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    Headache

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    jaffar mah
    The document discusses headaches, including: - The pathophysiology of headaches being caused by traction, displacement, inflammation or distension of pain-sensitive structures in the head or neck. - Key aspects of headache history taking including onset (acute, sub-acute, chronic), precipitating factors, associated symptoms, and features that exacerbate or relieve pain. - The physical examination of headaches, including vital signs, neurological examination of cranial nerves and sensory functions. - Red flags for serious headaches including systemic symptoms, neurological signs, sudden onset in those over 40, and progressive changes in headaches. - Examples of features of meningitis, intracranial hemorrhage, sub

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    Headache

    Uploaded by

    jaffar mah
    19 views4 pages
    The document discusses headaches, including: - The pathophysiology of headaches being caused by traction, displacement, inflammation or distension of pain-sensitive structures in the head or neck. - Key aspects of headache history taking including onset (acute, sub-acute, chronic), precipitating factors, associated symptoms, and features that exacerbate or relieve pain. - The physical examination of headaches, including vital signs, neurological examination of cranial nerves and sensory functions. - Red flags for serious headaches including systemic symptoms, neurological signs, sudden onset in those over 40, and progressive changes in headaches. - Examples of features of meningitis, intracranial hemorrhage, sub

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    The document discusses headaches, including: - The pathophysiology of headaches being caused by traction, displacement, inflammation or distension of pain-sensitive structures in the head or neck. - Key aspects of headache history taking including onset (acute, sub-acute, chronic), precipitating factors, associated symptoms, and features that exacerbate or relieve pain. - The physical examination of headaches, including vital signs, neurological examination of cranial nerves and sensory functions. - Red flags for serious headaches including systemic symptoms, neurological signs, sudden onset in those over 40, and progressive changes in headaches. - Examples of features of meningitis, intracranial hemorrhage, sub

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    19 views4 pages

    Headache

    Uploaded by

    jaffar mah
    The document discusses headaches, including: - The pathophysiology of headaches being caused by traction, displacement, inflammation or distension of pain-sensitive structures in the head or neck. - Key aspects of headache history taking including onset (acute, sub-acute, chronic), precipitating factors, associated symptoms, and features that exacerbate or relieve pain. - The physical examination of headaches, including vital signs, neurological examination of cranial nerves and sensory functions. - Red flags for serious headaches including systemic symptoms, neurological signs, sudden onset in those over 40, and progressive changes in headaches. - Examples of features of meningitis, intracranial hemorrhage, sub

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    of 4

    Headache

    Prof. Kareem AL-Tameemi

     Objectives of learning :
     To understand the pathophysiology of head pain . ( nice to know )
     History taking with characterization of headache into acute, sub-acute and chronic . ( Must to know )
     To perform careful physical examination . (must to know )
     To formulate a differential diagnosis . ( nice to know )
     Red flags for serious headache disorders . ( must to know )
     Investigation of headache . ( must to know )
     Treatment of headache ( be aware )

     Pathophysiology of headache and facial pain .


     Headache is caused by traction , displacement , , inflammation or distension of the
    pain sensitive structure in the head or neck . ( skull , parenchyma and Dura : painless).
    A.Pain sensitive structure within cranial vault :
     Venous sinuses .
     Ant. And middle meningeal arteries .
     Dura at the base of skull .
     V , IX , X cranial nerves .
     Proximal portion of the internal carotid artery and its branches near the circle of
    Willis.
     BS periaqueductal grey matter .
    B. Extra cranial pain sensitive structures : these include periosteum of the skull ; skin ;
    subcutaneous tissues , muscles and arteries ; neck muscles ; C2-C3 cervical nerves ; eyes ;
    ears , teeth , sinuses , and oropharynx ; and mucous membrane of the nasal cavity .

     History :
    1. Onset :
     Acute ?
     Sub-acute ?
     Chronic ?
    2. Precipitating factors :
     Stress , chocolate : migraine
     Alcohol : cluster
     Chewing : Tension
    3. Prodromal symptoms ( aura ) .
    4. Character of pain ?
    5. Location of pain ?
    6. Associated symptoms : weight loss , fever , dyspnea , visual disturbance , N/V ,
    photophobia , rhinorrhea .
    7. Pattern ?
    8. Condition releiving pain ?
    9. Condition exacerbating pain ?
    10.History of headache?

     Physical Examination
     Vital signs
     General : weight loss , skin , scalp , face and head .
     Neck : stiffness
     Heart &lung
     Neurological examination :
    1. Mental state
    2. Cranial nerves
     2nd - papilledema ( ICP ) , subhyaloid hemorrhage (SAH )
     3rd - pupils , movement .
     5th – sensation .
    3. Motor for asymmetry .
    4. Sensory : any focal or segmental loss , decrease corneal reflex ( red flag ) .

    RED FLAGS OF HEADACHE ( SNOOP)

    1. Systemic symptoms ( fever , cancer , HIV ) , illness conditions .


    2. Neurological signs & symptoms ( altered mental status , neurological deficit ,
    neck stiffness , seizure , menigismus , coma ) .
    3. Onset is new ( especially age >40 , sudden ) .
    4. Other associated condition or features ( head trauma , , headache awaken from
    sleep , worse on valsalva , exertion , or sexual activity ).
    5. Previous headache history ; progressive symptoms or changes in frequency and
    severity .

     Some typical features of serious causes of headache


    Disease Features Diagnosi
    s
    Meningitis Neck stiffness , headache , photophobia , and LP
    prostration , may not be febrile .
    ICH Nuchal rigidity , headache ± clouded CT
    consciousness ± seizure LP
    SOL Pounding headache + N/V ± focal neurological CT
    deficit ± mental state changes MRI
    Temporal Unilateral headache , elderly , visual changes , ESR
    arteritis jaw claudication Biopsy
    Acute angle Severe eye pain , red dilated pupil , N/V I.O.P
    closed glaucoma ( increase )
    Migraine Unilateral , throbbing , N/V , photophobic, Clinical
    decrease by sleep , increase by movement
    Cluster Severe retro ocular pain , ptosis , rhinorrhea , Clinical
    male , increase by alcohol
    Tension Bi frontal or bi occipital , band like , decrease by Clinical
    relaxation
    Trigeminal Episodic , unilateral facial pain ,increase by Clinical
    neuralgia laughing , eating , shaving , normal trigeminal
    nerve examination
     Exercise : match the headache type ( A-E ) to the clinical
    presentation below :
    A. Migraine headache
    B. Tension headache
    C. Cluster headache
    D. SAH
    E. Meningitis

    1. A 42 old man with polycystic kidney disease who complained


    of sudden onset of severe headache and then lost
    consciousness .
    2. A 21 old college student with fever , headache , photophobia
    and 25 WBC/HPF but no RBC or Xanthochromic in CSF .
    3. A 31 old women with long history of intermittent severe
    headache , unilateral throbbing but no preceding symptoms
    and no visual disturbance , occur once or twice / month .

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