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Characteristics
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Duration
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Fequency
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Mechanism
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Treatment
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|
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Tension
Tight band feeling, stress, low mood
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-Diffuse, ache,dull
– Worse on touching scalp, agg by noise
-Associated with tension
– Depression may co- exist
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– Hours – days
Worse towards end of the day
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– Chronic /
Episodic
– Infrequent – daily
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Muscular due to persistent contraction
e.g. cleching teeth, head posture, furrowing brow
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Reassurence
↓ psychological stress and analgesic over use
Antidepressants
β – blockers
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|
Migrane
Vomiting, sensitive to light/noise/movement, pre-migraine aura
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With or without aura
– onset childhood – early adult life – menopause
– unilateral throbbing headache
Exacerbated by movement.
Ass symp: nausea, vommiting, photo -, phono-, and osmophobia
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– 2- 48hrs
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– Recurrent
– Twice weekly
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Vascular and neuronal processes probably co-exist with changes in serotonin activity initiating attacks.
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Avoid precipitating factors
Prophylaxis: for severe /frequent attacks 5HT2 receptor blocker, β adrenergic receptor blocker
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Cluster
Episodes of night pain, usually in one eye, lasting around 8 weeks, inbetween periods of no symptoms
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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
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Serum histamine levels rise during attacks – ‘histamine cephalgia’
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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)
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Urgent tx required as soon as dx!
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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.
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Prednisolone
|
|
Raised intercranial pressure
Worse on waking, increase BP, decreased pulse
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– 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
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CT
MRI
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|||
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Low pressure headache
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– 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
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– spontaneous intracranial hypotension, postlumbar puncture, after obvious or occult CSF leak
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Spontaneous improvement is usual
Provide with fluids
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||
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amnesia, impaired consciousness
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– 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
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CT
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