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Questions and Answers
What percentage of females experience headache as a common symptom in clinical practice?
Which of the following is not a pain-sensitive structure in the cranium?
What is the primary step in evaluating a patient with headache?
Which of the following cranial nerves is not pain-sensitive?
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What is the term for headache associated with vascular disorders?
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What percentage of females and males are affected by migraine?
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What is the term for headache referred from diseases of the neck?
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What is a common precipitating factor of migraine attacks?
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How often may migraine attacks occur?
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What is a diagnostic criterion for migraine without aura?
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What is a general measure for managing migraine?
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What medication may be used during a migraine attack?
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What is the typical duration of a tension type headache?
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Which of the following medications is NOT typically used to treat cluster headaches?
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What is a characteristic of cluster headaches?
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What is often associated with tension type headaches?
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What is the primary mechanism of action of Sumatriptan?
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What is a common symptom of cluster headaches?
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Study Notes
Headache
- Headache is a common symptom in clinical practice, affecting 93% of males and 99% of females.
- It is a symptom of an underlying disease that requires further investigation.
Classification of Headache
- Migraine
- Tension type headache
- Cluster headache
- Headache associated with vascular disorders
- Headache associated with head trauma
- Cranial neuralgia
- Headache associated with non-vascular intracranial disorders
- Headache referred from diseases of the skull bone, neck, etc.
Migraine
- More common in females (15-20%) than males (5-10%)
- Strong family history is present
- Onset: at or shortly after puberty
- Frequency: may occur 2-3 times/week, decreasing with age
- Precipitating factors: excitement or excessive work, menses, bright light, extra sleep, strong smells, certain diets
- Diagnostic criteria:
- A. At least 5 attacks fulfilling B-D criteria
- B. Headache attacks lasting 7-48 hours
- C. Headache has at least two of the following: unilateral, pulsating, moderate/severe, aggravated by walking
- D. During headache, at least one of the following: nausea and/or vomiting, photophobia and phonophobia
Management of Migraine
- General measures: avoidance of stressful situations, mental and physical fatigue, precipitating diet elements, dealing with other precipitating factors
- Medical measures: during the attack, strong analgesics (e.g., aspirin, paracetamol), ergot preparation (e.g., Migranil) oral, IM or suppository
Tension Type Headache
- Frequently associated with anxiety, depressive disorders, and insomnia
- The commonest type of headache (68% of males and 88% of females)
- Each attack lasts from 30 minutes up to 7 days
- At least two of the following: pressing/tightening quality, mild or moderate, bilateral location, no aggravation as in migraine
- No nausea or vomiting, no phonophobia or photophobia
- May be associated with spasm of or tender pericranial muscles
- Usually precipitated by stressful situations, associated with insomnia, lost appetite
- Treatment: analgesics, muscle relaxants, antidepressants, anxiolytics
Cluster Headache
- Severe unilateral orbital, supra-orbital, and/or temporal pain
- Lasting 15-180 minutes
- Recurrent attacks over the day and may awaken the patient from sleep
- Headache is associated with at least one of the following on the pain side:
- Lacrimation
- Nasal congestion
- Miosis
- Eyelid edema
- Conjunctival injection
- Rhinorhea
- Ptosis
- Forehead and facial sweating
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Description
A comprehensive overview of headaches, including the definition, symptoms, and diagnostic approach. Learn about the essential questions to ask patients and the key aspects to consider during diagnosis.
