Headache headache Medical students Medical students

Medical students
Medical students
Medical students

1. Headache Dr. Adenwali Hassan Ahmed: ( Mwn , Bsc -Medical Doctor, Bsc - Public Health Officer, Msc-Gyn / Obest .

2. INTRODUCTION Headache is a frequent cause of Emergency Department visits. The challenge facing the Emergency Physician is to determine if the cause of the headache is relatively benign or due to a more sinister cause. suggesting tragic developments

3. Cont--- Most of patients presenting to the ER with headache, 50% have tension headaches , 10% migraines , 30% benign nonspecific headaches and only 8% a headache emanating ( spread out ) from a potentially serious cause. Less than 1% will have a life threatening reason for their headache such as a subarachnoid hemorrhage. A subarachnoid hemorrhage is bleeding in the space between brain and membrane that covers it.

4. Headache Definition Headache is pain in any region of the head. Headaches may occur on one or both sides of the head, be isolated to a certain location, radiate across the head from one point, or have a viselike quality. A headache may appear as a sharp pain, a throbbing sensation or a dull ache. Headaches can develop gradually or suddenly and may last from less than an hour to several days.

5. Cont--- A headache is pain or discomfort in the head or face area. Types of headaches include migraine, tension and cluster. Headaches can be primary or secondary. If it is secondary, it is caused by another condition. Avoiding headache triggers is the best prevention.

6. HEADACHE

7. Cont--- The vast majority of headaches are b enign . T ak e a detailed history to rule out serious causes of headache. (early diagnosis can save lives):

8. Classification: Headaches can be classified into: Primary headache Secondary headache

9. Primary headache: Migraine Tension Cluster Sinus Hormonal

10. Cluster headache:

11. Secondary headache: : Due to underlying serious condition. Some secondary headache disorders can be life-threatening and are caused by an underlying process such as medication overuse, infection, head trauma, or subarachnoid hemorrhage.

12. Serious causes of Secondary headache: SAH (A subarachnoid hemorrhage) Meningitis Tumor CVT (Cerebral venous thrombosis) Cerebral hemorrhage or infarction. O bstruction of the blood supply

13. Headache Common Types Migraine: POUND P ulsatile O nset 4-72hrs U nilateral N /V D isabling intensity, Photophobia/ Phonophobia , Chronic, Recurrent, +/- Aura ( Pulsatile : rhythmically; pulsating or throbbing) aura : A sensation (as of a cold breeze or bright light) that precedes the onset of certain disorders such as a migraine attack or epileptic seizure

14. Cont--- Cluster: unilateral sudden sharp retro-orbital pain, <3 hours usually at night, pseudo-Horner’s symptoms, precipitated by alcohol/smoking. Tension: tight band-like pain, tense neck/scalp muscles, precipitated by stress or lack of sleep. Horner syndrome is a rare neurological syndrome that affects your eye and the surrounding area on one side of your face

15. Differential Diagnosis Intra-cranial Bleed: epidural, Subdural, Subarachnoid, intracerebral hemorrhage Infection : Meningitis, Encephalitis, Brain abscess Increased ICP : Mass, Cerebral venous, Sinus thrombosis

16. Cont--- Extra-cranial Acute angle closure glaucoma Temporal arteritis - (Inflammation of the temporal arteries; characterized by headaches and difficulty chewing and (sometimes) visual impairment) Carotid artery dissection CO Poisoning Pregnancy-related headaches Acute angle-closure glaucoma presents as a sudden onset of severe unilateral eye pain or a headache associated with blurred vision, rainbow-colored halos around bright lights, nausea and vomiting.

17. Assessment History: red flags (sudden onset, thunderclap, exertional onset, Meningisms , Fever, Neurological deficit, AMS), Symptoms of increased ICP (persistent vomiting, headache worse lying down and in Altered mental status AMS). Red flags are specific attributes derived from a patient's medical history and the clinical examination that are usually linked with a high risk of having a serious disorder like an infection, cancer or a fracture.

18. Cont--- Physical Exam: Vitals, detailed neuro exam (cranial nerves Gait- The rate of moving (especially walking or running) Coordination, motor/sensory, reflexes) Neck for meningeal irritation Eye exam (slit lamp, Intraocular pressure (IOP) Temporal artery tenderness A slit lamp is a microscope with a bright light used during an eye exam.

19. Investigations Neuroimaging to rule out deadly causes. Most benign headaches do NOT need further investigation. LP: if CT head negative (>6h from onset) but suspicion of Subarachnoid Hemorrhage (SAH) ESR/CRP: if suspect Temporal arteritis LP: lumbar puncture Temporal arteritis : Inflammation of the temporal arteries; characterized by headaches and difficulty chewing and (sometimes) visual impairment

20. Management Common Benign Headache Regimen Fluids : No clear evidence but consider in dehydrated patient Antidopaminergic : Metoclopramide 10mg IV Antihistamine: Diphenhydramine 25mg IV Analgesic: Acetaminophen 1g PO

21. Cont--- NSAIDs: Ketorolac 15-30mg IV or Ibuprofen 600mg PO Steroids : Dexamethasone 10mg PO/IV (rebound migraine prophylaxis)

22. Cont--- Non-Traditional Uses Cluster Headaches : oxygen, sumatriptan , verapamil Refractory Headaches: magnesium, lidocaine , propofol , ketamine , valproate Nerve Blocks : greater occipital nerve, sphenopalatine block, trigger points Sumatriptan is used to treat acute migraine headaches in adults

23. Cont--- The terms refractory headache and intractable headache have been used interchangeably to describe headache that is difficult to treat or fails to respond to standard headache treatments. Refractory: (medicine) not responding to treatment

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