Headache: Definition and Diagnosis

Study Notes

Headache is a common symptom in clinical practice, affecting 93% of males and 99% of females.
It is a symptom of a disease that requires searching and every patient with a headache requires a detailed history.

Duration of suffering from headache
Is the headache increasing in severity, constant, or paroxysmal?
Side and site of headache
Duration of each attack
Precipitating factors (e.g., cough, psychic stress)
Relieving factors (e.g., vomiting, analgesics)
Character of headache
Associating symptoms
History of head trauma, nasal obstruction or discharge, visual disorders, teeth problems, etc.
Is the patient anxious, tense, or depressed?
Presence of signs of systemic disease (fever, anemia)

All tissues covering the cranium are pain sensitive (e.g., arteries, muscles, and pericranium)
Skull bone itself is insensitive to pain
Intracranial pain sensitive structures: venous sinuses, dura matter, and cerebral arteries

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, frequency decreases with age, more frequent at time of menstruation, less frequent during pregnancy

I. General measures:
- Avoidance of stressful situations
- Mental and physical fatigue
- Precipitating diet elements
II. Medical measures:
- During the attack:
  - Strong analgesics (e.g., aspirin, paracetamol)
  - Ergot preparation (e.g., Migranil) oral, IM, or suppository
  - 5HT-receptor agonist (Sumatriptan) given in 6mg SC injection
- Prophylactic measures:
  - B-blockers (e.g., Inderal 30-120 mg/day)
  - Ca+ channel blockers
  - Tri-cyclic antidepressants
  - Antiepileptics: valproate and topiramate

Frequently associated with anxiety, depressive disorders, and insomnia
The commonest (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 (non-pulsating) quality
- Mild or moderate
- Bilateral location
No nausea or vomiting
No phonophobia or photophobia
May be associated with tender pericranial muscles
Usually precipitated by stressful situations, associated with insomnia, lost appetite