1. Headache

2. 2nd Edition of The International Headache Classification (ICHD-2)
published by International Headache Society in Cephalalgia 2004
electronic version –

3. Primary headaches 1. MIGRAINE 2. TENSION-TYPE HEADACHE (TTH)
3. CLUSTER HEADACHE AND OTHER TRIGEMINAL AUTONOMIC CEPHALALGIAS
4. OTHER PRIMARY HEADACHES

4. 1. Migraine 1.1. Migraine without aura 1.2. Migraine with aura
1.3. Childhood periodic syndromes that are commonly precusors of migraine
1.4. Retinal migraine
1.5. Complications of migraine
1.6. Probable migraine

5. 2. Tension-type headache
2.1. Infrequent episodic tension-type headache
2.2. Frequent episodic tension-type headache
2.3. Chronic tension-type headache
2.4. Probable tension-type headache

6. 3. Cluster headache and other trigeminal autonomic cephalalgias
3.2. Paroxysmal hemicrania
3.3. Short-lasting unilateral neuralgiform headache attacks with conjuctival injection and tearing (SUNCT)
3.4. Probable trigeminal autonomic cephalalgia

7. 4. Other primary headaches
4.1. Primary stabbing headache
4.2. Primary cough headache
4.3. Primary exertional headache
4.4. Primary headache associated with sexual activity
4.5. Hypnic headache
4.6. Primary tunderclap headache
4.7. Hemicrania continua
4.8. New daily-persistent headache (NDPH)

8. Secondary headaches 5. Headache attributed to head and/or neck trauma
6. Headache attributed to cranial or cervical vascular disorders
7. Headache attributed to non-vascular intracranial disorders
8. Headache attributed to a substance or its withdrawal
9. Headache attributed to infection

9. Secondary headaches
10. Headache attributed to disorders of homeostasis
11. Headache attributed to facial pain attributed to disorder of cranial, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial cranial structures
12. Headache attributed to psychiatric disorder

10. Cranial neuralgias and central causes of facial pain
13.1. – 13.19
13.1. Trigeminal neuralgia
14. Other headache, cranial neuralgia, central or primary facial pain

11. Headache quality intensity localisation response on the physical
characteristics
quality    
intensity 
localisation
response on the physical
activity
accompanying signs     
Haas, D.C., SUNY Upstate Medical University, 2002

12. Headache Accompanying signs nauzea, vomitus phonophoby, photophoby
aura
informations about drugs which are used

13. Migraine prevalence – 10% prevalence in women Nauzea 17,5 % Fonofóbia
prevalence in men
5,7 %
positive familial
history
58 %
            
Nauzea 
Fonofóbia
Fotofóbia
Bolesť
Unilaterálna
Pulzujúca
Provokovaná
fyzickou aktivitou
            
Haas, D.C., SUNY Upstate Medical University, 2002

14. Pathophysiology of migraine
Hypotalamus and limbic system
prodroms
Neuronal dysfunction and vascular changes
aura and headache

15. Pathophysiology of migraine
Spreading depression of CBF from occipital region during aura
Spreading depression activate trigeminovascular endings

16. Pathophysiology of migraine
There is unknown mechanism of activation nuclei in brainstem (nc. caudalis trigeminalis)
- by spreading depression
- by biochemical changes
- both
Activation stimulate peripheral findings of n.V.

17. Pathophysiology of migraine
After stimulation of n. V. - production of P substance P and neurokinin A
 neurogenic inflammation
Stimulation of serotoninergic cells

18. Pathophysiology of migraine
Receptors of 5-HT (serotonin):
activation of inhibiting 5-HT1B/1D receptores  production of serotonin, P substance, neurokinin  block of neurogenic inflammation
agonists of these receptores (triptans)
– treatment of migraine

19. Factors provoke atack of migraine
Hormonal (menstruation, kontraceptives)
Dietetical (alcohol, Na glutamat, chocolate, cheese)
Psychological (stress, anxieta, depression)
From environment (odors, changes of weather, high above sea-level)
Drugs ( NTG, histamin, reserpin, estrogens)
Others (head injury, physical activity)

