HEADACH: Really Headach To

Treat
Dr Sumit Dave
Consultant Neurosurgeon
Kshetrapal Hospital, Multispeciality and
Research Centre, Ajmer
• Primary
• Secondary
 Primary
International Headach Society Classification:
• Migraine.
• Tension Headach.
• Trigeminal Autonomic Cephalgia.
o Cluster Headach.
o Syndrome of Short Lasting Unilateral Neuralgiform
Headach with Conjunctival Injection and Tearing
(SUNCT).
o Chronic Paroxysmal Hemicrania.
o Episodic Paroxysmal Hemicrania.
 Secondary
• Head and neck trauma
• Brain tumours
• Vascular disorders
• Infections
• Substance abuse
• Homeostasis disorders
• Psychiatric disorders
• Cranial Neuralgia
 Migraine
• 5 attacks
• Each lasting 4-72 hours
• 2/4 characterstics-
o U/L location
o Pulsatile Character
o Moderate to severe Intensity
o Aggravation by routine physical activity

• 1/2 associated-
o Nausea or vomitting
o Photophobia or phonophobia
 Phase of Migraine
 Prodrome  Aura • U/L • Tired.
• Mood • Focal • Throbbing • Irritable.
change. symptoms . • Impaired
• Food < 60min. • Moderate concentra
craving. • Scotoma. to severe. tion.
• Yawning. • Scintillatin • Aggravate • Scalp
• Fatigue. g figures. d by tendernes
• Increased • Distortion physical s
urination. of objects. activity. • Mood
change.
 Headach
 Postdrom
e
Tension type Headach
• 10 episodes.
• 30 minutes to 7 days
• 2/4 characterstics-
o B/L location.
o Tightening character.
o Mild to moderate severity.
o Not aggravated by routine activity.
• No Nausea or Vomitting.
• No Photophobia or Phonophobia.
Cluster Headach
• 5 attacks
• Very severe. U/L orbital, supraorbital,
temporal pain.
• 15minutes – 3 hours.
• 1/6 character-
o I/L conjunctival injection or lacrimation.
o I/L nasal congestion & rhinorrea.
o I/L eyelid edema.
o I/L forehead and facial sweating.
o I/L miosis / ptosis.
• Agitation / restlessness.
• Frequency- alternate day to 8 episode per
day.
 Syndrome of Short Lasting Unilateral Neuralgiform Headach
with Conjunctival Injection and Tearing (SUNCT).

• 20 attacks
• U/L orbital, supraorbital, temporal(nose,
cheek, ear, palate)
• Stabing or pulsatile character
• 5 seconds to 4 minutes duration.
• I/L conjuntival injection and lacrimation.
• Frequency 3-200 per day
 Paroxysmal Hemicrania
• 20 attacks
• U/L orbital,supraorbital, temporal pain
• 2-30 minutes
• Severe
• 1/5 characters
I/L conjunctival injection / lacrimation
I/L nasal congesion / rhinorroea
I/L eyelid edema
I/L forehead and facial sweating
I/L miosis / ptosis
Frequency 75 per day
 Types of paroxysmal hemicrania
 Episodic  Chronic
• Above + • Above +
• 2 attacks period lasting • Attack recur over more
7-365 days than a year without
• Pain free period is less remission
than 1 month. • Pain free period is more
than 1 month.