headache: when to see a physician morris levin, md section of neurology dartmouth medical school
TRANSCRIPT
Headache:Headache:
When to see a When to see a physicianphysician
Morris Levin, MDSection of NeurologyDartmouth Medical School
Head Pain - sourcesHead Pain - sources
MeningesBrain veins and arteriesPain nervesPeriosteumScalpScalp musclesScalp blood vesselsSinusesEyesEarsTeeth, TMJArteries of the neckNeck spine Neck muscles
IHS Classification - 2003 IHSIHS Classification - 2003 IHSPrimary HA
1. Migraine2. Tension-type3. Cluster4. Exertional
Secondary HA5. Post-traumatic6. Blood vessel disease7. Brain tumor 8. Substances9. Infection10. Medical problems11. Neck, Eyes, SInuses12. Psychiatric 13. Neuralgias
Primary HeadachesPrimary Headaches
MigraineMigraine
– severe, one-sided,severe, one-sided,
– nauseanausea
Tension-TypeTension-Type
– milder, more diffuse, milder, more diffuse,
– no nausea
ClusterCluster
– brief, around the eye, brief, around the eye,
– occurs in cyclesoccurs in cycles
Warning Signs in Headache Warning Signs in Headache
Sudden Sudden Brought on by exertion Brought on by exertion New kind of headache, or change in pattern New kind of headache, or change in pattern Onset in middle age or laterOnset in middle age or later FeverFever Change in behavior or thinkingChange in behavior or thinking Changes in sensation, strengthChanges in sensation, strength Setting of systemic disease - eg Cancer, AIDSSetting of systemic disease - eg Cancer, AIDS
Medical Evaluation of Medical Evaluation of HeadachesHeadaches
History of the HA problemHistory of the HA problem
General medical historyGeneral medical history
General examination General examination
Diagnostic testingDiagnostic testing
Medical EvaluationMedical Evaluation
History
– Where, WhenWhere, When– What Triggers, what helpsWhat Triggers, what helps– What other symptomsWhat other symptoms– Family historyFamily history– Medical problems and Medical problems and
medicationsmedications
Medical EvaluationMedical Evaluation
Examination Examination
– Head and NeckHead and Neck– General examGeneral exam– Neurological examNeurological exam
Mental functionMental function
VisionVision
Motor functionMotor function
SensationSensation
CoordinationCoordination
Options:
Blood tests
X-rays
MRI, CT
Lumbar Puncture
TestingTesting
Medical EvaluationMedical Evaluation
MRI
Brain Tumors and HABrain Tumors and HA
50% of Brain neoplasms present with HA50% of Brain neoplasms present with HA
< .1% of HA sufferers have brain neoplasm< .1% of HA sufferers have brain neoplasm
Vascular problemsVascular problemsArteriovenous malformation aneurysm
InfectionsInfections
Brain abscess Cysticercosis
IHS Classification - 2003 IHSIHS Classification - 2003 IHS
Primary HA1. Migraine2. Tension-type3. Cluster4. Exertional
Secondary HA5. Post-traumatic6. Blood vessel disease7. Brain tumor 8. Substances9. Infection10. Medical problems11. Neck, Eyes, SInuses12. Psychiatric 13. Neuralgias
However –
Recurring headaches are usually primary (migraine or tension-type headache)
Headache - Headache - When to see a PhysicianWhen to see a Physician
ConclusionsConclusions
Headache can be a warning sign Headache can be a warning sign
of serious illnessof serious illness
Most correctable causes of Most correctable causes of
headache can be found headache can be found
Most headache problems are due Most headache problems are due
to “primary headache”to “primary headache”