Cephalagia aka Chronic Headache..(part 2)

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*CHRONIC HEADACHE

👉Tension headache:
The usual cause of bilateral, non-pulsatile headache ± scalp muscle tenderness, but without vomiting or sensitivity to head movement. Stress relief, eg massage or antidepressants, may have more to offer than a neurologist.

👉 Raised intracranial pressure:
Typically worse on waking, lying down or bending forward, or with coughing. Also vomiting, papilloedema, fits, false localizing signs or behavioural change. Do imaging to exclude a space-occupying lesion, and consider idiopathic intracranial hypertension. LP is contraindicated until after imaging.

👉 Medication overuse headache:
Culprits are mixed analgesics, especially those containing paracetamol, codeine, opiates, ergotamine and triptans.
This is a common reason for episodic headache becoming chronic daily headache.
Analgesia must be withdrawn—aspirin or naproxen may mollify the rebound headache.
A preventive may help once other drugs withdrawn (eg tricyclics, valproate, gabapentin. Advise patients to use over-the-counter analgesia no more than 6 days per month.

* FREQUENCIES OF HEADACHE TYPES

Tension-type 45%

Migraine 30%

Referred <8%

Systemic infection 7%

With head trauma 3%

With drugs 2%

Miscellaneous 5%*

CVD, Metabolic diseases, intracranial diseases, cluster headaches, neuralgias

* RED FLAGS 🎌 SIGNS IN HEADACHE

👉 ELEVATED BP
👉NEUROLOGIC DEFICITS
👉 FEVER
👉 NECK STIFFNESS
👉 PAPPILOEDEMA
👉 CONVULSIONS
👉 ASSOCIATED WITH BLINDNESS/VASCULITIS

* INVESTIGATIONS FOR HEADACHES

👉 Neuroimaging
👉 Electroencephalography
👉 Angiography
👉 Serum biochemistry
👉 Arterial blood gases
👉 Serology
👉 Biopsy of blood vessels

References

👉 Oxford handbook of Clinical Medicine
👉 A Compendium of Clinical Medicine by A. O. Falase and O. O. Akinkugbe
👉 Prof. Mayowa O. O. slide on HEADACHE

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