headache hamad 141128044851 conversion gate01
TRANSCRIPT
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APPROACHE TO
HEADACHE
Hamad
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DEFINITION
Headache, or cephalalgia, is Defned as diuse pain in Various parts o th
With the pain not confned To the area o distribution O a nerve.
Headache is among the Most common pain problems encountered n am
Headache, "hich is a ver! common s!mptom, can be caused b! a seriou
#nderl!ing abnormalit! but is usuall! a primar! headache disorder, such
headache, tension$t!pe headache, cluster headache, and paro%!smal He
&bout '() o all adults e%perience headache at some time in their lives
than *+) o children have reported signifcant headaches b! the age o
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GENERAL MECHANISMS OFHEADACHE
Traction on ma-or intracranial vessels.
Distention, dilation o intracranial arteries
nammationnear pain sensitive structures
Direct pressure on cranial or cervical nerve/ustained contractiono scalp or nec0
muscles
/timulationrom disease o e!e, ear, noseand sinuses 1reerred pain2
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EPIDEMIOLOGY
hT34/O4h M56&43h 7O8D /TM#8#/ H3&D&7H3h 78#/T36
69%
15%
15%
0.1%
Primary Headache Lifetime Prevalence
h Hangoverh Fever
h Metabolic disorder
h isorders of nose!sin"ses
h Head tra"ma
h isorders of eyes
h #asc"lar disorders
$%6&%
%
15%
'%
&%
1%
(econdary Headache
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HEADACHE INTHE ED
hT34/O4h M56&43h 78#/T36
& %
%
) 1 %
Primary Headache
h ("barachnoid Hemorrhage
h Meningitis
h *em+oral ,rteritis
h ("bd"ral Hematoma
h -( t"mor
h Miscellaneo"s illness
ho s+ecific diagnosis
) 1 %
) 1 %
) 1 %
) 1 %
& %
&& %
$ %
(econdary Headache
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PRIMARY HEADACHE
Migraine
TensionCluster
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TENSION HEADACHE
International Headache Society Diagnostic Criteria
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hDurationh 9( min to * da!s
h:ain characteristics 1at least ;2h :ressingilateral location
h 4o aggravation b! routine ph!sical activit!
h&ssociate s!mptoms 1must have both2
h 4o vomitingh 4o more than one o? nausea, photophobia,
phonophobia
hH@: and diagnostic tests do not suggest underl!organic disease
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MIGRAINE WITHOUTAURAInternational Headache Society Diagnostic Criteria
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h&t least A or more periodic attac0sh
DurationhB$*; h i untreated or unsuccessull! treatedh:ain characteristics1at least ;2
h#nilateral locationh:ulsating =ualit!hModerate to severe intensit!
h&ggravation b! "al0ing stairs or similar ph!sicah&ssociated s!mptoms 1at least 2h 4ausea, vomiting, or bothh :hotophobia or phonophobia
hH@: and diagnostic tests do not suggest underl!ingdisease
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MIGRAINE WITH AURAInternational Headache Society Diagnostic Criteria
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h&t least 9 periodic attac0sh&ura characertistics 1at least 9 2
hOne or more ull! reversible aura s!mptoms indicocal cerebral cortical or brain$stem d!sunction
h&t least aura s!mptom develops graduall! over
minutes or ; or more s!mptoms occur in successih4o single aura s!mptom lasts C A( minutes
hHeadache begins "ithin A( minutes o aura onset
hHistor!, ph!sical, and diagnostic tests do not suggesunderl!ing organic disease
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CLUSTERHEADACHEInternational Headache Society Diagnostic Criteria
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hDurationh + to ( minutes untreated
h:ain characteristicsh /evere unilateral orbital, supraorbital, or temporal pain
h&ssociated s!mptoms1at least , ipsilateral h 7on-unctival in-ection, lacrimationh 4asal congestion, rhinorrheah Eorehead and acial s"elling
h Miosis, ptosish 3!elid edema
hEre=uenc!?h >et"een ever! other da! to
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SECONDARYHEADACHE
h ntracranial hemorrhage
/ubarachnoid hemorrhage
ntracerebral hemorrhage
/ubdural
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hTemporal arteritis
hMass lesions
hTumor, abscess, arteriovenous malorma
h<itude sic0ness
hMetabolic
hH!pogl!cemia, ever, h!poth!roid, anem
h5laucoma
h:seudotumor cerebri 1benign intracranialh!pertension2
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hTrigeminal neuralgia
h:ost$concussion s!ndromeh/inusitis "ithout complication
h:ost$lumbar puncture
hDiet
hMedications
hEatigue, poste%ertion, postcoital
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OVERALL APPROACH
-hief -om+laint/ Headache
Headache Alarms
vidence of serio"s headache disorder
by history or +hysical eam
iagnosis of
Primary Headache Disorder
Work-up to identify/exc
secondary headache et
Treat Primary Headache
2 3(
3( 2
-onsider 4or"+ for
secondary headache
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PHYSICAL EXAM
Vital signs Eever, h!pertension, h!po%ia
Head
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INVESTIGATION
7>7 3/6
#643 67
7/E
$6&I /J#88.
