Approach To Headache (2) New
Approach To Headache (2) New
Approach To Headache (2) New
A. Head injury
B. Systemic infection
C. Vascular disorders
D. Brain tumor
3.Which of the following case scenarios do
not depict tension type headache?
A. 34 yrs old women presenting with a chronic
headache for> 15 days per month
B. 41yrs old man presenting with a b/l headache
lasting for 4-6 hours
C. 38yrs old man presenting with a tight band
like discomfort around the head
D. 34yrs old woman presenting with a pulsatile
headache associated with nausea
4.pt comes with complains of non pulsatile
headache of tightening quality on both sides of his
forehead.he describes it as wearing a tight. he has
no nausea, photophobia or phonophobia. All of
following drugs can be used in treatment of this
condition expect?
A. Aspirin
B. Sumatriptan
C. Acetaminophen
D. Naproxen
5.41 yr old man has a 4 yr history of severe left sided
excruciating episodic headaches.most episodes are
accomanined by ipsilateral lacrimation,conjuctival injection and
rhinorrhea .there are no cutaneous triggers.it does not respond
to indomethacin and attacks get triggered by alcohol.what is
the likely diagnosis?
A. Trigeminal neuralgia
B. Cluster headache
C. SUNCT
D. Paroxysmal hemicranias
PAIN PRODUCING CRANIAL STRUCTURES
o Scalp
o Meningeal arteries
o Dural sinuses
o Falx cerebri
o Proximal segment of large pial arteries
How to approach headache ?
• HISTORY
• AGE OF ONSET
Childhood and Adolescent - Secondary to sinusitis,
Pharyngitis, Otitis media and Primary headache like
migraine
Adult – Tension type headache, Medication overuse
Elderly – Glucoma, Hypertension, Stroke, Brain
tumor or Brain metastasis
Duration and frequency of pain
• Vascular headache and Trigeminal neuralgia –
episodic pattern.
• Cluster headache – Seasonal and its range in
minutes.
• Migraine – in hours.
• Headache of organic origin ( ocular disease
sinusitis, brain tumor) are continous with acute
exacerbate caused by exercise ,change in
position.
Onset to peak time
• Rapid onset to peak (seconds to minutes) –
suspicion of organic disease
• Tension headache evolve over period of hours
to days and then remain constant
• Cluster headache rapid onset to peak time
• Migraine evolve over several hours
Location
• Vascular headache – Unilateral, side may change from
attack to attack
• Cluster headache – Localized to ocular and retro ocular
region
• Migraine – Involve entire hemi cranium
• Tension type headache – Typically bilateral involving
frontal, temporal and occipital region – band like or
cap like tightness
• Trigeminal neuralgia involve one division of trigeminal
nerve
Character and severity of pain
• Vascular headache – throbbing and pulsatile in
nature with intense pain
• Cluster headache – deep boring and burning pain
• Trigeminal neuralgia – paroxysmal shock like pain
• Tension type – persistent dull aching pain, band
like ,occasional exacerbations
• Headache associated with lumbar puncture will
worsen when pt assumes the recumbent position
PREMONITORY SYMPTOM AND AURAE