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Questions and Answers
What percentage of males experience headache as a common symptom?
What is the first step in evaluating a patient with headache?
Which of the following structures is insensitive to pain?
What is the characteristic of migraine in terms of gender?
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What is a common associated feature of migraine?
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What is the frequency of migraine attacks?
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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?
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What is the frequency of migraine attacks in relation to age?
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What is a characteristic of pain distribution in migraine?
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What is a common precipitating factor of migraine attacks?
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What is a diagnostic criterion for migraine?
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What is a medical measure for managing migraine during an attack?
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What is a common association with tension type headache?
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What is a characteristic of tension type headache?
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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.
