Headache

Headache
Dr/ Ghada mahmoud alghazaly

Lecture ILOs/ Objectives:
By the end of this lecture the student will be able to:
• To know the definition of headache
• To know the causes of headache
• To know the clinical presentation of a case of headache
• To be able to choose the correct investigations to diagnose a
case of headache
• To be able to differentiate between different causes of headache
• To be able to put a plain for the management of a case of
headache
Male patient presented by headache,
weakness of the lt side, his medical history is
hypertension and diabetes, the cause may be:
1. Intracranial hg
2. Infection
3. Migraine headache
4. Glaucoma
What is Headache
Pain in the head, neck or both

Types of Headaches
Primary:
Primary headaches have no underlying
organic disease
Secondary: there is underlying organic

disease
2ry headache
1. Hangover
2. Sinus infection
3. “Brain freeze,” also known as an ice cream
headache
4. Insomnia
5. Dehydration
2ry headache
1. Brain aneurysm
2. Brain tumor
3. Severe hypertension
4. Pain medication overuse
5. Sinusitis
6. Bacterial or viral meningitis
2ry headache
1. Neck or brain injury
2. Brain infection, such as encephalitis
3. Hydrocephalus
4. Problems with blood vessels
5. Stroke
6. Anxiety attacks
7. Depression
Primary Headaches
Primary headaches have no underlying

organic disease
Include migraine with aura, migraine
without aura, tension headaches and cluster
headaches.
Cluster Headaches
 These headaches occur in “clusters,” with

one to eight daily attacks lasting 15 to 90
minutes for a period of 4 to 6 weeks.
 These episodes are then followed by
pain-free intervals lasting 3 to 6 months
or more.
 Cluster headaches are more common in
men (8:1)
Cluster Headaches
 Severe, unilateral, localized to the

periorbital/temporal area
 Usually accompanied by one of:
lacrimation, rhinorrhea, ptosis,
miosis, nasal congestion, and eyelid
edema.
Tension Headaches
Bilateral mild-to-moderate
Occipital-frontal areas.
 Dull or band like, lasts for hours
 Associated with stress.
Do not awaken patients from sleep not
generally associated with vomiting or
neurologic symptoms.
Migraine Headaches
Start between the ages of 15 and 45 years, with

a 3:1 female predominance.
At least two of the following four headache
characteristics for diagnosis: unilateral
location, pulsatile quality, moderate-to-severe
intensity, or aggravation by movement.
Migraine Headaches
They must also be associated with one of the

following symptoms: nausea, vomiting, or
photo- or phonophobia.
Triggers: irregular sleep, hunger, alcohol,
certain foods, humidity, and emotional stress.
Migraines last between 4 and 72 hours and may
be accompanied by an aura.
Migraine Headaches
Migraines without aura, formerly termed

common migraines, are the most common
form of migraine.
 Migraines with aura, formerly termed classic
migraines, are less common.
 A family history of migraine is present in over
80%
Migraine Headaches
 Auras include flashing lights, shimmering lines,
and blind spots. Some individuals may
experience paresthesias, numbness, strange
odors, and speech disturbances.
Aura symptoms gradually develop over more
than 4 minutes and last up to 60 minutes, with
headache either following or accompanying the
aura within 60 minutes.
Analgesic Headaches
 Chronic use analgesic or anti migraine

drugs, especially those that contain
caffeine.
 Daily use of low-dose analgesics
 Analgesics are discontinued, improves
after a few weeks.
Causes of 2ry Headache
Subarachnoid hemorrhage (SAH)

Intracranial mass
Posttraumatic
Infection as encephalitis & meningitis
Glaucoma and defect in vision
Sinus disease
Diagnosis of Headache
History
Examination: general & neurological
Investigations: ESR, lumbar puncture,
fundus examination & imaging
History
 Unilateral vs. bilateral
 Severity
Quality (throbbing, squeezing)
Duration
Frequency
Associated neurologic symptoms
Aggravating or alleviating factors (foods, rest,
menstruation, OTC medications)
History
Associated symptoms (nausea, emesis, fever,
visual changes).
Other relevant information includes caffeine
intake, since caffeine withdrawal
Foods such as chocolate, alcohol, nuts, and
aged cheese may trigger migraines.
Reviewing medications is important because a
number of drugs such as indomethacin,
nifedipine, cimetidine, captopril, nitrates, and
oral contraceptives can trigger headaches.
Diagnosis of Headache
Examination: general & neurological

Investigations: ESR, lumbar puncture,
fundus examination & imaging as CT,
MRI brain
Indications of neuroimaging
 Headache of recent onset (<6 months)
 Headache beginning after 50 years of age
 Worsening headaches
 Headache that does not fit primary headache pattern
 Associated seizure
 Focal neurologic signs or symptoms
 Personality change
 Severe headaches unresponsive to therapy
 History of significant trauma
 New headache in a cancer patient
Management of Headache
According to the cause

MCQ
Male patient presented by headache,

weakness of the lt side, his medical history is
hypertension and diabetes, the cause may be:
1. Intracranial hg
2. Infection
3. Migraine headache
4. Glaucoma
MCQ
Which causes headache with neck rigidity, fever

and altered mental status?
A. Meningitis
B. Subarachnoid hemorrhage
C. Migraine
D. Brain abscess
Good Luck & Thank
You

Headache

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Headache

Dr/ Ghada mahmoud alghazaly

Pain in the head, neck or both

Secondary: there is underlying organic

Primary headaches have no underlying

 These headaches occur in “clusters,” with

 Severe, unilateral, localized to the

Start between the ages of 15 and 45 years, with

They must also be associated with one of the

Migraines without aura, formerly termed

 Chronic use analgesic or anti migraine

Subarachnoid hemorrhage (SAH)

Examination: general & neurological

According to the cause

Male patient presented by headache,

Which causes headache with neck rigidity, fever

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