Symptoms
& Disease





 





Headache



    

Headache
is usually benign symptom, and only occassionaly
is due to a serious underlying cause. Even in
emergency settings, only 5 percent of patients
with headache have a serious underlying disorder.
However, it is necessary to identify and treat
these serious conditions. Therefore, it is better
to classify any patient of headache as benign or
due to serious underlying disorder.

  



Benign

Provoked by

1. Red wine

2. Sustained exertion

3. Organic odor

4. Hunger

5. Lack of sleep

6. Weather changes

7. Menses
Serious
Underlying Disorders:-

1. Induced by bending, lifting, coughing

2. First severe headeche ever

3. Disturbs sleep or occurs immediately
upon awakening

4. Abnormal neurological examination

5. Fever or other unexplained

6. Vomiting preceeds headache.

7. Age over 55 years

   




Patients who present with first severe headache
ever can be due to some serious cause like
meningitis, subarachnoid hemorrhage, glaucoma or
purulent sinusitis. In these patients, the
following laboratory tests will reveal the
underlying cause.

  

1. Neurological examination

2. Abnormal examination to be followed by MRI or
CT scan.

3. Measurement of blood pressure

4. Urine examination

5. Fundoscopy

6. Measurement of intracoular pressure

7. Psychological state of the patient.

 

Migraine

Headache with nausea vomiting and photophobia.
Reccurent attack with pain free interval.
Hereditary predisposition. More common in women.

 


Aggravated by-

Red wine, menses, hunger, glare, lack of sleep,
perfumes, worry.

 

Relief
by-

Sleep, NSAIDS, Sumatriptan, pregnancy.

 

Treatment-

Acute Attack-

1. Aspirin or paracetamol

2. Ibuprofen[600-800 mg.]

3. Naproxen[375-750 mg]

4. Ergotamine 3 mg

 


If oral therapy is not effective subcutaneous
sumatriptan or IV Chlopromazine or
prochlorperazine.

 


Prophylaxis-

Propranolol [60-320 mg] daily

Amitriptyline [10-175 mg] daily

Valproate [500-1500 mg] daily

 

Cluster
headache-

One to three short lived attacks daily of
periorbital pain over a 4 to 8 weeks followed by
pain free interval of nearly one year. Associated
with nausea, nasal stuffiness, red eye, ptosis.
More common in males. Hereditary factor is absent.

Pain is unilateral and affects the same side in
subsequent months. Attacks last for 30 minutes to
2 hours.

Precipitating factors

Food or emotional factors do not play a role.
Alcohol provokes attacks in 70% of patients.

 


Treatment-

Acute Attack

1. Inhalation of 100% oxygen [9L/min} for 15
minutes.

2. Sumatriptan 6 mg subcutaneously.

 

Prophylactic
treatment:

1. Propranolol and amitriptyline not effective

2. Lithium [600-900 mg daily] is useful

3. Prednisone, 60 mg daily for 7 days followed by
a rapid tapering dose.

4. Ergotamine [1 mg] is most effective when given
1-2 hours before an expected attack.

 

Tension
headache

Chronic headache with tight band like discomfort
and tight posterior neck muscles.

Pain increases slowly, fluctuates in severity and
persists for many days.

Associated with anxiety or depression.

More common in female.

 

Provoked
by-

Factors similar to migraine.

 

Lumbar
puncuture headache

Follows lumbar puncture within 48-72 hours. Begins
when the patient sits or stands upright and relief
by reclining or compression of abdomen. Associated
with nausea, stiff neck, photophobia, vertigo.
Resolves over a few days.

  

Treatment

1. I.V. caffeine sodium benzonate [500mg]

2. Injection of 15 ml. of autologous whole blood
in those who do not respond to caffeine.

 

Post
concussion headache

Follows an apparently trivial injury to head.

Headache, dizziness, vertigo, impaired memory,
anxiety, irritability and difficulty in
concentration.

Headache resolves after several weeks.

  


Treatment-

1. Symptomatic support

2. Assurance

  


Temporal [gaint cell] arteritis

Common in people above 50 years of age. It is due
to inflammation of external carotid arteries.

Headache with malaise and muscle ache. Occurs over
temporal arteries with red streaking of the
overlying skin. Pain is superficial, external to
skull and not deep inside. Scalp tenderness is
marked. Burshing of hair or resting the head over
pillow is very painful. If untreated it results
into blindnness.

 

Laboratory
tests

1. ESR- elevated

2. Temporal artery biopsy to confirm the
diagnosis.

 

Treatment-

Prednisone 80 mg daily for 6 weeks.

 

Cough
headache

Transient, severe head pain upon coughing,
bending, lifting, sneezing, stooping. Pain lasts
for seconds or a few minutes H/o lower respiratory
infection with severe coughing. More common in
males.

 

Laboratory
tests-

MRI is neccessary in all patients since structural
anomalies are seen in 25 percent of patient.

 

Treatment-

1. For benign disorder, indomethacin [50-200 mg]
daily.

2. Threpeutic lumber puncture with removal of
40ml. of CSF.

 

Loital headache

More common in males. Abrupt in onset and subsides
in a few minutes. If coitus is interrupted.
Headache is always benign. If it persists for
hours or accompainied by vomiting subarachnoid
hemorrhage should be excluded.

 

Headache
due to systemic illness

E.G SLE, infections mononucleosis chronic
pulmonary failure, inflammatory bowel disease, HIV
and malignant hypertension. Also drugs like oral
contraceptives, ovulation promoting drugs or
withdrawal of corticosteroids.

