Headaches (Cephalalgia)



Headaches (Cephalalgia)







  • Evaluation



    • General—pain affecting the head, although typically not confined to a particular nerve distribution


    • Classification



      • Common primary headache disorders



        • Tension-type headache


        • Migraine headache


        • Cluster headache


      • Secondary headache disorders



        • Vascular (e.g., subarachnoid hemorrhage, stroke, arteritis, arteriovenous [AV] malformation, etc.)


        • Intracranial (e.g., neoplasm, pseudotumor cerebri, infection, posttrauma, etc.)


        • Metabolic (e.g., hypoglycemia, hypoxia, hypercapnia, dialysis, etc.)


        • Myofascial (e.g., cervical spine disorders, etc.)


        • Sleep disorders (e.g., obstructive sleep apnea)


        • Substance use or withdrawal


    • Diagnostic algorithm



      • Initial task—rule out a potentially life-threatening etiology for the patient’s headache.



  • Common primary headaches and acute management



    • Tension-type headache



      • Clinical—bilateral, band-like pressure around the head with varying location and intensity



        • Attacks last 30 minutes to 7 days (sometimes months in extreme cases).


        • It is associated with tightness of the neck and shoulders.


        • There is no nausea, vomiting, aura, or photophobia.


      • Etiology—usually results from stress (emotional upset)



        • Associated with physical causes (muscle strain/tension of the neck and shoulders)


      • Treatment



        • Nonpharmacologic



          • Stress avoidance, stretching, relaxation exercises, physical therapy, and so on


        • Pharmacologic options for abortive therapy (i.e., acute treatment)





          • Nonsteroidal anti-inflammatory drugs (NSAIDS) (avoid in those with gastrointestinal [GI] or bleeding disorders)



            • Naproxen (Naprosyn) 250 to 500 mg PO BID


          • Muscle relaxants



            • Cyclobenzaprine (Flexeril) 5 to 10 mg PO TID.


            • Diazepam (Valium) 2 to 10 mg PO BID to QID


          • Combination analgesics



            • Midrin 325/100/65—take one to two capsules PO q6h. Midrin is composed of:



              • Acetaminophen 325 mg = Tylenol


              • Dichloralphenazone 100 mg—an anxiolytic


              • Isometheptene 65 mg—a sympathomimetic


            • Fioricet 325/50/40—take one to two tablets PO q8h. Fioricet is composed of:



              • Acetaminophen 325 mg = Tylenol


              • Butalbital 50 mg—a barbiturate (abusable agent)


              • Caffeine 40 mg—a stimulant


    • Migraine headache



      • Clinical—unilateral (or sometimes bilateral) pulsating headache lasting 4 to 72 hours



        • It is associated with nausea, vomiting, photophobia, and/or phonophobia.


        • Can be worsened by physical activity as mild as walking stairs.


        • Patients try to lie still in a dark room in order to get comfortable.


      • Mechanism—disturbance in serotonin activity in the central nervous system (CNS) with cerebral vascular dilation


      • Etiology—genetic


      • Epidemiology—3♀: 1♂ in adults; affects 10% of Americans


      • Precipitants—foods (e.g., chocolate), alcohol, stress, odors, exertion, hormonal changes, and so on


      • Classification



        • Migraine with aura (formerly classic migraine)



          • General—an aura is a short-lived (10-30 minutes) neurologic process.



            • Auras are usually visual (tunnel vision, scotoma, etc.)


        • Migraine without aura (formerly common migraine)



          • General—occur gradually or present on waking from sleep



      • Treatment

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Aug 28, 2016 | Posted by in PSYCHIATRY | Comments Off on Headaches (Cephalalgia)

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