Headache: Dep. of Neurology, General Hospital of Ningxia Medical University Cell Phone:13709599000

Headache
Dep. Of Neurology, General hospital of Ningxia medical

university
Haining Li E-mail:lhnwww@126.com
Cell phone:13709599000
General principles
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3
4
Disease categories of out patients
5
Classification
Primary
headache Secondary
headache
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Primary headache
 In most patients
 No physical signs
 Diagnosis is made entirely from the
history
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Secondary headache
 Vascular
 Infective
 Neoplastic
8
Key structures involved in primary
headache
9
Evaluation of the headache patient
History Examination Neuroimaging
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History
 Mode of onset- acute: subacute, chronic, or

recurrent and episodic
 Subsequent course: episodic, progressive,
or chronic and persistent
 Site: unilateral or bilateral; frontal, temporal,
or occipital; radiation to neck, arm, or
shoulder
11
History
 Character of pain-constant, throbbing,
stabbing, or dull/pressure-like
 Frequency and duration
 Accompanying feature-additional
neurological symptoms, neck stiffness,
autonomic symptoms
 Exacerbating factors-movement, light,
noise, smell (e.g. migraine); coughing,
sneezing, bending (e.g. raised
intracranial pressure)
12
History
 Inducing factors-alcohol (cluster
headache and migraine), menstruation
(migraine) ,stress (most headaches are
worse with stress), postural change (high
or low intracranial pressure )
 Particular time of onset-mornings
(migraine, raised intracranial pressure),
awoken at night (cluster headache)
13
History
 Past history of headache
 Family history- migraine, hypertension,
intracranial hemorrhage
 General health- systemic ill-health,
existing medical conditions
 Drug history- analgesic abuse,
recreational drugs.
14
Examination
 Complete neurologic examination
 CT or MRI scan
 Lumbar puncture
 Blood pressure
 Signs of local disease of the ears, eyes,or
sinuses; restriction of neck movements and
pain; thickening of the superficial temporal
arteries
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No. 1
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No. 2
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No.3
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No.4
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No. 5
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Migraine
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Cause and pathogenesis
 Certain foods: tyramine-containing
cheeses, meat, such as hot dogs or bacon,
with nitrite preservatives. Food additives:
monosodium glutamate.
 Drugs: especially oral contraceptive agents;
vasodilators
 Bright lights may also trigger or
precipitate attacks.
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 Genetics: About 60% patients of migraine
have families . Three genetic loci for
familial hemiplegic migraine have been
identified.
 Endocrine factor
Gender: women> men; Headache mostly
occurs before or menacme in women , and
the headache becomes reduction or
stopping in pregnancy and after
menopause.
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 Neurotransmitter
Serotonin in platelets decreases

and urinary serotonin increases during
the acute phase of a migraine attack .
Depletion of serotonin by reserpine
may precipitate migraine and decreased
by serotonin antagonists (sumatriptan)
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The classification of migraine
1. Classic migraine
2. Common migraine
3. Special type:
a. Ophthalmoplegic M.
b. Hemiplegic M.
c. Basilar artery M.
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With aura Classic M
Headache
Without Common
aura M
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 Gender: 15% women VS 6% men
 Age
 Location
 Character of pain
 Frequency and duration
 Accompanying
 Exacerbating factors
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Clinic features
1. Migraine with aura (Classic migraine)
1) Auras: visual alteration, particularly

hemianopic , field defects and scotomas.
2) The aura may precede, accompany or

even follow the headache.
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Time min
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Clinic features
2. Migraine without aura (Common migraine)
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Clinic features
3. Special type:
a. Ophthalmoplegic M.
During or after migraine attack occur
ocular nerve paralysis, ptosis ,pupil
dilation ,etc. and persists hours or weeks.
b.Hemiplegic M.
With hemiplegia; last 10m.~days~weeks;
children, less in adult.
32
Clinic features
c.Basilar artery migraine
Most common in children and youthful
women; visual alteration: field defects
and scotomata, ataxia, vertigo, tinnitus，
diplopia，nystagmus，dysarthria，
bilateral limbs numb and weak,
impairment of recognize and
consciousness, and nausea, vomiting,etc.
33
Diagnosis of migraine
According to the International Headache
Society (HIS) recommended a
programm in 2004, the diagnosis of
migraine will be in keeping with below
criterion.
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Simplified diagnostic criteria for migraine
Repeated attacks of headache lasting 4-72 h in

patients with a normal physical examination, no
other reasonable cause for the headche, and:
At least 2 of the following Plus at least 1 of the
features: following features:
Unilateral pain Nausea/Vomiting
Throbbing pain Photophobia and
phonophobia
Aggravation by movement
Moderate or severe intensity
35
Difference diagnosis
1. Cluster headache
2. Tension-type headache
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Treatment
To alleviate 1
the headache
during an To reduce the
Treatment
attack. frequency of
future attacks.
2
卒中后认知障碍管理专家共识
37
Treatment
Analgesics.
Acute attack
5-HT1,5-
HT1B/1D
Treatment Agonists
Prevention -receptor
blocker
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Tension-type headache
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Clinical Features
 Tension-type headache is a chronic
disorder that most patients begin after age
20.
 Frequent (often daily) attacks ,
nonthrobbing, bilateral occiptal or front,
even all head pain, Sometimes likened
to a press ,tight band around the head,
may be episodic or persist months or years.
 Not associated with nausea, vomiting, or
prodromal visual disturbance.
 Many patients have sleep disorders,
anxious, depression and nervous.
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Pathophysiology
 Incompletely understood.
 Unlike migraine.
 A more generalized disturbance of
sensory modulation.
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Treatment
 Simple analgesics
 Behavioral approaches including
relaxation can be effective.
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Cluster Headache
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Clinical features
 Men > women ;(4～5：1）
 20-50 yr.;
 Recurrent; several or many times daily
for several days or weeks;
 Prodromes are uncommon, ictal and
stop suddenly;
 Periorbital strong pain with congestion
of the conjunctivae, lacrimation,
occasional ptosis of the eyelids and
sweating;
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Treatment
Acute attack treatment:
 100% oxygen at 10-12L/min for 15-20
min
 Sumatriptan or zolmitriptan
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Treatment
Preventive treatments
 Verapamil
 Lithium
 Glucocorticoids
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Headache

Dep. Of Neurology, General hospital of Ningxia medical

History Examination Neuroimaging

 Mode of onset- acute: subacute, chronic, or

Serotonin in platelets decreases

1) Auras: visual alteration, particularly

2) The aura may precede, accompany or

2. Migraine without aura (Common migraine)

Repeated attacks of headache lasting 4-72 h in

 A more generalized disturbance of

 Behavioral approaches including

relaxation can be effective.

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