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Questions and Answers
What percentage of females experience headaches?
What percentage of females experience headaches?
What is the first step in evaluating a patient with headache?
What is the first step in evaluating a patient with headache?
What is not a pain-sensitive structure in the cranium?
What is not a pain-sensitive structure in the cranium?
Which of the following is NOT a type of headache?
Which of the following is NOT a type of headache?
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What is a common characteristic of Migraine headaches?
What is a common characteristic of Migraine headaches?
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What is a possible precipitating factor for headache?
What is a possible precipitating factor for headache?
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From which of the following structures can headache be referred?
From which of the following structures can headache be referred?
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How often may Migraine headaches occur?
How often may Migraine headaches occur?
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What happens to the frequency of migraine attacks with age?
What happens to the frequency of migraine attacks with age?
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What is a common precipitating factor of migraine attacks?
What is a common precipitating factor of migraine attacks?
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What is a diagnostic criterion for migraine?
What is a diagnostic criterion for migraine?
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What is a management strategy for migraine?
What is a management strategy for migraine?
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What is a characteristic of tension type headache?
What is a characteristic of tension type headache?
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What is a treatment option for tension type headache?
What is a treatment option for tension type headache?
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What is not a characteristic of tension type headache?
What is not a characteristic of tension type headache?
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What is a common association of tension type headache?
What is a common association of tension type headache?
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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 a disease that requires searching and every patient with a headache requires a detailed history.
History of Headache
- 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)
Mode of Production of Headache
- 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
Classification of Headache
- Migraine
- Tension type headache
- Cluster headache
- Headache associated with vascular disorders
- Headache associated with head trauma
- Cranial neuralgia
Headache Referred from Diseases
- Skull bone
- Neck (e.g., cervical spondylosis)
- Eyes (e.g., glaucoma, refractive errors)
- Ears (e.g., OM, OE)
- Nose and sinuses (e.g., sinusitis)
- Teeth, jaw, and related structure disorders
- Tempor-mandibular joint diseases
Migraine
- 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
Precipitating Factors of Migraine
- Excitation or excessive work
- Menses
- Bright light
- Extra sleep
- Strong smells
- Minor trauma
- Certain diets (e.g., cheese, chocolate, alcohol, nuts)
Distribution of Pain in Migraine
- Diagnostic criteria of migraine:
- 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 or any routine physical stress
- D. During headache at least one of the following:
- Nausea and/or vomiting
Management of Migraine
- 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
- During the attack:
Tension Type Headache
- 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
Treatment of Tension Type Headache
- Analgesics
- Muscle relaxants
- Antidepressants and anxiolytics
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Description
Understand the definition and diagnosis of headache, a common symptom in clinical practice, including its duration, severity, and sides affected.