Headache Dr shinisha paul

epidemiology 8% serious complications 1% life threatening

history Location Intensity Aggravating / relieving factors Previous history Systemic illness

Type of pain Throbbing : migraine Pressure / tighteness : tension headache Explosive / excruciating : cluster headache

examination Systemic Neurological Psychiatric Ocular

Ocular examination Vision – with PH, colour vision Extra ocular movements – cranial nerve palsy Pupillary reaction Fundus examination – papilloedema, optic neuritis Visual fields – glaucoma , neurological defect

migraine Brainstem neuronal hyperexcitability With aura / Without aura

Ocular causes of headache Ocular migraine - Cluster headache : commen in men, unilateral, sharp stabbing eye pain, several episodes over 24 hrs, each episode lasting from minutes to 2 hrs, 5th CN distribution, 30% have horners syndrome. Treatment : high flow O2, sumatriptan, prednisolone

- Ophthalmoplegic migraine : cranial nerve palsy, Diplopia and U/L headache

- Classical migraine : visual aura with scintillating scotoma

Basilar artery migraine

2. Refractive errors 3. Accomodative spasm : hypermetropia 4 2. Refractive errors 3. Accomodative spasm : hypermetropia 4. Acute iridocyclitis : frontal headache and eye pain due to ciliary muscle spasm

5. Acute congestive glaucoma - sudden onset of eye pain radiating to head, ear, teeth and sinus - blurred vision, coloured haloes, scotoma -signs : congestion, cloudy cornea, fixed pupil, raised IOP

6. Posterior scleritis - T sign

7. Herpes zoster ophthalmicus - unilateral headache prior to lesions - vesicular eruptions along ophthalmic division of 5th nerve

8. Optic neuritis - headache with eye pain - defective vision - RAPD

9. Ocular trauma - raised IOP - ciliary spasm

10. intraocular/ intraorbital tumors

11. Orbital cellulitis

12. Lacrimal gland tumors

13. Lid infections - blepharitis - hordeolum

14. Corneal ulcers

15. Papilloedema - transient blurring of vision - bilateral disc edema - raised ICT

16. Giant cell arteritis - unilateral headache worse at night - commen in women - affects small and medium sized vessels - Diagnosis : ESR, CRP, Temporal artery biopsy

Red flag signs New onset headache > 50 yrs of age Headache associated with nausea, vomiting Worsens with Valsalva Jaw claudication LOC Trauma

conclusion Headache is a common and challenging complaint Proper diagnosis is mandatory CT/MRI if required OPHTHALMIC EXAMINATION IS COMPULSORY

18.06.2018 THANK YOU - OVER TO ENT