Sunday, February 4, 2018

Headache : Clinical Overview of Primary Headache Disorders

Primary headache disorders are poorly understood and the treatment isn't satisfactory. Hence it's super important to rule out Secondary causes before labelling a patient to have primary headache.
Here's a summary of clinical profiles of patients with Primary Headache disease.
Patient profiles for primary headache disorders
1. Migraine headache
Age : 30-40 years
Sex : Females >>> Males
Frequency : May be random, usually following a trigger.
Trigger : Subjective ; Lack / excess sleep , Menses , Starving , Chocolate for some people , Excess sunlight , oily food , etc.
Character : Throbbing / Pulsatile headache
Distribution : generally hemicranial to begin with but may Generalise over 1-2 hours.
Associated features
Preceded by an Aura - in the form of halos / fortification Spectra / floaters etc.
The attack is associated with Nausea, vomiting , photophobia and phonophobia.
Post Headache state : weakness after the headache subsides. Generally 4-48 h is the duration.
> 72 h = Status Migranosus.
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2 . Tension type headache
Age : 30-40 years
Sex : Females = Males
Frequency : May be random. Can occur daily.
Trigger :  unclear ; Stress or Tension may or may not be an established risk factor.
Character : constriction/ band like sensation around the head - Like a helmet.
Distribution : band like around the head. Fronto occipital region affected more than others.
Associated features
NO nausea vomiting ; may have photo and phonophobia. Not as rapidly progressive as migraine headaches.
Post Headache state : weakness not as severe as in migraine headache.
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3. Cluster headache
Age : 20-30 years
Sex : Females <<< Males
Frequency : Can occur daily - classically at the same time every day or at similar intervals during the day.
Trigger :  unclear ; alcohol , smoking , hot weather may precipitate
Character : Throbbing / can be sharp pain. May be sudden in onset. Very severe.
Distribution : always unilateral and involves Peri and retrorbital area.
Associated features
Ipsilateral miosis , conjunctival injection , chemosis , rhinorrhea , sweating over forehead.
Patient may become agitated and restless.
Post Headache state : weakness not as severe as in migraine headache.
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Hope this post actually helped and wasn't merely a headache ;)
Happy Treating !
Stay awesome !
~ A.P. Burkholderia

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