What is headache? | what is headache caused by

The pain in the head is called a headache

Headache | Causes | Treatment

Headache Overview

we're going to look at headaches the main types of headaches and then treatment as well so headaches can be divided into two main types we have primary headaches, and we have secondary headaches that are pretty bad.

so is these being your red flag headaches and we'll talk about secondary

headaches towards the end of this article but we will firstly look at primary headaches are you're the main the most common types of headaches that are encountered by the general population so here I'm drawing this person with a headache and there are many types of primary headaches a very common type is one that affects one side of the face so unilateral and sort of upper half and these are young, and this is known as the migraine headache.

 then you have a tension headache which sort of feels like a tight tightness around your forehead you have the cluster headache. which is sort of around your eye orbit area and then you have a sinus headache which is related.

when you have sinusitis or irritation of your sinus and then you have a hormonal headache. which is a result of sort of your home or hormonal levels changing so

let's talk about each of these types of headaches in a bit more detail beginning with migraine, so migraine is a disorder. of recurrent attack, so it comes and goes the location of migraine is mostly unilateral 70% of the characteristic of the headache is gradual onset crescendo pattern, which is basically increasing intensity sort of, and frequency with

Headache | Causes | Treatment
 What is headache

moderate to severe in intensity so the pain duration of the headache is between

you know 4 to 72 hours roughly associated symptoms include nausea vomiting photophobia and also aura is sort of the feeling of something about to

happen which is the intense headache then you have the tension headache-no

tension headache you can think of it as being more muscular, so it's the most ubiquitous headache and is the most common reason why over-the-counter analgesics are actually bought so these are you're the most common this is the most common headache essentially the location of tension headaches is usually bilateral and around the

forehead area the characteristic it's pressure or tightness like a band which waxes and wanes the duration is variable and associated symptoms are usually none.

then you have the cluster headache now cluster headaches are pretty painful cluster headaches are a group of idiopathic headaches that are associated also with trigeminal neuralgia now trigeminal what I mean by that is trigeminal is a nerve trigeminal nerve. and it's a very important cranial nerve that does as many things as possible around.

your face essentially now the location of the cluster headaches is always unilateral and it's usually around the eye so it's one-sided around the eye the characteristic of a cluster headache is the pain begins quickly it's deep continuous pain excruciating and explosive in an in quality the duration it's pretty quick in respect to the other headaches.

we talked about 30 to 3 hours and the associated symptoms are essentially the

symptoms of the trigeminal nerve problem as well as some other nerve problems so just drawing it out here, I'm drawing a face now we have to quickly just understand what the trigeminal nerve does in order to understand the symptoms associated with the cluster headache so the trigeminal nerve it has since it's.

it's important for sensation around your face it senses an area around your forehead. which is supplied by the ophthalmic branch of the trigeminal then you have?

the maxillary branch of the trigeminal v2 which supplies sort of the nose area and then you have the mandibular branch which is v3 which supplies sort of the bottom area of your face so that's the sensations of the trigeminal nerve sort of is responsible for sensation around.

your face and these are its branches three branches so in cluster headache, you have pain in this area in blue here around the eye and the associated symptoms include Horner's syndrome which you have ptosis and meiosis, so ptosis is drooping of the eyelid and meiosis is a constriction so you're unable to dilate your pupils you.

can also have lacrimation and also nasal discharge so essentially what I'm trying to portray here is that the cluster headache you can have some associated symptoms involving the trigeminal nerve and sort of other nerve problems there in your neurology problems.

hope that made sense then you have sinus headaches which are associated with sinusitis.

you then have hormonal headaches as well and hormonal headaches essentially, it's when the changes in your hormone levels cause the headache.

so it can be associated with low Eastridge in concentration for example at the beginning of the menstrual cycle or withdrawal of hormone therapy so all of a sudden you have estrogen one minute and then you take away the hormonal therapy Eastridge and levels drop you get this headache so those were the five types of headaches.

primary headaches migraine tension cluster sinus and hormonal now let us look at the drugs used the common or main drugs used to treat each of these headaches beginning with the migraine so for migraines which are recurrent um NSAIDs or aspirin plus antiemetics and hydration is important so antiemetics are drugs that in a stop vomiting for tension headaches simple analgesics so.

