Headache Hamad 141128044851 Conversion Gate01

7/21/2019 Headache Hamad 141128044851 Conversion Gate01

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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&ltitude 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


Headache Alarms



iagnosis of

Primary Headache Disorder

Work-up to identify/exc

secondary headache et


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


Headache Alarms



iagnosis ofPrimary Headache Disorder

Work-up to identify/excsecondary headache et


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


Headache Alarms



iagnosis ofPrimary Headache Disorder

Work-up to identify/excsecondary headache et


2 3(

3( 2

-onsider 4or"+ for

secondary headache


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REFERENCES

J#M&6

73738

W3>/T3

Documents

Headache Hamad 141128044851 Conversion Gate01