Headache
Headache is a common problem. It can be primary (headache is the pathology) or secondary (headache secondary to other pathological process). Primary headache syndromes comprise of migraine, tension-type headache and cluster headache, whereas secondary hea
- PDF / 40,453 Bytes
- 2 Pages / 439.37 x 666.14 pts Page_size
- 21 Downloads / 196 Views
35
Headache is a common problem. It can be primary (headache is the pathology) or secondary (headache secondary to other pathological process). Primary headache syndromes comprise of migraine, tension-type headache and cluster headache, whereas secondary headache comprises of infection, trauma and subarachnoid syndrome.
35.1
Migraine
It is a chronic neurological disorder associated with frequent episodes of headache. It is seen in 10–15 % of the population. The male to female ratio is 1:3. The prevalence increases with age and maximum prevalence is seen in the fourth decade. Aura (visual disturbances, flashing lines, loss of vision, pins and needles, numbness, hemimotor weakness and dysphasia) is seen in 20 % of patients. It is mostly seen in frequent attacks of headache lasting 4–72 h that is throbbing in intensity and is aggravated by movement. Precipitating features include stress and foods such as wine and cheese. The pathophysiology includes cortical and neuronal hyperexcitability. In familial hemiplegic migraine, mutations in the P/Q calcium channel complex are seen. Basilar-type migraine is seen in young adults and presents with basilar symptoms (dysarthria, vertigo, tinnitus, ataxia, diplopia, bilateral paraesthesias). Management includes lifestyle modification which includes nutritious diet, regular exercise, regular sleep pattern and limited use of alcohol and caffeine. Patient should be put on preventive treatment (propranolol, 40–60 mg daily; pizotifen 0.5–2 mg daily), if there are more than 5 attacks/month. Acute attacks can be managed with triptans (5HT1B/1D) and ergot alkaloids. They constrict the dilated cranial blood vessels and inhibit impulse transmission within the trigeminal system. Effective medications include rizatriptan (10 mg) and sumatriptan (50 mg). Combining a triptan with NSAIDs is more efficacious.
R. Gupta, Pain Management, DOI 10.1007/978-3-642-55061-4_35, © Springer-Verlag Berlin Heidelberg 2014
85
86
35.2
35 Headache
Tension-Type Headache
This is predominantly seen in males (m:f/5:4). It presents in two forms: • Episodic TTH: less than 15 attacks are seen per month. • Chronic TTH: more than 15 attacks per month. Headache is seen from 30 min to 7 days which is mild and is bilateral with no association with physical activity, nausea, vomiting and photophobia. Pericranial tenderness on manual palpation is seen. Patients complain of dull non-pulsating pain. Increased myofascial pain sensitivity is also seen. Depression increases the chances to develop tension-type headache (aggravates existing central sensitization). Acute episodes can be managed by simple analgesics and NSAIDs. Ibuprofen (800 mg) is the first choice (NNT 2). For chronic TTH, amitriptyline (10–75 mg) is effective.
35.3
Cluster Headache
Prevalence is
Data Loading...
