headache
DESCRIPTION
Headache. HEADACHES. PRIMARY CARE MANAGEMENT. Headaches-overview. Primary headaches - Migraine -tension type -cluster headache/cephalgias -Others. Headache classification. Secondary headaches- Trauma Cranial/ cervical vascular disorder Substance or its withdrawl Infection - PowerPoint PPT PresentationTRANSCRIPT
Headache
HEADACHES
PRIMARY CARE MANAGEMENT
Headaches-overview
Primary headaches -Migraine -tension type -cluster headache/cephalgias -Others
Headache classification
Secondary headaches- Trauma Cranial/ cervical vascular disorder Substance or its withdrawl Infection Homeostasis related Neck , sinuses,eyes,nose, teeth Anxiety/somatisation
Headache classification
Neuralgias/other headaches Eg cranial neralgias, trigeminal neuralgia,
atypical facial pain
Headaches
Affect 40% of UK population Migraine- 15% of population. Females:males 3:1 Tension headaches- 80% of population Cluster headache 1 in 200
MIGRAINE
Migraine
Migraine management
Look at predisposing factors -stress,
fatigue,depression,anxiety,menstruation, menopause, head/neck trauma.
-trigger factors-dietary (20%), relaxation, travel, missing meals/sleep, bright lights, noise, strenuous exercise, mensruation.
Migraine
Duration (hours3 days) Without aura in 2/3rd -unilateral, pulsating,
moderate/severe intensity, aggravated by exercise, nausea/vomiting. Photophonophobia
With aura in 1/3rd- spreading scintillating scotoma, unilateral paraesthesia, dysphasia
Migraine-drug intervention
Step one- simple analgesic+/- antiemeticEg aspirin 600-900mg +buccastem 3-6mgbd
Step two – rectal analgesic +/- antiemeticEg diclofenac suppositaries+domperidone
suppositariesStep three – triptans-use at onset of pain, not
aura. Some rebound of symptoms in 20-50% of patients within 48 hours.
Triptans
Sumatriptan 50-100mg Zolmitriptan 2.5mg then rpt after 2 hours (not
children) Rizatriptan 10mg (equiv sumatriptan 100mg) Almotritan 12.5mg-HIGH EFFICACY. COST
EFFECTIVE
Migraine prophylaxis
Ineffective for medication overuse headaches Use for 4-6 months-taper off over 2-3 weeks. Agents: betablockers, TCAD, pizotifen,
gabapentin, lisinopril Other agents-topiramate, sodium valproate,
clonidine Non drug therapies
Tension headache
Tension headaches
Chronic tension type headache:-
-more than 15 days per month
- often daily
-often stress/lifestyle related
Tension headaches
Episodic tension-type headache-
-may be unilateral but tend to be generalised
- pressure/tightness
- often spreads from neck
-stress related or related to cervical/cranial musculoskeletal anomalies
Tension headache management Lifestyle changes Regular exercise Drug treatments-acute-aspirin 600-900mg,
ibuprofen 600mg, naproxen 250-500mg, paracetamol 500mg-1g
Prophylaxis-amitriptyline, nortriptyline, propranolol, SSRIs
Medication overuse headaches Affects 1 in 50 adults Females:males 5:1 First noted with phenacetin/ergotamine More common with aspirin/
NSAIDs/paracetamol/codeine/DF118 Can take several weeks to resolve after
medication withdrawl Key feature-pre-emptive use of analgesia
Medication overuse headaches-cont. Low doses daily carry larger risk than higher
doses weekly Esp common if using simple analgesia more
days than not per month Using triptans, codeine >10days per month Worse on awakening in the morning Worse after physical exertion
Medication withdrawl headache-treatment Stage one-abrupt withdrawl most effective-Sx
will worsen in days 3-7. Stage 2-recovery from MOH Stage 3- review and assess the underlying
primary headache disorder Stage 4- prevent relapse Failure to withdraw- naproxen
250mgtds/500mg bd, tcad.
References
Mentor/GP notebook BASH (British Association for the Study of
Headaches)-guidelines. www.bash.org.uk Neurological Differential diagnoses. Batten,
J. 2nd edition.