20. 1. Migraine 1.1. Migraine without aura („common“, hemicrania simplex)
1.2. Migraine with aura

21. Migraine with aura Aura - visual - sensoric - afasic - motoric
IHS – lasts: 4 – 60 min. (70% do 30´)

22. Migraine with aura Visual aura scintilating scotoma
small point is enlarging to cik-cak border (scintilation),
in the middle is dark scotoma
Haas, D.C., SUNY Upstate Medical University, 2002

23. Migraine with aura Visual aura colloured scintilating scotoma
Haas, D.C., SUNY Upstate Medical University, 2002

24. Migraine with aura Positive fenomenons cik-cak Negativ scotoms
Haas, D.C., SUNY Upstate Medical University, 2002)

25. Migraine Nauzea Phonophoby Photophoby Pain Unilateral Pulsating
Provoke by physical
activity
Lasts 4 – 72 hodín
            
Haas, D.C., SUNY Upstate Medical University, 2002

26. 1.6. Compliations of migraine
Status migrenosus
headache lasts more than72 hours
brain infarct
neurological deficit is not reversible till
7 days and/or infarct on CT or others

27. Migraine - therapy
Triptans (eletriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan) – middle or severe attacks of headache
ASA
Paracetamol + ASA + coffein
Ibuprofen
Naproxen
DHE sc, im, iv

28. Migraine – therapy mechanism of triptans
Vasoconstriction of meningeal, cerebral, pial vessels
activation 5-HT1B receptores in smooth muscles of vessels
Inhibition of neurogenic inflamation
stimulation 5-HT1D receptores at the endings of trigeminal C and A fibers (subst. P, neurokinín A, CGRP)
Central inhibition of pain
activation 5-HT1D, 1F receptores in brainstem decrease excitability of neurones ncl. trig. caudalis

29. Migraine – therapy Prevention – more than 3 attacks/month
betablockers, blockers of calcium,
chanels, antiepileptics

30. Tension headache The most often chronic headache
Prevalence - women – 88%
Prevalence – men – 69%
 the most days outside of work

31. Tension headache Pain - around the head - nonpulsating - bilateral
- 30 min. – 7 days
- not increased by physical activity
Haas, D.C., SUNY Upstate Medical University, 2002

32. Cluster headache 6 times more frequent in men Pain - periorbital
- frontal, temporal
- UNILATERAL
- burning
Haas, D.C., SUNY Upstate Medical University, 2002

33. Cluster headache Pain Alarm-clock pain lasts: 15 – 180 min.
shorter than migraine
Congestion
Lacrimation
Conjuctival inflamation
Alarm-clock pain
-beginning at night

34. Cluster headache
02, triptans, DHE,

35. Tension headache Increased muscle tone in the neck
Stright cervical lordosis
Therapy
Analgetics, myorelaxants, nonsteroid antiflogistics, physioteraphy, psychoteraphy, local 1% mesocain

36. Trigeminal neuralgia
Etiology – focal demyelinisation of n.V. or of ganglion
Idiopatic – pulsations of arteries near n.V.
Symptomatic – tumors
Prevalence – 6/100000,more women, and older people

37. Trigeminal neuralgy Clinical feature
shooting pain in area of n.V., increasing after chawing, in symptomatic - trigger area, loose of weight
Therapy
anticonvulsants – Gabapentin,
alcoholisation of ganglion, surgery

38. Temporal arteriitis Inflammation of a. temporalis superficialis
Age – risc factor
Headache in temporal region, thick, painful temporal superficial artery, chawing claudications, stronger pain
polymyalgia reumatica – spasm and pain of masticatory muscles

39. Temporal arteriitis Late diagnosis– risc of blindness and stroke
Dg. – laboratory – FW, CRP,
AG, biopsy
Therapy – Prednison – 60 (100) mg/day
long time, after decreasing – control of FW,  FW – back to former dose