 

 



 




 

Symptoms & Disease

 

Headache

    
Headache is usually benign symptom, and only occassionaly is due to a serious underlying cause. Even in emergency settings, only 5 percent of patients with headache have a serious underlying disorder. However, it is necessary to identify and treat these serious conditions. Therefore, it is better to classify any patient of headache as benign or due to serious underlying disorder.

  

Benign
Provoked by
1. Red wine
2. Sustained exertion
3. Organic odor
4. Hunger
5. Lack of sleep
6. Weather changes
7. Menses

Serious Underlying Disorders:-
1. Induced by bending, lifting, coughing
2. First severe headeche ever
3. Disturbs sleep or occurs immediately upon awakening
4. Abnormal neurological examination
5. Fever or other unexplained
6. Vomiting preceeds headache.
7. Age over 55 years

   

Patients who present with first severe headache ever can be due to some serious cause like meningitis, subarachnoid hemorrhage, glaucoma or purulent sinusitis. In these patients, the following laboratory tests will reveal the underlying cause.
  
1. Neurological examination
2. Abnormal examination to be followed by MRI or CT scan.
3. Measurement of blood pressure
4. Urine examination
5. Fundoscopy
6. Measurement of intracoular pressure
7. Psychological state of the patient.
 
Migraine
Headache with nausea vomiting and photophobia. Reccurent attack with pain free interval. Hereditary predisposition. More common in women.
 
Aggravated by-
Red wine, menses, hunger, glare, lack of sleep, perfumes, worry.
 
Relief by-
Sleep, NSAIDS, Sumatriptan, pregnancy.
 
Treatment-
Acute Attack-
1. Aspirin or paracetamol
2. Ibuprofen[600-800 mg.]
3. Naproxen[375-750 mg]
4. Ergotamine 3 mg
 
If oral therapy is not effective subcutaneous sumatriptan or IV Chlopromazine or prochlorperazine.
 
Prophylaxis-
Propranolol [60-320 mg] daily
Amitriptyline [10-175 mg] daily
Valproate [500-1500 mg] daily
 
Cluster headache-
One to three short lived attacks daily of periorbital pain over a 4 to 8 weeks followed by pain free interval of nearly one year. Associated with nausea, nasal stuffiness, red eye, ptosis. More common in males. Hereditary factor is absent.
Pain is unilateral and affects the same side in subsequent months. Attacks last for 30 minutes to 2 hours.
Precipitating factors
Food or emotional factors do not play a role. Alcohol provokes attacks in 70% of patients.
 
Treatment-
Acute Attack
1. Inhalation of 100% oxygen [9L/min} for 15 minutes.
2. Sumatriptan 6 mg subcutaneously.
 
Prophylactic treatment:
1. Propranolol and amitriptyline not effective
2. Lithium [600-900 mg daily] is useful
3. Prednisone, 60 mg daily for 7 days followed by a rapid tapering dose.
4. Ergotamine [1 mg] is most effective when given 1-2 hours before an expected attack.
 
Tension headache
Chronic headache with tight band like discomfort and tight posterior neck muscles.
Pain increases slowly, fluctuates in severity and persists for many days.
Associated with anxiety or depression.
More common in female.
 
Provoked by-
Factors similar to migraine.
 
Lumbar puncuture headache
Follows lumbar puncture within 48-72 hours. Begins when the patient sits or stands upright and relief by reclining or compression of abdomen. Associated with nausea, stiff neck, photophobia, vertigo. Resolves over a few days.
  
Treatment
1. I.V. caffeine sodium benzonate [500mg]
2. Injection of 15 ml. of autologous whole blood in those who do not respond to caffeine.
 
Post concussion headache
Follows an apparently trivial injury to head.
Headache, dizziness, vertigo, impaired memory, anxiety, irritability and difficulty in concentration.
Headache resolves after several weeks.
  
Treatment-
1. Symptomatic support
2. Assurance
  
Temporal [gaint cell] arteritis
Common in people above 50 years of age. It is due to inflammation of external carotid arteries.
Headache with malaise and muscle ache. Occurs over temporal arteries with red streaking of the overlying skin. Pain is superficial, external to skull and not deep inside. Scalp tenderness is marked. Burshing of hair or resting the head over pillow is very painful. If untreated it results into blindnness.
 
Laboratory tests
1. ESR- elevated
2. Temporal artery biopsy to confirm the diagnosis.
 
Treatment-
Prednisone 80 mg daily for 6 weeks.
 
Cough headache
Transient, severe head pain upon coughing, bending, lifting, sneezing, stooping. Pain lasts for seconds or a few minutes H/o lower respiratory infection with severe coughing. More common in males.
 
Laboratory tests-
MRI is neccessary in all patients since structural anomalies are seen in 25 percent of patient.
 
Treatment-
1. For benign disorder, indomethacin [50-200 mg] daily.
2. Threpeutic lumber puncture with removal of 40ml. of CSF.
 
Loital headache
More common in males. Abrupt in onset and subsides in a few minutes. If coitus is interrupted. Headache is always benign. If it persists for hours or accompainied by vomiting subarachnoid hemorrhage should be excluded.
 
Headache due to systemic illness
E.G SLE, infections mononucleosis chronic pulmonary failure, inflammatory bowel disease, HIV and malignant hypertension. Also drugs like oral contraceptives, ovulation promoting drugs or withdrawal of corticosteroids.
 

 

 

By |2022-07-20T16:41:25+00:00July 20, 2022|Uncategorized|Comments Off on Headache

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