this is paracetamol and again it's the most common tension headache is the most common reason I guess that people are one of the common reasons why people buy over-the-counter paracetamol for cluster headaches subcutaneous sumatriptan or oxygen can be given is to prevent vomiting in general trip tens.

which includes sumatriptan is actually contraindicated in certain patients in certain patient patients with cardio coronary artery disease peripheral vascular disease or cerebrovascular disease for sinus headaches supportive therapy is important and on g6 anti limit antiemetics and also you can prescribe but you can give antibiotics depending on the cause of the sinusitis.

so I hope you hope you'll just hope that may I hope that was clear the different types of primary headaches as well as just the general management now let's look at secondary headaches which as I mentioned earlier are our serious and dangerous secondary headaches are result of serious underlying diseases or other conditions so we have some warning signs and symptoms for secondary headaches and ,we can remember this by the acronym snoot SN o o P s stands for system exists symptoms illness or condition such as cancer n is for neurological symptoms or abnormal signs always for arm sent which is new age greater than 40 or it's sudden such as when you have a thunderclap sort of feeling which is a subarachnoid hemorrhage essentially the other is for other associated conditions or features P is for previous headache history with headache progression or change in attack character so essentially what snoop is trying to say is that you know the headache that the person presents with is very abnormal and it's got all these signs and symptoms.

which will tell you hang on a second this is not normal there's a there's this is a more serious problem this is more serious than attention hey great headache or migraine.

so, let's look at some examples here I am drawing a person who has a very serious headache so examples of secondary headaches include intracranial hemorrhage, and this can include subdural epidural or subarachnoid hemorrhage and of course. these people can present with some neurological problems, as well as some you know some complaining of thunderclap essentially the onset, was thunderclap then you can have another example is giant cell arteritis which also is known as temporal arteritis.

which is essentially the temporal artery that is inflamed on the side of your head the final example of a secondary headache is in internal carotid dissection so in summary. we looked at headaches which can be primary or secondary primary include migraine tension cluster sinus and hormonal and secondary are your dangerous ones and weak it's a result of an underlying condition that is more serious and we can pick this up with the acronym snoop which helps us sort of identify if it's more serious.

Headache | Causes | Treatment
 What is headache

Headache (Emergency Medicine) – Emergency Medicine

We are talking about the approach to headaches in the emergency department thinking about patients. who present with headaches to the emergency department it's important to think about how often your goanna see this so headache is a really common presenting complaint to the emergency department there are about five million visits estimated per year in the United States,

and the other thing is that. this can be part of constitutional symptoms so if you can think back to the last time that you had a fever or had the flu you probably had a headache with that and that's part of a grouping of other symptoms when patients present to the emergency department with headaches.

we think about dividing headaches into two different groups so the first part is primary headache disorders we're talking about migraine headaches, cluster headaches tension headaches and this is the majority of people that will come in with headaches to the IDI secondary headache disorders are due to organic syndromes so that's due to patients. 

who have subarachnoid hemorrhages patients who have meningitis that is a large group of patients who present with headaches but primarily here we're going to be talking about these primary headache disorders when patients come to the emergency department with headaches the history the ER going to get from the patient is very important and it's important to try and get all the elements of history from your patient?

that you're able to first we're going to talk about the onset of symptoms you know this is very important especially. when we're trying to think about whether or not the patient has an organic cause primarily a subarachnoid hemorrhage thinking about headache is something that we think about because in the differential of consequence.

so, when we're thinking about the most dangerous things that can cause headaches, we're thinking about meningitis we're thinking about patients with a subarachnoid hemorrhage in their brain and our goal here is to rule out those things because like I said the primary reason that people come to the emergency department is for migraine headache or cluster headache and those patients just need symptomatic treatment.

our goal here is to try and find the few patients that have that organic cause for headaches so thinking about the aunt did the headaches start suddenly or was it a gradual onset so did the headaches start over a period of seconds or minutes or did it start over a period of hours was it a thunderclap headache what that basically means is the headache started all of a sudden like a thunderclap so it started very suddenly in nature so all of a sudden.