$6&I :4/.
7T
M6
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OVERALL APPROACH
-hief -om+laint/ Headache
Headache Alarms
vidence of serio"s headache disorder
by history or +hysical eam
iagnosis of
Primary Headache Disorder
Work-up to identify/exc
secondary headache et
Treat Primary Headache
2 3(
3( 2
-onsider 4or"+ for
secondary headache
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ED TREATMENT OF PRIMARYHEADACHE
hTension
hOral analgesics 14/&D/, acetaminophen2h Migraine
h/erotonin agonistsh e, sumitriptan +( mg :O or A.( mg /K
h4arcotics V or Mh 7luster
h(() o%!genhntranasal lidocaine L
h4/&D/
hMigraine specifc therapies
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PROPHYLAXIS TREATMENT OPRIMARY HEADACHE
hTensionh 6eassuranceh &ntidepressant @
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OV36&88 &::6O&7H
-hief -om+laint/ Headache
Headache Alarms
vidence of serio"s headache disorder
by history or +hysical eam
iagnosis ofPrimary Headache Disorder
Work-up to identify/excsecondary headache et
Treat Primary Headache
2 3(
3( 2
-onsider 4or"+ for
secondary headache
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DIAGNOSTIC STUDIES
7omputeried tomograph!
Hemorrhage, tumor, abscess, &VM
8umbar puncture
Hemorrhage, inection, increased 7/E pressur
8imited indications or M6, M6&, or angiograph! 8aborator! studies based on suspected etiologies
3/6? temporal arteritis
7arbo%!hemoglobin? carbon mono%ide
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SUBARACHNOIDHEMORRHAGE
&ppro%imatel! +() o have Nsentinal bleedN
+() "ith Nsentinal bleedN "ill rebleed "ithin ;$A "0s
6ebleed
+() mortalit!
C +() o survivors have signifcant neurologic defc
Head 7T negative in $() o cases
/ensitivit! decreases "ith time rom onset o s%
8: i head 7T negative 1rbcGs 9 hrs, %anthochromia ;
&ngiograph! i postive 7T or 8:
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TEMPORAL ARTERITIS
6are beore age +( Temporal arter! tenderness, s"elling, redness, nodularit! Visual disturbance
Visual loss in *$A() i untreated Fa" claudication /!stemic s!mptoms
Eever, "t loss, anore%ia, malaise :ol!m!algia rheumatica 1pro% muscle pain
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OV36&88 &::6O&7H
-hief -om+laint/ Headache
Headache Alarms
vidence of serio"s headache disorder
by history or +hysical eam
iagnosis ofPrimary Headache Disorder
Work-up to identify/excsecondary headache et
Treat Primary Headache
2 3(
3( 2
-onsider 4or"+ for
secondary headache
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REFERENCES
J#M&6
73738
W3>/T3