1. Headache
Headache is not a disease state or a condition.
Classification of headache:-
Headache classify into three types.
 Cluster headache
 Tension headache
 Migraine headache
Headache may be symptomatic (primary headache) or
asymptomatic (secondary headache). In community
pharmacy the overwhelming majority of the patients (80-
90%) will present with tension headache.
1*Tension headache:-
Etiology: - The mechanisms that bring about headache
are still poorly understood. Tension headaches commonly
referred to as muscle contraction headache, as
electromyography has shown potential muscle contraction,
which is also exacerbated by stress.
In tension headache the pain is bifrontal or bioccipital,
generalized and non- throbbing the patient may describe the
pain as tightness. Pain is normally mild to moderate and not
aggravated by movement, although it is often worse under
pressure or stress. The pain is gradual in onset and ten to
worsen progressively through the day.
Types:-
Two types,
(a) Acute tension headache: - It occurs when the
patient experiences the head for less then15 days per
month.
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2. (b) Chronic tension headache: - Head occur for
more then 15 days per month and last for more then 6
month.
2*Migraine headache: -
Migraine has three phases,
(i) Asymptomatic phase (phase 1) → show no symptoms.
(ii) Prodromal phase (phase 2) →visual disturbance actual
headache start.
(iii) Headache phase (phase 3) →pain nausea and
vomiting
Migraine headache has basically two types.
(a) Migraine with aura (b) Migraine without aura
(a) Migraine with aura: - (classic migraine)
This account for less then 25%
patient of migraine cases. The aura develops 5 to 20 min
and can last for up to 1hr.
Symptoms:-
Visual auras
• Scotomas (blind spots)
• Fortification spectra (zig-zag lines) or flashing and
flickering light.
Neurological auras
• Pines and needles typically start in hand, migrating up
to arm before jumping to the face and lips.
• Nausea, vomiting
• Photophobia
• Phonophobia
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3. Nature of pain: -pain is unilateral, throbbing and
moderate to sever. Some time the pain become generalized
and diffuse. Physical activity may intensify the pain.
(b)Migraine without aura: - (common migraine)
The remaining suffers 75 %
do not experience an aura but do suffer from all other
symptoms as describe above.
3*Cluster headache: -
Cluster headache is predominant condition that affects the
men aged b/w 40 and 60. typically the headache occur at
the same time each day and last b/w 10min and 3 h, 50%
patient experiencing night time symptoms. Patient are woke
2 to 3h after falling sleep with steady intense unilateral
orbital, boring pain.
It may be characterized by period of acute attack, lasting a
number of weeks to a few months. Alcohol may trigger the
attack.
Symptoms:-
• Conjunctivitis
• Nasal congestion
Drugs used for the treatment of migraine:-
1. Migraleve (paracetamol codeine)
2. Midrid (Isometheptene mucate)
3. Buccastem M (prochlorperazine)
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