 they didn't have a headache and then one second later they had a very severe headache what were they doing when their headaches started, and we'll talk about some of the common things that point. you in the direction of the headache being more related to a serious cause so are they just sitting around or were they exerting themselves what are the associated symptoms are there any neurologic changes is the patient having any weakness any sensory deficits are they having difficulty walking are they having difficulty with their speech or their vision trying to get that information from the patient is very important are they having a fever if they have a fever associated. 

with their headache that may point you in the direction of meningitis or an infection around the brain are they having any vomiting can be both a concerning symptom but can also be a common thing that patients who have migraine headaches present with so vomiting and migraine headache do sometimes go hand-in-hand was there any loss of consciousness in patients who present with a headache and loss of consciousness definitely can point you in the direction of the subarachnoid hemorrhage is there any signs of meningitis do they have a stiff neck are they able to move their neck adequately and was there any trauma was there any history of a blow to the head any kind of accident prior headache history is also very important does the patient has a history of similar headaches is this their worst ever headache sometimes patients can say, 

this is the most severe headache I've ever had it's very important to think about how you phrase that question to a patient so if you phrase that question to the patient by saying is this the most severe headache you've ever had they might definitely say yes but sometimes it's helpful to say can you compare this headache to other headaches that you've had is it of similar quality is it the more severe it did it is it just lasting longer. what are the things that made you come to the emergency department for this headache, especially in patients who have known history of headache disorder and then thinking about what they were doing.

when the headache started did the headaches start with exertion did it start when they were having sexual intercourse, or a Valsalva maneuver those three things so headaches that start with exertion sexual intercourse or Valsalva all can point you in the direction again of subarachnoid hemorrhage so by taking this history and getting these historical points.

we're basically trying to help distinguish who has nan concerning headache or a benign headache from the patients that have that underlying serious organic causes of headache moving on to the physical exam our job. here again is to help distinguish those concerning organic causes of headache from a primary headache process thing.

that are very important to do on the physical exam are to look at the back of the eye and try and look for papilledema or swelling in the back of the eye any evidence of papilledema definitely should prompt you to think about a more concerning underlying cause of the headache.

there are lots of different things that can cause papilledema but definitely, any kind of mass in the brain is one of the elevated intracranial hypertensions is another common cause of patients presenting with headaches to the emergency department a neurologic exam is a very important thing that you want to make sure you do for your patients.

you want to make sure that you check their cranial nerves examine them and make sure that those are all normal. you want to check their strength as well as their sensation as well as potentially having your patients stand up and check their gait and walk them around the room or the emergency department to make sure that they have a steady gait along with that cerebellar maneuvers can help you determine whether or not your patient has any concerning findings in the cerebellar exam assessing your patient for meningism us is another important thing to do on the physical exam what that basically means is you want to have your patient flex.

their neck patients who have meningitis will have a lot of difficulty or pain when they're going to flex their neck there are other maneuvers that you can do the Kearney's and birds in ski maneuvers and those will be discussed in another lecture but those can also indicate inflammation in the meninges so how to do.

we think about the diagnosis here we want to basically think about how concerned we are for a secondary headache etiology primary headaches generally don't require additional workups so for example if a patient comes in and they say they have a migraine headache that feels very similar to their other migraine headaches you generally don't need to do additional testing or workup you know if you're worried that someone has one of these secondary headache ideologies those are the patients so you want to start thinking about doing additional testing.

so what do we think about doing when patients have headaches you want to think about doing a non-contrast head CT that's the initial testing that we do for patients who present with headaches and the non-contrast head CT is great at looking for any kind of acute blood in the brain so looking for a subarachnoid hemorrhage as our cat scan machines get better and better we're better able to see subarachnoid blood and that also whether or not you're able to see it on a non-contrast head CT will depend on

the timeframe with which the patient presents to the emergency department.

we know that the non-contrast head CT is most sensitive in the first 6 hours after the headache began for subarachnoid hemorrhage, we also want to think about doing a CTA which is a CT angiogram or a CT venogram of the head.

those get a better look at the blood vessels both the arteries as well as the veins that supply blood to the brain and can help give a better idea as to whether or not there's a bleed or an aneurysm present than you want to think about doing any labs can sometimes point you in a direction of concern for infection or a possible other underlying reason for altered mental status and for a patient whom you're worried about meningitis they may need a lumbar puncture with an analysis of their cerebrospinal fluid.

