Headache课件.ppt

Headache Headache Headache affects 75% of population per year (45 million people) and 25% of Neurology OP referrals Daily headache affects 4% of population On any day 90,000 people are absent from work or school because of headache Migraine alone accounts for 20 million lost work or school days per year Cost of migraine to the economy in UK ￡1 billion per year Most headaches are due to: Tension-type headache 70% Migraine 14% Classification of headache 1. Primary headache (from IHS 2003) (must have characteristic or benign features without abnormal neurological signs) 1. Migraine 2. Tension-type headache 3. Cluster headache and other trigeminal autonomic cephalgias 4. Other headache not associated with structural lesion Classification of headache 2. Secondary headache(from IHS 2003) 5. Head or neck trauma? 6. Cranial or cervical vascular disorders 7. Non-vascular intracranial disorders 8. Substances or their withdrawal 9. Infection 10. Disorder of homeostasis 11. Eye, ENT, orofacial, or cervical disorders 12. Psychiatric disorder 13. Cranial neuralgias and central causes of facial pain 14. Headache not classifiable Migraine characteristics Attacks of headache lasting 4 to 72 hours Nausea and/or vomiting Intolerance of light Intolerance of noise Recurrent attacks Visual or neurological aura lasting 6 – 60 mins Consistent trigger A few headache cases Headache - Danger Signals First and worst headache Association with loss of consciousness or collapses non-migrainous visual disturbances or focal neurological signs fever or rash Sudden headache with vomiting and/or loss of consciousness at onset Neck stiffness Jaw claudication (pts over 50) Headache - Concerning features New onset headache after age 50 Genuinely increasing frequency and severity Waking patient from sleep Unresponsive to treatment Always on same side Following head trauma Precipitated by exertion New headache in patients: On anticoagulants With HIV or cancer Diagnosis Careful hi