Headache Headache is not a disease state or a condition.

Classification of headache:-Headache classify into three types.

Cluster headache Tension headache Migraine headache

Headache may be symptomatic (primary headache) or asymptomatic (secondary headache). In community pharmacy the overwhelming majority of the patients (80-90%) will present with tension headache.1*Tension headache:- Etiology: - The mechanisms that bring about headache are still poorly understood. Tension headaches commonly referred to as muscle contraction headache, as electromyography has shown potential muscle contraction, which is also exacerbated by stress.In tension headache the pain is bifrontal or bioccipital, generalized and non- throbbing the patient may describe the pain as tightness. Pain is normally mild to moderate and not aggravated by movement, although it is often worse under pressure or stress. The pain is gradual in onset and ten to worsen progressively through the day.Types:-Two types,

(a) Acute tension headache: - It occurs when the patient experiences the head for less then15 days per month.

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(b) Chronic tension headache: - Head occur for more then 15 days per month and last for more then 6 month. 2*Migraine headache: -Migraine has three phases,

(i) Asymptomatic phase (phase 1) → show no symptoms. (ii) Prodromal phase (phase 2) →visual disturbance actual headache start.(iii) Headache phase (phase 3) →pain nausea and vomiting Migraine headache has basically two types. (a) Migraine with aura (b) Migraine without aura

(a) Migraine with aura: - (classic migraine) This account for less then 25% patient of migraine cases. The aura develops 5 to 20 min and can last for up to 1hr.Symptoms:-Visual auras

Scotomas (blind spots) Fortification spectra (zig-zag lines) or flashing and

flickering light. Neurological auras

Pines and needles typically start in hand, migrating up to arm before jumping to the face and lips.

Nausea, vomiting Photophobia Phonophobia

Nature of pain: -pain is unilateral, throbbing and moderate to sever. Some time the pain become generalized and diffuse. Physical activity may intensify the pain.

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(b)Migraine without aura: - (common migraine) The remaining suffers 75 % do not experience an aura but do suffer from all other symptoms as describe above.

3*Cluster headache: - Cluster headache is predominant condition that affects the men aged b/w 40 and 60. typically the headache occur at the same time each day and last b/w 10min and 3 h, 50% patient experiencing night time symptoms. Patient are woke 2 to 3h after falling sleep with steady intense unilateral orbital, boring pain.It may be characterized by period of acute attack, lasting a number of weeks to a few months. Alcohol may trigger the attack. Symptoms:-

Conjunctivitis Nasal congestion

Drugs used for the treatment of migraine:-1.Migraleve (paracetamol codeine) 2. Midrid (Isometheptene mucate)3. Buccastem M (prochlorperazine)

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Medicine Use in children

Side effects

Drug interaction

Patient in whom care should be exercised

Pregnancy

Migraleve >10years Dry mouth, constipation & sedation

↑es sedation with alcohol, opioid analgesics, anxiolytics, hypnotics and antidepressant

Glaucoma , prostate enlargement

Avoid in third trimester

Midrid >12years Dizziness , rash

Avoid with the MAOIs , Beta-blockers & TCAs

Hypertension , diabetic

Avoid

Buccastem M

>18 years Drowsiness

↑es sedation with alcohol, opioid analgesics, anxiolytics, hypnotics and antidepressant

Patient with Parkinson's disease, Epilepsy and Glaucoma

ok

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