Headache | Causes | Treatment
 What is headache

 Causes: what is a headache caused by

️ Intracranial Causes

  • a: πŸ‘‰ Meningitis
  • b: πŸ‘‰ Encephalitis
  • c: πŸ‘‰ cerebral abscess
  • d: πŸ‘‰ cranial pressure
  • e: πŸ‘‰ Hypotension
  •  Extracranial causes
  • πŸ‘‰ Glaucoma
  • πŸ‘‰ Otitis
  • πŸ‘‰ sinusitis
  • πŸ‘‰dental pain

  General system causes

  • 1: πŸ‘‰Neuroglia
  • 2: πŸ‘‰ Hypoglycemia
  • 3: πŸ‘‰ Alkalosis and Acidosis
  • 4: πŸ‘‰fever
  • 5: πŸ‘‰drugs
  • 6: πŸ‘‰ Tension
  • 7: πŸ‘‰ Anxiety
  • 8: πŸ‘‰ Depression

A Treatment for Every Headache

headaches are really common about 90% of people have headaches or have had a headache some people have periodic recurring headaches and that's often very disabling they stop doing things that they enjoy because they're afraid that they're going to trigger a migraine and you know for lack of a better word it can often be really miserable there are actually thousands of types of headaches, not one or two there are thousands the migraine headaches tension-type headaches.

we also see exercise-induced headaches cluster headaches really a variety of headaches and the good news is that we literally have something to treat every single one of those headaches the mission at the headache center at Mount Sinai is to give individualized care one of the biggest questions is you know what why am I having this you know is there something more serious going on although we'll do a neurological exam and sometimes.

 we discover the answer in the neurological exam were most likely to discover the answer with history well we want to know when you first develop these headaches. the quality of the pain the location of the pain associated symptoms of the pain family history anyone in your family has something like that and once we've ruled out anything more serious than it's just all about making them feel better, we often use medications to reduce a number and severity and duration of attacks.

first treatment is education people have to understand what the problem is then we deal with trigger management we look at what things tend to bring on the attacks so I talk to patients all the time about lifestyle going to bed and waking up weekdays weekends same time no matter what patients do depict their migraine what's most important is we want to make it individual and we can do that because we have an enormous number of expert colleagues academic colleagues and every field that's related to headache and they're right here at Mount Sinai I've heard it over years people say to me kids don't get headaches well guess.

what they do get headaches what makes us very unique is that we have a board-certified pediatric neurologist on staff it's important to recognize your child headaches especially with recurring headaches that are happening often if your child's having recurring headaches especially if their headaches that are interfering with their life that needs to be addressed, I believe in a multidisciplinary approach multi-modality approach where we're using various different types of lifestyle modifications non-medication-based treatments,

 as well as medications and treating their child headaches, aren't good for you they're not good for you physically they may progress over time and if headaches are occurring,

 we better know what's causing them and hopefully manage them our goal is to start treating your headaches from the very first visit it's easy to access a headache center people can call and make an appointment they can go to the Mount Sinai dot org website we try really hard to fit patients and as quickly as possible even if that means going through lunch or having evening hours.

we see so many different headache types and so many different patients I promise that we'll have some familiarity with your case and if we don't then we'll do our best to read up on you and your history and to find something that makes you feel comfortable with our treatment.

Treatment with point: headache 

  • πŸ‘‰Treat the underlying cause
  • πŸ‘‰ Analgesic e.g Disprin, Panadol or caffeine containing Analgesic such as Panadol Extra
  • πŸ‘‰ Tranquilizer
  • πŸ‘‰ Massage
  • πŸ‘‰Anti depression if depression is caused

Headache & Migraine Prevention:

headache center as one of the leading headache specialists in the state of Florida I'm here today to talk to you about migraine headaches migraine is a common disease process affecting approximately 40 million Americans and 1 billion people worldwide.

