HEADACHE
BY – DR. SNEHA
• Headache, is one of the most common of all human physical
complaints.
• Headache is actually a symptom rather than a disease a stress
response, vasodilation (migraine), skeletal muscle tension
(tension headache), or a combination of factors.
DEFINITION –
A headache is a pain or discomfort in the head, scalp,
or neck.
TYPES OF HEADACHE
PRIMARY HEADACHE –Benign ,recurrent and no organic disease
as there cause, idiopathic stabbing and exertional
• 1) tension type headache(69%)
• 2 ) migraine headache
• 3) cluster headache( Trigeminal autonomic cephalgia)
• 4 ) other types of headache
SECONDARY HEADACHE – Systemic infection, head injury,
vascular disorder, brain tumors
1. TENSION TYPE HEADACHE
Is the most common type of headache is characterized by bilateral
location
• It is usually mild or moderate intensity & not aggravated by physical
activity
• • Tension type headache is sub categorize as
• • 1) infrequent episodic
• • 2) frequent episodic
• 3) chronic
• Etiology :
• It caused due to sustained pain full contraction of the muscles of the scalps & neck
• It is also associated with stress and depression (most common in middle aged female between 30-50 years.
• This also responds to low dose of amitriptyline.
• Clinical manifestation :
• Fullness , tightness or band like feels in head
• Headache does not involve nausea or vomiting .
• Photophobia – sensitivity to light
• Phonophobia – sensitivity to sound
• Doesn’t usually affect activity of daily living.
• Diagnostic tests :
• History taking
• Physical examination
• Electromyography (EMG) = this test may reveals the
sustained contractions of the muscles of the neck,
face & scalp.
TREATMENT – Acute attack –NSAIDS are given
CHRONIC TTH – Prophylaxis with amitriptyline.
2. MIGRAINE HEADACHE :
• Migraine headache is a recurring pain characterized by
unilateral or bilateral throbbing Pain
• Migraine type of headache occurs more in females than males
• It is associated with anatomical or nervous system dysfunction.
STAGES OF MIGRAINE
• 1. Premonitoring phase- Mood disturbance,
irritability,depressive symptoms 2 days prior to headache
• 2. Aura – visual , sensory , motor
• [Link]
• 4. Post headache- After headache resolves feels lethargic ,
exhausted
ETIOLOGY
• Different theories suggest different causes
• 1) vascular theory = vasoconstriction followed by
vasodilation with resulting in changes in blood flow causes the
throbbing pain.
• 2) second theory suggest that pain is results from muscular
tension
• 3) biochemical changes = changes in serotonin level
CLINICAL MANIFESTATIONS
• Classification of migraine:
• 1) migraine without aura(formerly called common migraine-
most common
• 2) migraine with aura (formerly called as a classic migraine)
It occurs in only 10% of migraine headache
Aura (feeling of pain before it starts) lasts for 10 to 30
minutes before the starts of the headache & may include:
Motor dysfunction :
Sensory dysfunction
• Weakness
• Visual field defects • Paralysis
• Tingling or burning sensation • Dizziness
• Paresthesia • Confusion
•Loss of consciousness
DIAGNOSTIC TESTS :
• PHYSICAL EXAMINATION
• NEUROLOGICAL EXAMINATION
• CT, MRI
DIAGNOSTIC CRITERIA FOR MIGRAINE
MANAGEMENT
3) CLUSTER HEADACHE:
it involves repeated headaches that can occur for weeks to months at a time
followed by a period of remission.
• Clinical manifestation :
a. Pain around the eye, forehead, cheeks, nose or gums
b. Swelling around the eye
c. Facial flushing
• Diagnostic tests:
1. Neurological examination
2. PE
3. CT, MRI
THANK YOU
