Details Descriptions About :: Headache

 Headache, although usually benign, can be a serious and commonly disabling disorder. The International Headache Society (IHS) identified a comprehensive classification system that includes more than 100 types of headaches, which are divided into 13 categories. Various processes may cause headache, and they range from benign to life-threatening.

Causes for Headache

Causes Primary headaches are classified based on their symptom profiles and account for 90% to 98% of headaches. Primary headaches include migraines, tension-type, and cluster. Acute and progressive, secondary headaches are the result of an identifiable structural or physiologic cause, including: head trauma vascular disorders nonvascular intracranial disorders substance abuse and substance withdrawal infections metabolic disorders disorders of the face and neck cranial neuralgias.

Pathophysiology Headache

Pathophysiology Primary headaches occur when pain-sensitive structures of the head, including the cerebral vasculature, musculature, and cranial or cervical nerves, are irritated. Vascular changes occur as follows: Stimulation of the trigeminal ganglion located in the midbrain causes releases of substance P and calcitonin gene-related peptide (CGRP). The release of substance P causes degranulation of mast cells. Mast cells release histamine, and platelets release serotonin. Vasodilation, plasma extravasation, and inflammation occur. Inflammation and release of substance P cause distention of cranial arteries and headache pain. Triggers either directly act on the vasomotor tone or mediate the neurochemical release of vasoactive substances. Vasoconstriction, platelet changes, and neurochemical mediators initiate cerebral ischemia and activate the trigeminal-vascular system.

Signs and symptoms Headache

Signs and symptoms Migraine Commonly preceded by temporary focal neurologic signs known as auras (auras are usually visual—scotomata, zigzag, flashing lights and colors, geometric shapes, jagged lines.) Unilateral in onset but may become generalized Begins as a dull ache that progressively worsens and develops into throbbing, pulsating pain Commonly associated with photophobia, nausea and vomiting, phonophobia, and paresthesia Tension-type Gradual onset of bilateral bandlike pressure or tightening of mild to moderate intensity; usually doesn’t prohibit daily activities Not aggravated by physical activity or accompanied by associated symptoms; may have phonophobia or photophobia May be triggered by stress, fatigue, loud noises, heat, or bright lights Chronic form possibly resembles depression or fibromyalgia syndrome Cluster Acute onset of excruciating severe unilateral orbital pain lasting 15 to 180 minutes Episodic clusters; one every other day to eight per day; commonly nocturnal Accompanied by ipsilateral lacrimation, conjunctival injection, rhinorrhea, miosis, ptosis, and nasal congestion Clinical Tip The presence of one or more of these factors is an indication for further evaluation: first-onset headache that begins after age 50 sudden-onset headache accelerating pattern of headaches new-onset headache in a patient with cancer or human immunodeficiency virus headache with systemic illness (fever, stiff neck, or rash) presence of focal neurologic symptoms (not typical aura) papilledema.

Diagnostic Lab Test results

Diagnostic test results Skull X-rays identify skull fracture. Computed tomography scan shows tumor or subarachnoid hemorrhage or other intracranial pathology; reveals pathology of sinuses. Lumbar puncture shows increased intracranial pressure suggesting tumor, edema, or hemorrhage. EEG shows alterations in the brain’s electrical activity, suggesting intracranial lesion, head injury, meningitis, or encephalitis. Sinus X-rays show sinusitis.

Treatment for Headache

Treatment Avoidance of trigger mechanisms Over-the-counter analgesics or anti-inflammatory agents Analgesics or combination analgesics Vasoconstrictors, such as ergotamine tartrate and dihydroergotamine Serotonin agonists, such as sumatriptan, naratriptan, rizatriptan, and zolmitriptan Antiemetics Opioid analgesics Sedatives or tranquilizers Intranasal lidocaine Corticosteroids Lithium carbonate Preventive therapy with beta-adrenergic blockers, calcium antagonists, tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin antagonists, monoamine oxidase inhibitors, anticonvulsants, or nonsteroidal anti-inflammatories


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