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Headache Dr. Mansour Al Moallem
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Headache related to etiology…
Vascular… Migraine Muscle contraction… Tension headache Inflammatory… Giant cell artritis meningitis Distortion… ● Brain tumor Idiopathic… Trigeminal neuralgia
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Pain sensitive structure invovle in headache
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Migraine… Common migraine Classical migraine “ with aura”
Complicated migraine Cluster headache “more in male”
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Migraine…Pathogenesis…
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Migraine…Symptoms…
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Migraine…Symptoms…
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Migraine…Cont… Affect…. 20% of female & 10-12% of male
Started at age 5-30 yrs peak at puberty 70% with family history It might trigger by different factors… Stress Sleep disturbance Drugs food
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Migraine…Cont… Treatment… For acute symptoms… Prophylactic… Analgesia
Ergotamine Serotonin agonist Antiemetic Prophylactic… Tricyclic antidepressant Beta blocker Some antiepileptic drugs
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Tension headache The most common headache
Mostly related to stress & emotional conflict 40% May have family history More in female It might associated with migraine Described as non throbbing , diffuse, tightness trigger point may be found
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Giant cell artritis Affect external branches of carotid artery mostly temporal artery. Segmented inflammation with lymphocyte, plasma cell & multi nucleated giant cells. Affect patients >50 yrs. Male : female 2:3 Subacute sever pain at temporal region. Mainly unilateral Examination at temporal region …tenderness , diminish or pulseless, tortious course If not treated… loss of vision 50% or other such as…MI
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Giant cell artritis…cont
Investigations… ESR Doppler Biopsy Treatment… steroid
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Trigeminal neuralgia Pain at distribution at 5th cranial nerve mainly at V2 or V3 or both More in female “3:2” above 50 yrs Commonly unilateral May be trigger by special maneuver e.g. laughing , shaving , brushing teeth …. Many they respond to medical treatment …if not or develop major side effect ….consider surgery
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Headache due to raise intracranial pressure
etiology Is variable 20% headache is the initial symptom More early if in posterior fossa Usually is intermittent, Increase during sleep & immediately after wakeup Increase with cough & strain May associate with nausea & projectile vomiting Mid line tumor may cause intermittent 3rd ventricle obstruction tumor in 4th ventricle may cause sever emesis & neck rigidity Conscious may altered Neurological sign(s) according to site of the lesion Papilloedema is common
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Benign raise intracranial pressure (BIH)
Idiopathic Almost in female … peak at 3rd decade Associated with… Obesity Drugs…e.g. steroid , Vit A… Symptoms…. Headache Double vision Blured vision
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Benign raise intracranial pressure (BIH)
Consider other diagnosis such as… ”Cerebral venous/sinus thrombosis” If patint pesent with… sizure Focal neurological deficit Finding… Bilateral papiloedema +/- 6th nerve Normal MRI/MRV Increase CSF pressure Normal CSF analysis
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Others… Meningitis Sinus thrombosis Paranasal sinus Hemorrhage
Subdural hematoma Subarachnoid hemorrhage Ineracerbral hemorrhage
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Approach to patient with headache
History Age Onset Duration Character of headache Associate symptoms Examination Full neurological examination including for papilledema
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Approach to patient with headache
When consider headache as emergency acute headache Change of character altered consciousness Seizure in examination… Neurological deficit Papilledema Neck rigidity fever
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Thank you
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