Headache
Headache is defined as the symptom of pain in the cranial region. It may be an isolated benign occurrence or manifestation of a wide variety of headache disorders.[1]
Classification
Primary headaches
Primary headaches are defined as "conditions in which the primary symptom is headache and the headache cannot be attributed to any known causes."[1]
Migraine headache
- Criteria
Diagnostic criteria developed by the International Headache Society are:[2]
Migraine without aura:
A. At least 5 attacks fulfilling criteria B-D
B. Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)
C. Headache has at least two of the following characteristics:
- unilateral location
- pulsating quality
- moderate or severe pain intensity
- aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs)
D. During headache at least one of the following:
- nausea and/or vomiting
- photophobia and phonophobia
E. Not attributed to another disorder
Tension headache
Cluster headache
- Criteria
Diagnostic criteria developed by the International Headache Society are:[3]
A. At least 5 attacks fulfilling criteria B-D
B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes if untreated1
C. Headache is accompanied by at least one of the following:
- ipsilateral conjunctival injection and/or lacrimation
- ipsilateral nasal congestion and/or rhinorrhoea
- ipsilateral eyelid oedema
- ipsilateral forehead and facial sweating
- ipsilateral miosis and/or ptosis
- a sense of restlessness or agitation
D. Attacks have a frequency from one every other day to 8 per day
E. Not attributed to another disorder
Secondary headache
Secondary headaches are defined as "conditions with headache symptom that can be attributed to a variety of causes including brain vascular disorders; wounds and injuries; infection; drug use or its withdrawal."[1]
The role of overuse of medications for treating migraine (triptans, analgesics, ergots) and their withdrawal as a cause of headache is controversial.[4]
Diagnosis
X-ray computed tomography (CT Scan) should be considered if one of the following is present:[5]
- cluster-type headache
- abnormal findings on neurologic examination
- undefined headache (ie, not cluster, migraine, or tension-type)
- headache with aura
- headache aggravated by exertion or a valsalva-like maneuver
- headache with vomiting
CT scan should also be considered in the following settings:
- Acute thunderclap headache. Prevalence of significant pathology is 40%[5]
- New-onset or change in chronic headaches. Prevalence of significant pathology is 32%.[5] This compares to a prevalence of significant pathology of 1% for patients with chronic headaches referred to a neurologist.[6] Presumably the prevalence would be lower in primary care.
- Patients with human immunodeficiency virus. This is based on a clinical practice guideline.[7]
Treatment
Prochlorperazine is better than promethazine in relieving nonspecific, benign headaches according to a randomized controlled trial.[8]
Migraine headache
Tension headache
Prognosis
Most chronic headaches are tension-type headache, although migraine may coexist.[9] Almost half have medication overuse.[9]
References
- ↑ 1.0 1.1 1.2 National Library of Medicine. Headache. Retrieved on 2007-12-11. Cite error: Invalid
<ref>tag; name "title" defined multiple times with different content Cite error: Invalid<ref>tag; name "title" defined multiple times with different content - ↑ International Headache Society. Migraine headache
- ↑ International Headache Society. Cluster headache
- ↑ Bøe MG, Mygland A, Salvesen R (2007). "Prednisolone does not reduce withdrawal headache: a randomized, double-blind study". Neurology 69 (1): 26–31. DOI:10.1212/01.wnl.0000263652.46222.e8. PMID 17475943. Research Blogging.
- ↑ 5.0 5.1 5.2 Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM (2006). "Does this patient with headache have a migraine or need neuroimaging?". JAMA 296 (10): 1274–83. DOI:10.1001/jama.296.10.1274. PMID 16968852. Research Blogging.
- ↑ Sempere AP, Porta-Etessam J, Medrano V, et al (2005). "Neuroimaging in the evaluation of patients with non-acute headache". Cephalalgia 25 (1): 30–5. DOI:10.1111/j.1468-2982.2004.00798.x. PMID 15606567. Research Blogging.
- ↑ (2002) "Clinical policy: critical issues in the evaluation and management of patients presenting to the emergency department with acute headache". Ann Emerg Med 39 (1): 108–22. PMID 11782746. [e]
- ↑ Callan JE, Kostic MA, Bachrach EA, Rieg TS (October 2008). "Prochlorperazine vs. promethazine for headache treatment in the emergency department: a randomized controlled trial". J Emerg Med 35 (3): 247–53. DOI:10.1016/j.jemermed.2007.09.047. PMID 18534808. Research Blogging.
- ↑ 9.0 9.1 Grande RB, Aaseth K, Saltyte Benth J, Gulbrandsen P, Russell MB, Lundqvist C (July 2009). "The Severity of Dependence Scale detects people with medication overuse: the Akershus study of chronic headache". J. Neurol. Neurosurg. Psychiatr. 80 (7): 784–9. DOI:10.1136/jnnp.2008.168864. PMID 19279030. Research Blogging.