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1. Primary Headaches- ICH Beta 3- 2013
And
Management
-Dr. Sachin Adukia

2.  Headache arises from activation of pain-sensitive intracranial
structures.
 1930s- Ray and Wolfe identified intracranial pain sensitive
strucutres
INTRACRANIAL EXTRACRANIAL
•arteries of the circle of Willis
•the first few centimeters of their
medium- sized branches,
•meningeal (dural) arteries
•large veins and dural venous sinuses
•portions of dura near blood vessels.
•external carotid artery and its
branches
•scalp and neck muscles,
•skin and cutaneous nerves
•cervical nerves and nerve roots
•mucosa of sinuses,
•teeth.

4. MIGRAINE
•Global Burden of Disease
Survey 2010- 3rd most
prevalent disorder
•7th specific cause of
disability worldwide

5. Meet criteria, but <5
attacks, - 1.5.1 - Probable
migraine without aura.
When pt. falls asleep
during an attack and
wakes up without it,
duration of attack is
reckoned until waking.
In age < 18 years: 2-72
hours
POUND

6. Aphasia is always regarded as a
unilateral symptom;
dysarthria may or may not be.
Visual aura in > 90%
Positive / negative phenomenon
Visual Aura Rating Scale
Next in freq- sensory disturbances
Positive / negative phenomenon
Less frequent - speech distr. Aphasic
Positive / negative phenomenon
Aura of motor weakness- Hemiplegic
migraine
Symptoms of these aura may follow one
another in succession visual sensory
 language

7. VARS score :- 5 visual symptom characteristics
 duration 5-60 min (3 points)
 develops gradually > or = 5 min (2 points)
 scotoma (2 points)
 zig-zag lines (2 points)
 unilateral (1 point).
◦ Max- 10 points.
◦ Score > or = 5  diagnosed as Migraine Aura
◦ Sensitivity - 96% and Specificity - 98%

14. PREVIOUSLY USED TERMS:
•Tension headache
• muscle contraction headache
•Psychomyogenic headache
•stress headache
•Ordinary headache
•essential headache
•idiopathic headache
•Psychogenic headache
How to elicit pericranial tenderness

30.  no receptor specificity.
 have effects at
◦ 5-HT1B and 5-HT1D receptors,
◦ 5-HT1F, 5-HT1A, 5-HT2A, 5-HT2B,
◦ Dopamine D1 and D2, & adrenergic a1, a2, and b receptors
◦ half-life - 36 h, helpful in long duration migraine

32.  Corticosteroids
◦ Intractable Migraine or Status Migrainosus.
◦ a rapidly tapering dose of Prednisone beginning with 60 mg
◦ or a 3-day pulse thr. of Dexamethasone (4 mg tid, bid, qd)
 Antiemetics
◦ Neuroleptics antagonize dopamine receptors in CTZ
◦ Commonly used
 metoclopramide, chlorpromazine, prochlorperazine, promethazine, haloperidol
 Narcotic analgesics
◦ when other medications cannot be used
◦ reserved for pts with CAD
◦ pregnant women.

39.  Steroid- Pred, M-pred, Triamcinolone
 Ergot tartarate/ DHE
 CCB- Verapamil
 Lithium- adv efects- DI and thirst, GI distr, Tremors
Treatment in difficult cases:
 combination of
◦ verapamil and topiramate
◦ or verapamil and lithium
 For particularly resistant headaches, triple therapy
◦ verapamil with either topiramate or valproate plus lithium.

40.  adverse events
◦ corneal anesthesia,
◦ keratitis,
◦ anesthesia dolorosa.
 benefit may be short lasting, used only rarely

41. Paroxysmal hemicranias

47.  Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL. Bradley's neurology in
clinical practice. Elsevier Health Sciences; 2015 Oct 25
 Headache Classification Committee of the International Headache Society
(IHS. The international classification of headache disorders, (beta version).
Cephalalgia. 2013 Jul 1;33(9):629-808.
 Tepper SJ, Tepper DE, editors. The Cleveland Clinic manual of headache
therapy. Springer; 2011 Aug 22.

48. Thank You