Medical Archive

General principles

Anatomy and physiology of headache

Clinical evaluation of acute, new-onset headache

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Chronic daily headache
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P13 C422 Migraine and Other Primary Headache Disorders

Secondary headache

Meningitis

Intracranial hemorrhage

Brain tumor

Temporal arteritis

Glaucoma

Primary headache disorders

Chronic daily or near-daily headache (CDH)

Management of medically intractable disabling primary chronic daily headache

Medication-overuse headache

• Pathophysiology
  • Genetic predisposition + central pain sensitization + alteration of neuronal excitability and receptor downregulation.
  • Butalbital-containing products, acetaminophen, and opioids are the most commonly implicated drugs.
• Clinical presentation
  • Near-daily headache in the setting of regular use of acute headache medications.
  • Symptoms frequently mimic a migraine-type or tension-type headache.
  • Present upon awakening as well as symptom relief for only short periods, with quick rebound necessitating further medication use.
• Diagnosis
  • Symptoms present for ?3 months
  • Underlying headache disorder may worsen or develop an entirely new headache pattern.

New daily persistent headache (NDPH)

• Clinical presentation
• Secondary NDPH
  • Low CSF volume headache
  • Raised CSF pressure headache
    • Idiopathic intracranial hypertension (pseudotumor cerebri)
      • Risk factors: young obese women, tetracycline, obesity(BMI>30kg/m2), vitamin A, danazol
      • Clinical features
        • Headache, tinnitus, diplopia (d/t CN VI palsy)
        • Cushing reflex: hypertension, bradycardia, respiratory depression -> suggestive of brainstem compression.
      • Visual field: enlarged blind spot and peripheral constriction
      • Lumbar puncture: ?opening pressure, temporary headache relief.
      • Treatment: weight loss, acetazolamide(?CSF production)
      • Shunting or optic nerve sheath fenestration may be performed to prevent blindness.
  • Posttraumatic headache
  • Other causes
  • Treatment

Primary care and headache management