Headache | Causes | Treatment
 What is headache

the World Health Organization considers migraine is one of the top 10 leading causes of disability in the world migraine headaches are a disease process much like diabetes or asthma migraines require medication therapy there are two types of therapy one is a cute migraine therapy that you take only when you have a migraine headache and the other big category of medication are migraine preventative therapy the mainstay focus and migraine treatment is migraine prevention we would prefer that you not have a migraine headache let's focus.

first on migraine prevention since that is the first line of treatment for most migraine sufferers for many years, we have had different migraine preventive therapies they have varying degrees of success and efficacy, but the unfortunate fact is that many of them have side effects. many migraine sufferers needed to be on 2 or 3 of these medications and even then, they had limited benefit from the migraine preventive drugs that we had available to us for many years were all twentieth-century drugs we have now moved into the 21st century,

 and have a whole new class of migraine prevention medications known as the C gr P blockers .these C gr P blockers have a very high degree of migraine blocking efficacy much better than any of the other medications that we have ever used in the past they are all monoclonal antibodies and are administered as a once a month subcutaneous injection the C gr P blockers work by blocking the first initiating cascade on the way to a migraine headache the FDA has approved.

three new GCR P blockers the first is the aim of egg what approved in May of 2018 followed by a Jovi and M gala tea both approved in September of 2018 the use of CG RP blockers allows you the migraine sufferer to possibly wean off the other migraine prevention drugs that may be causing you side effects our experience here at the Florida headache center is that our migraine sufferers whether they have episodic or,

 chronic migraine headaches have seen a dramatic drop-off in the number of monthly migraine headache days that they had episodic migraine sufferers are defined as having 14 or fewer migraine days per month whereas chronic migraine sufferers are defined as having 15 or greater headache days per month.

we have seen patients suffering from 30 headache days per month get started on the GCR P blockers and see their headaches plummet down to having two to four migraine days per month some patients even obtain zero headache days per month with the use of GCR P blockers in patients that have had.

this dramatic drop-off the number of headache days they can be weaned off with their other migraine preventative drugs and feel much better off of these medications the other nice thing about the GCR P blockers is that it gets rid of the other migraine symptoms the migraine sufferers have such as brain fog migraine fog feeling poorly worried about going out somewhere because they're going to have a migraine and it also allows them to spend more family time go on vacations,

and do other activities that they may not be able to do because they are afraid of having a migraine headaches with the use of the GCR P blockers we can see such a dramatic increase in the quality of life of our migraine patients that they never had before in their life imagine if you had migraine headaches for 40 years and you had 15 headaches days per month that means that half of those 40 years or 20 years.

 you were spending in bed disabled throwing up and incapacitated be of your migraine headache with the use of the siege ERP blockers we can cut that down to a minimum number and allow .you to have your life back and improve your quality of life we have seen patients that suffer from intractable headaches that do not respond to other preventive medications get started on the C GRP blockers this even includes our chronic headache patients,

 that get started on C GRP blockers that have such a dramatic drop-off in their migraine days that they have virtually zero headache days per month these patients consider the C GRP blockers truly a miracle drug for their problem here at Florida headache center we have many patients on the C GRP blockers for the migraine headache problem many of these patients had chronic migraines having up to 30 headache days per month once they were started on the C GRP blockers some of these patients drop down to zero headache days per month giving into their life and quality of life back these patients consider the C GRP blockers a miracle drug since the C GRP blockers,

were first approved in May of 2018 and I started all of my Botox migraine patients on a C GRP blocker I have not had to give any of those patients Botox again because of the high efficacy of the C GRP blockers and blocking patients' migraines down to very few or none per month so if you're tired of the Botox headache roller coaster effect the C GRP blockers,

would be an ideal migraine preventative therapy for you if you suffer from four or more migraine days per month the C GRP blockers may be the life-changing therapy for you please contact the Florida headache center at Sarasota neurology at 9:41 nine fifty-five five-eight to allow us to help you improve your quality of life.





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