2. EVALUATION OF
HEADACHE
• HISTORY
– Nature of the headache
– Daily pattern of hedache
– Location
– Associated symptoms
– Precipitating or alleviating factors
– Overall pattern
– Family history
3. • VAST MAJORITY OF PATIENTS WITH
HEADACHE HAVE NORMAL VISUAL ACUITY
• PE:
• BP, Pulse
• Meningeal signs
• Symmetry of cranial nerve and motor functions
4. TYPES OF HEADACHE
• PRIMARY
– Migraine
– Tension- type
– Cluster
• SECONDARY
5. NEUROIMAGING?
• Sudden onset of severe headache
• Unexplained change in headache pattern
• Unresponsive to medical therapies
• HA related to physical exertion or change in body position
• New onset of headache after the age of 50 years
• New headaches in immunosuppressed patients
• (+) focal neurologic signs
• (+) fever, neck stiffness, change in mental status, behavioral
changes
6. MIGRAINE
• Condition consisting of repetitive bouts of
headache
• F>M
• (+) familial tendency
• (+) history of motion sickness in childhood
• Onset- puberty or young adulthood
• Decrease after menopause
7. Characteristic:
• unilaterality, pulsating, N/V, photophobia,
aggravated by physical activities
Exacerbated by:
• menstruation, pregnancy, hunger, stress,
certain foods and sleep deprivation
8. I. Migraine with aura
• Classic migraine
• 30%
• Visual aura: begins w/ a small scotoma
near fixation that gradually expands,
then breaks up
• < 45 minutes
• Followed by HA on the contralateral side
of the head
• Untreated: 4 to 72 hrs
9.
10. II. Migraine without aura
• Common migraine
• 65%
• No preceding neurologic symtoms
• Global
• Can last hours to days
13. EVALUATION
• Headache or aura always occur on the same
side
• Headache precedes the aura
• Neurologic deficit, persists after aura resolves
• Features of aura are atypical
14. Tension -type headache
• Chronic
• Aching
• Worse at the end of day
• Precipitated by stress
• Associated with depression
15. TREATMENT
• Reassurance
• Avoid precipitating factors:
• Chocolates, nitrates, MSG, cheese,
caffeine, red wine, alcohol, nuts,
shellfish
• OCPs
• Stress, change in sleep patterns,
strong scents such as perfume,
cigarette smoke and exercise