Lokin Headache (Sakit sa Ulo)

Headache is pain or discomfort where… (be specific)

Upper part of head, from orbits to suboccipital area

General mechanisms of headache

Traction on major intracranial vessels

Distension, dilation of intracranial arteries

Inflammation near pain sensitive structures

Direct pressure on cranial or cervical nerves

Sustained contraction of scalp or neck muscles

Stimulation from disease of eye, ear, nose, and sinuses

“SC SI DD, at DT”

Pain sensitive structures found in, or around the head

Cranial venous sinuses

Arteries at the base of brain

Arteries of dura

Dura near base of brain, and large arteries

All extra-cranial structures

Pain-insensitive structures in the cranium

Brain parenchyma

Ependyma

Choroid

Pia

Arachnoid

Dura over convexity of the brain

Skull

What makes a headache primary? Give examples of primary headache

No underlying cause

Migraine, tension, cluster

Examples of underlying causes of secondary headache

CNS infection

Neoplasm (tumors in the brain)

CVD (e.g. strokes)

__ % will have at least one headache/year

__ % will seek physician evaluation, c/c headache

__ % will have emergent secondary cause

60-75%

5-10%

10%

T/F: Migraine is the most common primary HA

False: 69% of PHAs are tension headaches, migraines are 15%, while 0.1% is cluster

Statement T/F: Fever is the most common cause of secondary HA. HAs from disorders of the nose/sinus are a relatively smaller percentage, but are common clinically.

1st statement is false, 2nd statement is true

(note: vascular disorders include stroke)

General clinical presentation of primary headache

Onset

Duration of episodes

Recurrent, non progressive

Positive family history

Normal neurological examinations

HAs that are hereditary

Migraine

Subarachnoid hemorrhage (secondary to brain aneurysm)

Evidence of serious headache disorder by history or physical exam; usually life threatening

Headache alarms

Things to ask for headache history

Reason for consultation

Onset (How did it start)

PMHx (Have you had previous similar headaches, if so when did this type of headache start)

Location

Quality of pain

Associated symptoms

Precipitating/Aggravating factors

Relieving factors

Medical history

Family history

Environment (Carbon monoxide)

Possible reasons for consultation

1. First HA or worst HA

2. Accompanied by new or frightening features

3. Last straw? Has already tried to resolve headache in other ways.

Possible locations of headache

Unilateral/bilateral

Frontal/occipital/facial

Possible qualities of headache pain

Pulsatile, steady, shock-like, tightness

Possible associated symptoms of headache

Nausea, vomiting, LOC, flushing, lacrimation, drop attack, neck stiffness, photophobia, dizziness

Possible precipitating/aggravating factors of HA

Trauma, exertion, noise, position, foods, drugs, weather, anxiety, menstration

Possible relieving factors of HA

Darkroom, position, pressing on scalp, medication

Relevant medical history to HA

Cancer, hypertension, HIV (these conditions can affect the CNS, and lead to headaches)

Recent procedures

• Lumbar punctures can cause spinal headache

Change in medications

• Nitrates (prevents angina) can cause HA, via vasodilation

Physical exam

Read up

What are bruits? What are they a sign of?

Abnormal pulsations

Abnormal blood flow in the blood vessel

Ear problems causing headache

OM (otitis media) (ear infection)

Hemotympanum

Rash is a sign of

inflammation, and a medical illness which may be causing the HA

Symptoms of Horner’s syndrome

Ptosis, anhidrosis, meiosis

Ataxia can be brought about by

Tumors, abnormal blood vessels

Cause and location of sinus headaches

Sinusitis

Behind browbone, and/or cheekbones — este the frontal and maxillary sinuses

A headache that’s like a band squeezing the head

Tension headache

HA focused around one eye

Cluster headache

HA with unilateral pain, accompanied by nausea, visual changes

Migraine

T/F Migraines can change sides between attacks

True

Migraine vs Tension Headache

Clinical features suggestive of secondary headache

Common causes of headache

Headache red flags

Sudden/new onset

Wakes patient from sleep

Associated features

• Vomiting

• Visual symptoms

• Weakness/numbness

• Meningeal irritation

T/F migraine is associated with anorexia, nausea, and vomiting

True

_% of population have migraines, and suffer more than __ attacks a month

25%, 4

Migraine without aura presentation

Migraine with aura presentation

Migraine prevalence (age group, sex)

30-50 yo

Females

Phase of migraine with psychological, neurological, and autonomic symptoms

Premonitory/prodromal phase

> osmophobia is irritability in terms of smell

Phenomenon related to headache phase of migraine

trigeminovascular and neurogenic events

Phenomenon associated with aura

Cortical spreading depression

Trigger for cerebral cortex

Emotion, stress

Trigger for thalamus

Bright lights, noise, smells

Trigger for hypothalamus

Internal bodily environment and mechanisms

Trigger for carotid vessels

Vasodilators