Module 9 Part 3: Primary Headache Disorders, Part 2

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En provenance du cours de University of California, San Francisco

Introduction to Clinical Neurology

444 notes

University of California, San Francisco

Introduction to Clinical Neurology

444 notes

An overview of the relevant aspects of the epidemiology, clinical presentation, basic disease mechanisms, diagnostic approaches and treatment options of the most common neurological diseases.

À partir de la leçon

Headache & Backpain

The description goes here

Module 9 Part 1: Introduction5:48

Module 9 Part 2: Primary Headache Disorders, Part 117:30

Module 9 Part 3: Primary Headache Disorders, Part 26:13

Module 9 Part 4: Primary Headache Disorders, Part 33:54

Rencontrer les enseignants

Daniel Lowenstein, MD
Professor and Vice Chair, Department of Neurology
School of Medicine
S. Andrew Josephson, MD
Associate Professor
School of Medicine
Wade Smith, MD
Professor
School of Medicine

[BLANK_AUDIO]

>> Now I want to briefly mention tension-type headache

because this is this is arguably the most

common type of headache that's say, not associated

with having the flu or some other similar disorder.

and, and again, many of you can probably relate to this type of headache.

This is taken again from the International Headache Society criteria.

Tension type headaches are defined as headaches that are lasting from

30 minutes to 7 days, they can be episodic or chronic.

They have to have at least 3 of the

follow a bilateral as opposed to unilateral in migraine.

Pressing or tightening non-pulsating quality

compared to pulsating and migraine.

Mild or moderate intensity rather than moderate or severe

intensity migraine and not aggravated by routine physical activity.

So you can see that these

are components that just fall shy of the

kinds of symptoms that we described before in migraine.

Also, no nausea, vomiting, photophobia or

phonophobia and not attributed to another disorder.

Again incredibly common, and the treatment, these are treatments that

actually most people are able to figure out fairly easily.

Stress management, counseling again simple medications, such as

aspirin and non-steroidals.

Bio feedback has sometimes been shown to be effective.

And for the more severe and chronic types of

tension type of headaches, anti-depressant or anxiolytics can be useful.

So Mister Hackett can you tell me why you came into the hospital.

I'm experiencing headaches, and for like for the

past 3-4,5 days, you know, straight in a row.

>> Mm hm.

>> You know they come at the same time and it's kind of making it worse.

[UNKNOWN].

>> [INAUDIBLE] They come in every day, you know?

>> What, what time do they come on? >> Around

10:30, 10:35 they come around and they stay around for about an hour.

>> Mm-hm.

>> You know? >> Are they pretty severe?

>> Yeah very much so. >> Uh-huh.

Where, where's the pain?

>> The pain starts like up here and, and works you know, right this

way like this, and just shoots up like on this side of my face.

>> Mm-hm.

That's it.

>> Does anything happen to your eye or your face?

>> Yes.

My eye turns red and it, and it feels like it's going to fall out of face,

out of my head, you know. It's awful.

It's, you get this tears and everything else.

>> Mm-hm. Does it occur during the day time at all?

>> No. >> Uh-huh.

So over the last 5 days, you've had these

headaches pop up everyday, the same time, only at night?

>> At night. That's right.

>> Uh-huh.

>> Have you had, have you ever had a headache like this before?

>> Yes.

I have before. >> Oh.

So are these new headaches or old headaches?

>> These are old headaches.

>> Old headaches.

And, and why, why do you mean? When did

you have them last? >> Well last was was November.

>> Mm-hm.

>> And then it's going all the way back to like 1972.

>> Oh really, what happened in November?

>> November the the [INAUDIBLE] arrived there around 9, it

was about 9:39, 40, something like that, they came on.

They woke me up out of my sleep and then

they just, just just took me up to this peak.

>> Mm-hm.

And how many days did it occur in November?

>> 3 days. >> Uh-huh.

And so when you say these have happened before, did they always seem to

come together in groups of a couple nights and then you're free for awhile?

>> Yeah.

>> And how, how much, how long might it be that you're free from a headache?

>> Maybe a month. Maybe maybe a month, maybe less.

>> Mm-hm.

>> It's maybe a month, maybe I think 2 months.

>> I see, okay.

And have you noticed anything that makes it better?

>> yeah.

Well, nothing really makes it better, but you know like, I can easily.

I've, I've, I've taken the [INAUDIBLE].

>> Mm-hm. >> And, and it eases, eases the pain.

It doesn't take it away. >> Mm-hm.

>> But.

[BLANK_AUDIO]

>> Well I don't think you'll find a

better description of the experience of having cluster headaches.

This, this gentleman really provided you with all the, the the

classic symptoms that usually occurs in men ages 20 to 50.

It's characterized by unilateral periorbital pain, this kind

of like ice pick behind the orbit pain.

It has this remarkable circadian rhythmicity.

This patient's

headaches were occurring between about 10:30 and 10:35 at night,

every night while the headaches occurred lasting about an hour.

They oftentimes have autonomic symptoms or redness

or tearing of the eyes on one-side.

They can be quite sensitive to alcohol and the reason they're named cluster headaches

is because the attacks cluster over time and this is depicted here in

again our cartoon of the time course of headaches.

A cluster headache fairly abrupt onset usually at the same time of night or day

and the headache usually last only the, only an, an hour or a couple of hours.

And importantly, if you look at it over

the larger time scale, these individual daily circadian

headaches come in clusters of, of 3, 4, 5 or 6 over the course of a number of days

and then there's this delayed period, sometimes many, many weeks

or even months before another cluster appears and so forth.

[SOUND]

The treatment of cluster headache again as in all

these cases, I'm not going to go into any detail.

I just want

to have you appreciate the various approaches that can be used.

The Triptan drugs can be useful.

Prednisone during that short period of time

when the patient knows that they're at

risk of having successive headaches as part of the cluster, can be very useful.

Calcium channel blockers, Ergots, oxygen therapy often times at night

Lidocaine and Lithium have all proven to be quite effective in selected patients.

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