HEADACHE

DR. MANSOUR AL MOALLEM

HEADACHE RELATED TO ETIOLOGY…• Vascular…

• Migraine

• Muscle contraction…

• Tension headache

• Inflammatory…

• Giant cell artritis • meningitis

• Distortion…

● Brain tumor

• Idiopathic…

• Trigeminal neuralgia

PAIN SENSITIVE STRUCTURE INVOVLE IN HEADACHE

MIGRAINE…• Common migraine

• Classical migraine “ with aura”

• Complicated migraine

• Cluster headache “more in male”

MIGRAINE…PATHOGENESIS…

MIGRAINE…SYMPTOMS…

MIGRAINE…SYMPTOMS…

MIGRAINE…CONT…• Affect…. 20% of female & 10-12% of male

• Started at age 5-30 yrs peak at puberty

• 70% with family history

• It might trigger by different factors…

• Stress• Sleep disturbance• Drugs• food

MIGRAINE…CONT…

Treatment…

• For acute symptoms…• Analgesia

• Ergotamine

• Serotonin agonist

• Antiemetic

• Prophylactic…• Tricyclic antidepressant

• Beta blocker

• Some antiepileptic drugs

TENSION HEADACHE• The most common headache

• Mostly related to stress & emotional conflict

• 40% May have family history

• More in female

• It might associated with migraine

• Described as non throbbing , diffuse, tightness

• trigger point may be found

GIANT CELL ARTRITIS • Affect external branches of carotid artery mostly

temporal artery.

• Segmented inflammation with lymphocyte, plasma cell & multi nucleated giant cells.

• Affect patients >50 yrs.

• Male : female 2:3

• Subacute sever pain at temporal region.

• Mainly unilateral

• Examination at temporal region …tenderness , diminish or pulseless, tortious course

• If not treated… loss of vision 50% or other such as…MI

GIANT CELL ARTRITIS…CONT

• Investigations…• ESR• Doppler• Biopsy

• Treatment…• steroid

TRIGEMINAL NEURALGIA • Pain at distribution at 5th cranial nerve mainly at

V2 or V3 or both

• More in female “3:2” above 50 yrs

• Commonly unilateral

• May be trigger by special maneuver e.g. laughing , shaving , brushing teeth ….

• Many they respond to medical treatment …if not or develop major side effect ….consider surgery

HEADACHE DUE TO RAISE INTRACRANIAL PRESSURE• etiology Is variable

• 20% headache is the initial symptom

• More early if in posterior fossa

• Usually is intermittent, Increase during sleep & immediately after wakeup

• Increase with cough & strain

• May associate with nausea & projectile vomiting

• Mid line tumor may cause intermittent 3rd ventricle obstruction

• tumor in 4th ventricle may cause sever emesis & neck rigidity

• Conscious may altered

• Neurological sign(s) according to site of the lesion

• Papilloedema is common

BENIGN RAISE INTRACRANIAL PRESSURE (BIH)• Idiopathic

• Almost in female … peak at 3rd decade

• Associated with…

• Obesity• Drugs…e.g. steroid , Vit A…

• Symptoms….

• Headache• Double vision• Blured vision

BENIGN RAISE INTRACRANIAL PRESSURE (BIH)

• Consider other diagnosis such as… ”Cerebral venous/sinus thrombosis” If patint pesent with…

• sizure

• Focal neurological deficit

• Finding…

• Bilateral papiloedema

• +/- 6th nerve

• Normal MRI/MRV

• Increase CSF pressure

• Normal CSF analysis

OTHERS…• Meningitis

• Sinus thrombosis

• Paranasal sinus

• Hemorrhage

• Subdural hematoma

• Subarachnoid hemorrhage

• Ineracerbral hemorrhage

APPROACH TO PATIENT WITH HEADACHE

• History

• Age

• Onset

• Duration

• Character of headache

• Associate symptoms

• Examination

• Full neurological examination including for papilledema

APPROACH TO PATIENT WITH HEADACHE

When consider headache as emergency

• acute headache• Change of character• altered consciousness• Seizure• in examination…

• Neurological deficit• Papilledema• Neck rigidity• fever