Headache

International classification of Headache :

The primary headaches :

1. Tension headache
2. Migraine
3. Trigeminal autonomic cephalalgia
4. Other primary headache  disorder

Secondary headache :

1. Headache due to injury or trauma to the head or neck
2. Headache due to cervical or cranial vascular disorder
3. Headache due  withdrawal of a substance
4. Headache due  to infection
5. Headache due to non vascular intracranial disorder in the cranium
6. Headache due to disorder of facial pain  or homoeostasis
7. Headache due to psychological disorder
8. Painful cranial neuropathy and/or  other facial pain
9. Other  headache  disorders

Criteria of Headache Diagnosis

Criteria of Secondary headache :

• sudden onset headache
• never experienced this type of headache before
• headache different from the usual  headache
• increased in frequency and intensity of headache
• headache begins after age fifty,
• neurological deficit with headache
• headache in  a patient with cancer or immunotherapy ,
• headache in a patient with psychiatric disease
• headache in a patient of meningitis irritation. Intensive care needed.

Migraine

Migraine  cause severe throbbing pain or pulsing sensation, usually unilateral or one sided headache . sometime it is accompanied by nausea, vomiting, irritability or  sensitivity to light and sound.
Migraine attacks can last for 4 to 7 days with severely.

Symptoms of migraine :

• Unilateral (often bilateral)severe throbbing type headache and pulsatile sensation
• Insensibility to light and sound
• Nausea, vomiting
• Aura are symptoms of Nervous system which is reversible mainly symptoms of visual disturbance and few other begin gradually and last for 20-60 minutes.
• For some people have an aura occurs before or with the migraine . An aura means some symotomes of nervous system
• visual disturbances
• Flashes of light
• blind spots
• tingling sensation
• Pin and neddle sensation
• difficulty speaking
• Uncontrollable jerky movement etc

After a migraine attack

• Patients may feel
• drained
• confused
• and washed out for upto a single day.
• Few people feeling elated
• Sudden head movement may causing  pain briefly

Consult doctor immediately when following sign and symptoms occurs:

• Sudden change pattern of headache.
• focal neurological  sign
• fever, stiff neck, neck rigidity, mental confusion, convulsion,  double vision,diplopia,  weakness, numbness or trouble speaking ar tingling sensation.
• head injury or trauma which worsens the headache.
• A chronic headache which is increase after exertion,coughing, sneezing,  straining or a sudden movement

Cause of Migraine :

• Cause of migraine are not completly known but seems to be Genetic factor And predisposing factor(environment  factor) appear to play  a rule
• Changes in  brainstem and its activity with the fifth cranial nerve ( trigeminal nerve, a major pain pathway, might be involved).So that imbalances occurs in brain chemicals — including 5HT (serotonin)which helps controle  pain in nervous system.
• Not only serotonin but also calcitonin gene related peptide [CGRP] paly role in the pain pathway of migraine.

Migraine triggers factor :

• Flactuation in Estrogen (before or during menstrual period, pregnancy and menopause)
• Oral contraceptive pills
• Vasodilators(Nitroglycerin)
• Drinks(mainly wine and caffeine)
• Stress at work
• Brightbor blare light
• Irritating or loud sound
• Strong smells such as perfume, smoke etc
• Missing sleep or too much sleep
• Intense work including intense sexual activity
• Barometric pressure worsen the migraine
• Weather changes. A change of weather or barometric pressure can worsen  a migraine.
• Monosodium glutamate used as preservatives in some food
• Family history

Male female ratio  is 1:3 (women are more affected than male)

Treatment of migraine :

• Avoids trigger factor
• Counselling
• Analgesic (telfenamic acid)
• Some time combination analgesic used
• Domperidone for fast absorption (in headache peristalsis are very slow domperidone cause fast Paristalsis and fast absorption)
• Triptans (Sumatriptan)

Complications Of Migraine

• Tacking higher dose of analgesic drugs causing  medication-overuse headaches.

Tension Headache

We need to know that 80% of older people have this type of headache. Tension type headaches also start in adolescents like migraines and are more common in women. This headache is caused by the contraction of the muscles of the head.

The symptoms of tension type headache are as follows-

•  There is pain all over the head.
• The pain is felt like a strain or band.
• The pain is not as severe as migraine.
• The patient can do all kinds of activities with pain but the pain cannot be felt during work but the headache comes back as soon as the work is done.
• Usually there is no nausea or vomiting with headaches. This headache can last from a few hours to a few days.
• These headaches are related to anxiety, family or professional or emotional stress.

Cluster Headache:

Cluster Headache is much less common. 0.1 percent of people have this type of headache. The incidence of such headaches is higher in men. Estimated rate male: female = 6: 1. The symptoms of cluster headache are as follows-

1. Transient is repeated.
2. The pain is extremely intense.
3. There is pain around the eyes or in the back.
4. The eyes become red and watery. The upper eyelids may fall off.
5. The pain occurs at the same time every day or several times a day and lasts for several weeks. Then the pain goes away and after a few months / years the pain starts again.

Secondary Headache:

Headaches can be caused by various physical or head ailments. These headaches are called secondary headaches. Such as- (typhoid, viral), meningitis (viral, bacterial or tumorful meningitis), sinusitis, mastoiditis, brain tumor, bleeding or stroke, (Zhao), head injury, etc.

Case 1

severe headache or worst headache  with acute onset( thunderclap headache) with  decreased level of consciousness with vomiting /or syncope at first of headache

First do CT
CT scan is negative
Then do lumbar puncture
shows no abnormality,
Then referred to neurologist

Case  2
With fever,  neck stiffness and neck rigidity  perform  CT and lumbar puncture

Case 3
headache of recent onset (days/weeks)
Gradually  worsening headache/ persistent headache
Perform head CT
Perform routine blood tests with ESR And CRP
The tests are show  negative result, when perform neurological evaluation within seven days •

Case 4
past history of headache
Headache similar to previous headache in intensity, duration and associated symptoms see vital signs examination and neurological evaluation
Perform routine blood test with CT scan
CT show negative result then discharge patient from admission

Ref:

https://ihs-headache.org/en/resources/guidelines/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383075/

https://docplayer.net/13909111-Clinical-practice-guideline-for-chronic-headache-2013.html

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