A Headache or cephalgia is pain anywhere in the region of the head and neck. It can be a symptom of the different conditions of head and neck.
PRIMARY HEADACHE DISORDERS
(FREQUENCY MORE THAN 15 DAYS /MONTH)
(FREQUENCY LESS THAN 15 DAYS /MONTH
1-SHORT DURATION CHRONIC 2- CHRONIC DAILY HEADACHE
DAILY HEADACHE (daily or near daily headache lasting more
(Duration less han 4 hrs or than 4 hrs
multiple Discrete episode)
CHRONIC CHRONIC TENSION TYPE NEW DAILY HEMICRANIA
MIGRANE HEADACHE PERSISTENT CONTINUA
Chronic tension headache and migraine are two commonest headache seen in clinical practice.
1-PRE MONITORY PHASE
- Experienced by 50 percent of pts .
Causes irritability, depression, tiredness, food cravings, unusual bursts of energy.
–LAST 10-30 MTS
Can affect vision on 1 side; blank patches , bright or flushing lights or colored zigzag lines
-possibly sensory symptoms; pins and needles , numbness
-difficulty in speaking or finding right words.
-can last from 4hrs to 2-3 days
-severe one sided headache, most commonly at the front or in the temple but can occur both
sides of head or anywhere.
-throbbing or bounding headache which is made worse by movement.
-often accompanied by nausea, vomiting may seem to relieve the headache.
-pt may want to avoid light and nosy situations, preferring to be alone in the dark.
-headache fades but may leave the pt feeling tired, irritable, depressed with difficulty in
Simplified diagnostic method for migraine
Symptoms associated with your headache
• Usually one-sided
• Moderate or severe pain
• Throbbing pain
• Pain aggravated by routine activity
• Nausea or vomiting
Aversion to light or so Migraine peaks during the most productive
If you checked 3 or more of the YES boxes, you have several of the diagnostic criteria for migraine. You should talk to your doctor about diagnosing and treating your headaches
COUNSELLING ON POTENTIAL TRIGGERS
-certain foods in some people and alcohol but more commonly
delayed, missed, or inadequqte meals, caffeine withdrawl, dehydration.
-lack of sleep or excessive sleep
-intense exercise, long distance travel across time zones.
-bright or flickering lights, strong smells, and weather changes.
emotional distress or relaxation after a stress full period.
- changes in female hormones (in women)that cause
menstruation as well as breaks in hormonal contraception or hormone
diary to be maintained.
1-Exact cause is unknown
2-A failure of normal sensory functioning or sterile neurogenic inflammation has been
suggested as a cause
Neurons in the brain
are activated by a mechanism
not well understood
This, in turn,
causes a cascade of secondary
events leading to:
– Release of inflammatory substances surrounding the blood vessels of the brain
– Inflammation of the blood vessels and the surrounding tissue on the outside of the brain
– Pain pathways are activated
MEDICATION OVERUSE HEADACHE
Most commonly associated with regular use of simple analgesics on more than 15 days a month
and or regular use of opoids ,ergots ,or triptans or any combination of these more than 10 days
WHAT SHOULD YOU TELL YOUR DOCTOR ABOUT MIGRANE ATTACKS?
• How long have you had headaches? How frequent? How disabling?
– When did they start?
• What happens when you have a headache?
– Describe the pain and other symptoms
• Who else in your immediate family gets headaches?
– Any type of headache (migraine, tension or sinus)
• What might cause you to get a headache
– Alcohol, too little sleep, stress, missed meals
What kinds of treatments will help?
– Taken when a migraine is experienced like sumatriptan, rizatriptan, Zolitryptan in nasa spray form
– Treats pain and other symptoms after the attack has begun
– Certain preventive medications are effective and to be taken on a daily basis for few months
– Reduces the frequency and intensity of attacks.
– Inj BOTULINIUM TOXIN is beneficial when headache is refractory to medications.
• Behavioral approaches
– Limit caffeine and other triggers
– Reduce stress
– Regular sleep
– Counseling or psychotherapy
– Biofeedback / relaxation
– Eat regularly / don’t skip meals
So which specific food triggers have been shown to be the culprits and therefore should be avoided:
· Tyramine containing foods found natu.rally in aged cheeses, and also found in red wine, alcoholic drinks, and some processed meats.
· Food additives/preservatives like nitrates and nitrites found in hot dogs, ham, sausage, and other processed or cured meats.
· Monosodium glutamate (MSG) in Chinese food.
· Alcohol — specifically the impurities in alcohol or by-products your body produces as it metabolizes alcohol. Culprits include red wine, beer, whiskey and champagne
· Caffeine: coffee, chocolate, tea, colas, sodas
· Pepperoni, hot dogs, luncheon meats
· Bread and other baked goods and crackers
· Dried fruits
· Smoked or dried fish
· Potato chips
· Pizza, peanuts, peanut butter
· chicken livers, and other specific foods and
Likewise for my diabetics…artificial sweeteners like aspartamecan be bad triggers of headaches. Also to be avoided are anyCOLD beverages especially after an exercise. Sensitivity to ice cream has been reported among migraine sufferers so avoid the temptation!
Trigger Free To Be Migraine Free!
SCORE (0-10) 0-2 mild 3-6 moderate 7-10 severe pain
DR. PUNEET AGARWAL
M.D, D.M(Neurology), FCCN(UCLA,USA)
Ex Asst. Prof Neurology, AIIMS, N.Delhi
HEAD OF NEUROLOGY
Max Superspeciality Hospital
Ph: 011-66116666(O), 9971545666(m),