Headache

Headache


Origin of headache: 
  1. Stimulation of peripheral nocioreceptors due to tissue injury
  2. Damage of pain producing pathways of peripheral or central nervous system. 
COMMON CAUSES of HEADACHE
Primary Headache         Secondary Headache  Tension-type                    Systemic infection
Migraine                            Head injury
Idiopathic stabbing        Vascular disorders
Exertions                          Subarachnoid Hemorrhage
Cluster                               Brain tumour

Pain producing cranial structures: Scalp, Middle meningeal artery, Dural sinuses, Falx cerebri, Proximal segments of large pial arteries. 

Headache is of two types: 

Primary Headache

Definition:Here, headache and it's associated features are disorder in itself(without any exogenous cause) . 

Structures involved
  • Large intracranial vessels and dura matter
  • Peripheral terminal of trigeminal nerve innervating these structures
  • Caudal portion of trigeminal nerve
  • Ventro posteromedial thalamus and cortex
  • Pain modualting system in brain

Types of primary headache

a) Migraine
b) Tension type
c) Cluster headache
d) Trigeminal Autonomic Cephalgia

Secondary Headache

Definition: It occurs due to some exogenous disorder(eg. Upper respiratory tract infection) 

Causes
  1. Meningitis-Acute and severe with stiff neck and fever
  2. Intracranial hemorrhage: Same as meningitis but fever absent
  3. Brain tumour
  4. Temporal arteritis
  5. Glaucoma
Clinical Evaluation of Acute ,New onset Headache

  • Consider-Meningitis, SAH, Epidural/Subdural Hematoma, Glaucoma, Tumour, Purulent sinusitis
  • Neurological examination  
  • Lumbar puncture
  • CT, MRI
  • Cranial artery palpitation
  • Evaluation of cervical spine by effect of passive movement of head
  • Investigation and imaging of CVS and renal system by BP monitoring and urine examination
  • Psychological state evaluation



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