Headache

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Headache

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 Tension Headache
Presentation: Bilateral, band-like pressure or tightness
• Duration: 30 minutes to several hours
• Lacks photophobia, phonophobia, or aura

Pathophysiology: Stress, sleep deprivation, hunger

Dx: Clinical

Mgmt: NSAIDs
• TCAs for prophylaxis

Wikicommons – Public Domain

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 Migraine Headache
Presentation: Unilateral, pulsating pain which improves with sleep
• Duration: 4 hours to several days
• Photophobia, phonophobia
• Migraine with aura: “Scotoma” or focal deficits

Pathophysiology: Stress, OCPs/menstruation, Tyramine

• Irritation of CN V and meninges

Dx: Clinical

Mgmt: Abortive and Prophylactic

Wikicommons – Häggström Public Domain

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 Migraine Headache
Abortive:
• Acetaminophen/NSAIDs
• Ergotamine
• Sumatriptan

Prophylactic:
• Propranolol
• Topiramate
• Valproate
• Amitriptyline

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 Migraine Headache
Abortive:
• NSAIDs (Pregnancy)
• Ergotamine (MAO inhibitors, Pregnancy)
• Sumatriptan (MAO inhibitors, Coronary vasospasm)

Prophylactic:
• Propranolol (Asthma/COPD, Diabetes)
• Topiramate (Kidney stones, Pregnancy)
• Valproate (Liver disease, Pregnancy)
• Amitriptyline (Anticholinergic)

https://blausen.com/

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 Cluster Headache
Presentation: Male w/ severe unilateral headache and orbital pain
• Duration: 15 minutes to several hours
• Frequency: Daily for weeks at a time
• Lacrimation and Rhinorrhea
• Horner’s syndrome: Ptosis, Miosis, Anhidrosis

Pathophysiology: Idiopathic

Dx: Clinical

Mgmt: O2 therapy, Sumatriptan

• Verapamil for prophylaxis

Wikicommons – Public Domain

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 Trigeminal Neuralgia
Presentation: Sudden-onset, severe facial pain in V2 or V3 distribution
• Duration: < 1 minute
• Trigger Zone (If bilateral => Multiple Sclerosis)

Pathophysiology: Irritation of CN V root

Dx: Clinical

Mgmt: Carbamazepine
• 2 nd-line: Valproate, Gabapentin
• Surgery

https://blausen.com/

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 Pseudotumor Cerebri
Presentation: “Idiopathic Intracranial Hypertension”
• Obese or pregnant woman w/ HA and diplopia/visual loss
• Pulsatile tinnitus
• HA worsens when lying flat

Pathophysiology: ↑CSF production, venous sinus congestion

• Medications: Vitamin A, Tetracyclines

Wikicommons – Public Domain

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 Pseudotumor Cerebri
Dx: Exam => Papilledema +/- CN VI palsy
• MRI => Decreased or Normal-sized Ventricles
• Lumbar Puncture => ↑ Opening Pressure

Mgmt: Stop contributory medications

• Acetazolamide (1st-line)
• Furosemide, Topiramate
• Lifestyle: Salt reduction, weight loss
• Surgery: Shunts, Optic Nerve Sheath Fenestration

https://blausen.com/

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