comparative presentation of clinical features: Tension headache: Site- generalised/nuchal (may radiate forward from the occipital region). Duration- constant, may continue weeks or months without break. Character- usually not severe, dull, tight or like a pressure. Associations- may be associated with anxiety, depression. Migraine: Site- unilateral (hemicranial). Duration- episodic; headache may persist for several days. Character- aching, throbbing. Associations- prostration, nausea, vomiting, focal neurological events (usually visual), photophobia Temporal arteritis: Site- temporal. Duration- constant (nocturnal). Character- burning. Associations- scalp tenderness, jaw claudication, malaise. Raised intracranial pressure: Site- generalized. Duration- progressive. Character- throbbing. Associations- drowsiness, vomiting, papilloedema. Meningitis headache: Site- generalized/nuchal. Duration- acute progressive. ‘,, Character- throbbing. Associations- meningism, pyrexia. |
| Observation | |
| Pathology |
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