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Questions and Answers
What percentage of males experience headache as a common symptom?
What percentage of males experience headache as a common symptom?
What is the first step in evaluating a patient with headache?
What is the first step in evaluating a patient with headache?
Which of the following structures is insensitive to pain?
Which of the following structures is insensitive to pain?
What is the characteristic of migraine in terms of gender?
What is the characteristic of migraine in terms of gender?
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What is a common associated feature of migraine?
What is a common associated feature of migraine?
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What is the frequency of migraine attacks?
What is the frequency of migraine attacks?
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Which of the following is a pain-sensitive structure in the cranium?
Which of the following is a pain-sensitive structure in the cranium?
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What is a common cause of headache referred from other diseases?
What is a common cause of headache referred from other diseases?
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What is the frequency of migraine attacks in relation to age?
What is the frequency of migraine attacks in relation to age?
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What is a characteristic of pain distribution in migraine?
What is a characteristic of pain distribution in migraine?
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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 medical measure for managing migraine during an attack?
What is a medical measure for managing migraine during an attack?
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What is a common association with tension type headache?
What is a common association with tension type headache?
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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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Study Notes
Headache Definition and Epidemiology
- Headache is defined as pain in the head, a common symptom in 93% of males and 99% of females.
- It is a symptom of a disease that requires further investigation.
History of Headache
- Every patient with headache requires a detailed history, including:
- Duration of suffering from headache
- Severity and pattern of headache (increasing, 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.
- Presence of anxiety, tension, or depression
- 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 include:
- Venous sinuses
- Dura matter
- 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., otitis media, otitis externa)
- Nose and sinuses (e.g., sinusitis)
- Teeth, jaw, and related structure disorders
- Temporo-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 attacks:
- Excitation or excessive work
- Menses
- Bright light
- Extra sleep
- Strong smells
- Minor trauma
- Certain diets (e.g., cheese, chocolate, alcohol, nuts)
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 (e.g., 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, and lost appetite
Treatment of Tension Type Headache
- Analgesics
- Muscle relaxants
- Antidepressants and anxiolytics
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Description
This quiz covers the definition, symptoms, and diagnosis of headaches, including the importance of taking a detailed patient history. It's a useful resource for medical students and professionals.
