1 / 21

Headache

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

petra-frost
Download Presentation

Headache

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Headache

  2. HEADACHES PRIMARY CARE MANAGEMENT

  3. Headaches-overview • Primary headaches • -Migraine • -tension type • -cluster headache/cephalgias • -Others

  4. Headache classification • Secondary headaches- • Trauma • Cranial/ cervical vascular disorder • Substance or its withdrawl • Infection • Homeostasis related • Neck , sinuses,eyes,nose, teeth • Anxiety/somatisation

  5. Headache classification • Neuralgias/other headaches • Eg cranial neralgias, trigeminal neuralgia, atypical facial pain

  6. Headaches • Affect 40% of UK population • Migraine- 15% of population. • Females:males 3:1 • Tension headaches- 80% of population • Cluster headache 1 in 200

  7. MIGRAINE

  8. Migraine

  9. 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.

  10. Migraine • Duration (hours3 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

  11. Migraine-drug intervention • Step one- simple analgesic+/- antiemetic Eg aspirin 600-900mg +buccastem 3-6mgbd Step two – rectal analgesic +/- antiemetic Eg diclofenac suppositaries+domperidone suppositaries Step three – triptans-use at onset of pain, not aura. Some rebound of symptoms in 20-50% of patients within 48 hours.

  12. 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

  13. 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

  14. Tension headache

  15. Tension headaches • Chronic tension type headache:- -more than 15 days per month - often daily -often stress/lifestyle related

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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.

  21. References • Mentor/GP notebook • BASH (British Association for the Study of Headaches)-guidelines. www.bash.org.uk • Neurological Differential diagnoses. Batten, J. 2nd edition.

More Related