Characteristics
Duration
Fequency
Mechanism
Treatment
Tension
 
Tight band feeling, stress, low mood
 -Diffuse, ache,dull
– Worse on touching scalp, agg by noise
-Associated with tension
Depression may co- exist
– Hours – days
Worse towards end of the day
– Chronic /
Episodic
– Infrequent – daily
Muscular due to persistent contraction
e.g. cleching teeth, head posture, furrowing brow
Reassurence
↓ psychological stress and analgesic over use
Antidepressants
β – blockers
Migrane
 
Vomiting, sensitive to light/noise/movement, pre-migraine aura
With or without aura
– onset childhood – early adult life – menopause
– unilateral throbbing headache
Exacerbated by movement.
Ass symp: nausea, vommiting, photo -, phono-, and osmophobia
– 2- 48hrs
– Recurrent
– Twice weekly
Vascular and neuronal processes probably co-exist with changes in serotonin activity initiating attacks.
Avoid precipitating factors
Prophylaxis: for severe /frequent attacks 5HT2 receptor blocker, β adrenergic receptor blocker
Cluster
 
Episodes of night pain, usually in one eye, lasting around 8 weeks, inbetween periods of no symptoms
Severe unilateral pain around one eye
+/- temporal pain
Ass symp:
– ipsilateral conjuctival infection
– lacrimation
– rhinorrhea / blockage
– transient horners syndrome
– 10mins -2hrs
– Once – twice daily
– wakes from sleep
– attacks from weeks – months
Serum histamine levels rise during attacks – ‘histamine cephalgia’
Prednisolone
Methysergide
Ca 2+ channel blockers
Lithium carbonate
Temporal arteritis
 
Tender scalp, >50, threat to vision
– Severe throbbing
– Overlies involved vessel
(thus tender), non pulsitile
– Ass symp: strokes, hearing loss, myelopathy and neuropathy
– Jaw claudication (pain on chewing / talking)
– Visual (blindness / diplopia)
Urgent tx required as soon as dx!
Urgent tx required as soon as dx!
Autoimmune condition of unknown origin
Large and medium-sized arteries undergo intense ‘giant-cell’ infiltration, with fragmentation of the lamina and narrowing of the lumen, resulting in distal ischaemia as well as stimulating pain sensitive fibres.
Prednisolone
Raised intercranial pressure
 
Worse on waking, increase BP, decreased pulse
– generalised
– aggravated by bending or coughing
– worse in the morning on awkening, may wake patient from sleep
-severity gradually progresses
Ass symp: vommiting, transient loss of vison, eventual imparement of concious level
CT
MRI
Low pressure headache
 
– posturally dependant (worse when erect eased on laying down)
– MRI shows characteristic displacement of midline structures e.g. cerebellar tonsils, meningeal enhancement with contrast Gd and elevated CSF protien
– spontaneous intracranial hypotension, postlumbar puncture, after obvious or occult CSF leak
Spontaneous improvement is usual
 
Provide with fluids
 
– instantaneous onset
– severe pain spreading over the vertex to the occiput
– patient may drop to knees or loose conciousness
Ass symp: vomminting, focal neurological signs haemotoma
CT

 

 

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