HEADACHE (CEPHAGIA).pptx

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1. HEADACHE ( CEPHALGIA )

2. Definition : It may be defined as pain located in the upper regions of the head from the orbit to the suboccipital area. Etiology: Intracranial tumors Hemorrhage CNS infections Acute systemic infection Cerebral hypoxia

3. Severe hypertension Acute/chronic diseases of eyes, ears, nose& throat. Classification of headache according to International Headache Society Migraine Tension Type Headache Cluster Headache Miscellaneous Headache associated with structural lesions Headache associated with head trauma

4. 6. Headache associated with vascular disorders 7. Headache associated with nonvascular intracranial disorders 8. Headache associated with substances and their withdrawal 9. . Headache associated with non cephalic infections 10. Headache associated with metabolic disorders 11. Headache or facial pain associated with disorders of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structure 12. Cranial neuralgia, nerve trunk pain Headache not classified

5. Main types of headache Migraine (Vascular Headache) Tension Headache Cluster Headache Lumbar puncture Headache Post concussion Headache

6. 1. Migraine (vascular Headache) Onset : During puberty or in the second decade of life and decreases in late 50’s and early 60’s . It is common in females due to hormonal changes. It is familial disorder. Characteristics of pain: Pain is described as throbbing and pulsatile .

7. Pain is accompanied with photophobia, phonophobia , anorexia, nausea and vomiting and focal neurologic signs. Triggering factors of Migraine (Vascular Headache): MH is triggered by – Relief of intense stress Missing meals Menstruation & Ovulation Alcohol intake-due to vasoconstriction Certain food intake- chocolate, cheese, citrus fruits, coffee, dairy products

8. Hypoglycemia Stress Inadequate sleep Patient finds relief in quiet and dark environment 2. Tension headache It results from muscle contraction caused by stress , anxiety or depression associated with tension. Pain is described as tight band like discomfort. Pain builds slowly, fluctuates in severity and persists continuously for many days.

9. Tension headache is triggered by fatigue and stress. Diagnosis is confirmed if headache occurs for more than 15 days in a month. 3. Cluster Headache Pain occur in unilateral orbital, supra orbital and temporal region. Pain lasts from 15 minutes to several hours. Pain occurs from several times in a day to once every other day

10. Attacks of pain occur in a series lasting for weeks to months. Pain is accompanied with lacrimation, nasal congestion, rhinorrhea , facial sweating. Pain is described as deep, boring, intense in severity that patient has difficulty in remaining still. 4. Lumbar Puncture Headache Loss of CSF volume from LP reduces the brain supporting cushion leading to headache. It begins within 48 hours of LP and may be delayed upto 12 days.

11. Head pain is positional – begins when patient sits, stand upright and relieved on lying in bed or with abdominal compression. Pain is located in occipitofrontal region and accompanied by nausea , stiff neck, blurred vision, photophobia, tinnitus and vertigo. 5. Post Concussion headache Occurs after head injury. Patient C/O headache, dizziness, vertigo and impaired memory

12. Patophysiology Pathologic mechanisms of most headache may be one of the following- Traction on or dilation of intracranial arteries and distention of extracranial arteries. Traction on or displacement of intracranial veins. Compression/traction/ inflamation of sensory/cranial/spinal nerves

13. Spasm of cranial/ cervical muscles. Meningeal irritation or increased ICP Assessment and Diagnostic Evaluation Detail History Physical examination of Head & Neck Neurological Examination Medication History Occupational History Description of Headache- location, quality, precipitating factors, associated symptoms, relieving factors

14. Diagnostic tests- CT head, MRI, Cerebral Angiography Blood test - CBC, ESR, electrolytes, Glucose Clinical Manifestations- Migraine Headache- Occurs in 4 phases Prodrom Phase – Symptoms occur hours to days before migraine starts. Depression, feeling cold, irritability, food craving, anorexia, increased urination, change in activity level. Patient experience same prodrom phase at each episode

15. Aura Phase- last for less than an hour Patient has focal neurological symptoms- visual disturbance- light & bright spots Numbness & tingling of lips, face, hands. Mild confusion, slight weakness of one extremity etc. Headache Phase- Throbbing headache occurs for several hours 4 to 27 hrs. Headache is severe with photophobia and nausea& vomiting

16. Recovery Phase - pain gradually subsides. Patient sleeps for extended period Tension Headache C/M Steady constant feeling of pressure in head as weight on head Begins in forehead, temple or back of neck. Cluster Headache C/M Pain is unilateral and excruciating localized on the eye & orbit and radiates to the facial area.

17. Medical Management of Headache Migraine Headache Ergotamine tartarate Aspirin, acetamenophen , ibuprofen Cluster headache 100% oxygen by face mask for 15 minutes. Ergotamine tartarate Tension Headache Avoid stress Relaxation therapy, Muscle relaxant Non narcotic analgesics