HEADACHE
Shayma Khan
170312882011
MESCO College of pharmac
GENERL PRINCIPLES
.A classification system developed by the
International headache characterizes headache
as primary and secondary.
Primary headache:
Are those in which headache and its associated
features are the disorders in itself.
Secondary headache:
Are those caused by exogenous disorders.
• Primary headache often results in considerable
disability and decrease in the patients quality
of life.
• Mild secondary headache, such as that seen in
association with upper respiratory tract
infection, is common but rarely worrisome.
• Life-threatening headache is relatively
uncommon but can lead to various
complications if not treated properly.
Common causes of headache
Anatomy and Physiology of Headache
• Pain usually occurs when peripheral nociceptors
are stimulated in response to tissue injury,
visceral distension or other factors.
• In such situations, pain perception is a normal
physiologic response mediated by a healthy
nervous system.
• Relatively few cranial structure are pain-
producing; these include the scalp, middle
meningeal artery ,dural sinuses falx cerebriand
proximal segments of the large pial artery.
Tension-Type headache
• The term tension type headache is commonly
used to describe a chronic head-pain
syndrome characterized by bilateral tight,
band-like discomfort. The pin typically builts
slowly, fluctuates in severity, and may persist
more or less continously for many days.
• The headache may be episodic or chronic
(present >5 days per month).
Tension-Type headache
• A useful clinical approach is to diagnose TTH in
patients whose headaches are completely
without accompanying features such as
nausea, vomitings, photophobia,
phonophobia, osmophobia, throbbing, and
aggravation of movement.
• Such an approach neatly separates migraine,
which has one or more of these features.
Treatment
• The pain of TTH can generally be managed
with simple analgesics such as
Acetaminophen, Aspirin or NSAIDs.
• For chronic TTH, amitriptyline is the only
proven treatment.
• Triptans are effective in TTH when the patient
also has migraine.
Migraine
• Migraine, the second most common cause of
headache, and the most common headache-
related, and indeed neurologic, cause of
disability in the world afflicts approximately
5% of women and 6% of men over a –year
period.
• Migraine can often be recognized by its
activators, referred to as triggers.
Migraine
• The brain of the patient with migraine is
particularly sensitive to environmental and
sensory stimuli.
• This sensitivity is amplified in females during the
mestrual cycles.
• Headaches can be initiated or amplified by various
triggers, including glare, bright lights, sounds,
hunger, physical exertion, hormonal fluctuation
during mensus, lack or excess sleep, alcohol or
other chemical stimulation.
Treatment
Non-pharmacological management:
• Most patients benefit by the identification and
avoidance of specific headache triggers. A
regulated lifestyle is helpful, including healthy
diet, regular exercise, regular sleep patterns,
avoidance of excess caffein and alcohol.
• If these measures fail to prevent an attack,
pharmacological approaches are used.
Acute Attack therapies for migraine
• Most drugs effective in the treatment if migraine
are members of one of three major pharmacologic
classes: NSAIDs, 5HT receptor Agonist and
dopamine receptor antagonists.
NSAIDs:
• The combination of acetaminophen, aspirin, and
caffeine has been approved for use by the U.S food
and drug administration (F.D.A).
• The combination of aspirin and metoclopramide is
as effective as single dose of oral sumatriptan.
5HT receptor Agonist:
• Stimulation of 5-HT receptors can stop acute
migraine attack.
• Ergotamine and dihydroergotamine are
nonselective receptors agonist, whereas the
triptans are selective 5-HT receptors agonists.
• Various triptans used- sumatriptan, almotriptans,
eletriptan, frovatriptan, rizatriptan, zolmitriptan
are available.
Dopamine receptors Antagonists:
• Dopamine receptor antagonist, such as
metoclopramide 10mg or domperidone 10 mg
is used because drug absorption is impaired
during migraine because of reduced
gastrointestinal motility.
Cluster Headache
• Headache that occur in patterns or clusters.
• More than 1 million cases per year in India.
• It is defined as a type of severe headache in
which the pain is usually limited to one side of
the head, tending to recur over a period of
several weeks.
• A cluster headache commonly awakens you in
the middle of the night with intense pain in or
around one eye and one side of the head.
Treatment
• Many patients with acute cluster headache
respond very well to oxygen inhalation. This
should be given as 100% oxygen at 10-12 L/min
for 15-20 mins.
• Sumatriptan 6mg SC is rapid in onset and will
usually shorten an attack to 10-15 min.
• Sumatriptan (20mg) and zolmitriptan (5mg)
nasal sprays are both effective in acute cluster
headache.
SUNCT/SUNA
• SUNCT (short-lasting unilateral attacks with
conjunctival injection and tearing) is a rare
primary headache syndrome characterized by
severe, unilateral orbital or temporal pain that
is stabbing or throbbing in quality.
• Diagnosis requires at least 20 attacks, lasting
for 5-240 seconds, ipsilateral conjunctival
injection and lacrimation should be present.
Treatment
• Therapy of acute attacks is not a useful
concept in SUNCT/SUNA Because the attacks
are of such short duration. However, IV
lidocaine, which arrest the symptoms, can be
used in hospitalized patients.
• The most effective treatment for prevention is
lamotrigine, 200-400 mg/d, has been reported
by patients to offer modest benefit.
