Headache
Headache is defined as the symptom of pain in the cranial region. It may be an isolated benign occurrence or manifestation of a wide variety of headache disorders.[1]
Classification
Primary headaches
Primary headaches are defined as "conditions in which the primary symptom is headache and the headache cannot be attributed to any known causes."[1]
Migraine headache
Tension headache
Secondary headache
Secondary headaches are defined as "conditions with headache symptom that can be attributed to a variety of causes including brain vascular disorders; wounds and injuries; infection; drug use or its withdrawal."[1]
The role of overuse of medications for treating migraine (triptans, analgesics, ergots) and their withdrawal as a cause of headache is controversial.[2]
Diagnosis
X-ray computed tomography (CT Scan) should be considered if one of the following is present:[3]
- cluster-type headache
- abnormal findings on neurologic examination
- undefined headache (ie, not cluster, migraine, or tension-type)
- headache with aura
- headache aggravated by exertion or a valsalva-like maneuver
- headache with vomiting
CT scan should also be considered in the following settings:
- Acute thunderclap headache. Prevalence of significant pathology is 40%[3]
- New-onset or change in chronic headaches. Prevalence of significant pathology is 32%.[3] This compares to a prevalence of significant pathology of 1% for patients with chronic headaches referred to a neurologist.[4] Presumably the prevalence would be lower in primary care.
- Patients with human immunodeficiency virus. This is based on a clinical practice guideline.[5]
References
- ↑ 1.0 1.1 1.2 National Library of Medicine. Headache. Retrieved on 2007-12-11. Cite error: Invalid
<ref>tag; name "title" defined multiple times with different content Cite error: Invalid<ref>tag; name "title" defined multiple times with different content - ↑ Bøe MG, Mygland A, Salvesen R (2007). "Prednisolone does not reduce withdrawal headache: a randomized, double-blind study". Neurology 69 (1): 26–31. DOI:10.1212/01.wnl.0000263652.46222.e8. PMID 17475943. Research Blogging.
- ↑ 3.0 3.1 3.2 Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM (2006). "Does this patient with headache have a migraine or need neuroimaging?". JAMA 296 (10): 1274–83. DOI:10.1001/jama.296.10.1274. PMID 16968852. Research Blogging.
- ↑ Sempere AP, Porta-Etessam J, Medrano V, et al (2005). "Neuroimaging in the evaluation of patients with non-acute headache". Cephalalgia 25 (1): 30–5. DOI:10.1111/j.1468-2982.2004.00798.x. PMID 15606567. Research Blogging.
- ↑ (2002) "Clinical policy: critical issues in the evaluation and management of patients presenting to the emergency department with acute headache". Ann Emerg Med 39 (1): 108–22. PMID 11782746. [e]