HEAD ACHE

-DR.RACHAKONDA RAJKUMAR
M.B.B.S.,M.D{GEN.MED}
CONTENTS:
 Introduction
 Secondary Head Ache
 Primary Head Ache Disorders
 Primary Care And Head Ache Management
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INTRODUCTION:

 General principles
 Anatomy & physiology of head ache
 Clinical evaluation of acute new onset headache
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General principles:
 Pain in head or face & most common
 Unpleasant sensation localized to a part of the body
 Described as:
 Penetrating /tissue-destructive process
(stabbing, burning, twisting, tearing, squeezing)
 Bodily or emotional reaction (e.g., Terrifying,
nauseating, sickening)
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 International Headache Society characterized as

 Primary head ache
 Secondary head ache
  Primary headaches:
 its associated features are the disorder itself
 considerable disability & quality of life.
 secondary headaches:
 caused by exogenous disorders
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Anatomy & Physiology:

 Anatomy
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 Pathophysiology:
 Nociceptors absent in parenchyma.
 Pain originating in sourrounding structures
 Blood vessels,
 Meninges, muscle fibers, facial structures,
and cranial / spinal nerves.
 traction /irritation
 meninges & blood vessels.
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 receptors may be stimulated

 head trauma or tumors
 Blood vessel spasms, dilated blood vessels,
 inflammation / infection
 meninges
 muscular tension
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 key structures in primary headache:
 large intracranial vessels & dura mater
 peripheral terminals of the trigeminal nerve
 trigeminocervical complex
 Rostral pain-processing regions,
 ventroposteromedial thalamus
 Cortex
 pain-modulatory systems-hypothalamus & brainstem.
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Acute new onset HA:

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 CT/ MRI
  Lumbar puncture (LP)
  General evaluation:
 cranial arteries
 cervical spine by -passive movement of the head
and by imaging
 blood pressure monitoring and urine
examination; refraction.
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 Eyes by fundoscopy
 Intraocular pressure measurement
  Refraction
 Pyschological state
 Recurrent headache-otologic / endodontic surgical
procedures.
 Vast majority of patients presenting with severe
headache have a benign cause.
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Secondary head ache:

 Dx and Rx of the underlying condition.

 Meningitis
 Intracranial hemorrhage
 Brain tumor
 Temporal arteritis
 Glaucoma
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Primary head ache disorders:

 Headache and associated features occur in the

absence of any exogenous cause.
 Migraine
 Tension type head ache
 Trigeminal autonamic cephalgias including cluster
head ache
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 Paroxysmal hemicrania
 Short-lasting unilateral neuralgiform headache with
conjunctival injection and tearing (SUNCT)
 Short-lasting unilateral neuralgiform headache with
autonomic symptoms (SUNA)
 Hemicrania continua
 Other primary head ache disorders
 Primary Cough Headache
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 Primary Exercise Headache

 Primary Headache Associated with Sexual
Activity
 Primary Thunderclap Headache
 Cold-Stimulus Headache
 External Pressure Headache
 Primary Stabbing Headache
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 Nummular Headache
 Hypnic Headache
 New Daily Persistent Headache
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Primary Care & Head Management:

 Identify
 Diagnosis
 Common is migraine >90%
 If difficult to diagnosis;refer
 Treatment
 Prognosis
 Counselling
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