Abc of headache (abc series)

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<ul><li>1.HeadacheAnne MacGregorDirector of Clinical ResearchThe City of London Migraine ClinicAlison FrithClinical Research SisterThe City of London Migraine Clinic A John Wiley &amp; Sons, Ltd., Publication</li></ul><p>2. This edition rst published 2009, 2009 by Blackwell Publishing LtdBMJ Books is an imprint of BMJ Publishing Group Limited, used under licence by Blackwell Publishing which was acquired by JohnWiley &amp; Sons in February 2007. 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No warranty may be created or extended by any promotionalstatements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.Library of Congress Cataloging-in-Publication DataABC of headache / edited by Anne MacGregor, Alison Frith. p. ; cm.Includes bibliographical references and index.ISBN 978-1-4051-7066-6 (alk. paper)1. Headache. I. MacGregor, Anne, 1960 II. Frith, Alison.[DNLM: 1. Headachediagnosis. 2. Headache Disordersdiagnosis. WL 342 A112 2008]RC392.A27 2008616.8491dc222008001983ISBN: 978-1-4051-7066-6A catalogue record for this book is available from the British LibrarySet in 9.25/12 pt Minion by SNP Best-set Typesetter Ltd., Hong KongPrinted in Singapore by COS Printers Pte Ltd1 2009 3. Contents Preface, v Contributors, vi 1 Approach to Headaches, 1 Anne MacGregor 2 Migraine, 9 Anne MacGregor 3 Tension-type Headache, 15 Anne MacGregor 4 Cluster Headache, 20 David W. Dodick 5 Medication Overuse Headache, 24 David W. Dodick 6 Menstrual Headaches, 28 Alison Frith 7 Childhood Periodic Syndromes, 36 Ishaq Abu-Arafeh 8 Teenage Headache, 41 Ishaq Abu-Arafeh 9 Exertional Headache, 46 R. Allan Purdy10 Thunderclap Headache, 50 David W. Dodick11 Headache and Brain Tumour, 53 R. Allan Purdy12 Headache and Neck Pain, 56 Anne MacGregor13 Headache and Depression, 60 Anne MacGregor14 Pain in the Temple, 68 R. Allan Purdy15 Facial Pain, 72 David W. Dodick Further resources, 76 Index, 77iii 4. PrefaceOur aim with this ABC book is to provide the reader with a clear, included since they are greatly feared by both patients and health-concise text to recognize and manage headache effectively. We are care professionals.grateful for the opportunity to collaborate with colleagues to Individual case studies cannot address all the issues relating toprovide current information based on best available evidence anda specic group of headache sufferers. However, we felt it wasexpert specialist opinion.important to devote chapters on headache and associated syn- First we present an overall approach to headache including dromes in children and adolescents to highlight their speciceliciting the history, identifying red ags and current issues in issues. With regard to headache in the elderly, the treatments areinvestigation and management. The chapters that follow arethe same as for other age groups, but the differential diagnosis iscarefully selected case studies with emphasis on history taking toparticularly important as demonstrated in the chapter on giant cellestablish differential diagnoses, investigations that may be required arteritis. As a quarter of all women are affected by migraine andand specic management strategies. Although we illustrate the half of them recognise an association with menstruation, we felt itmain primary headaches of migraine, tension-type headache,was appropriate to include a case study for this group.and cluster headache, we recognize that not all secondaryWe hope that this approach to headache reects presentation ofheadache types are covered. Obvious headaches due to head headache to a wide range of healthcare professionals, helping themtrauma or infection for example, have been omitted. Instead, we to improve the diagnosis and the management of this complex andhave chosen common but under-recognized medication overusechallenging condition.headaches and headaches attributed to depression, neck painand trigeminal neuralgia. Headaches associated with underlyingAnne MacGregorcranial vascular disorder and brain tumours, although rare, are Alison Frithv 5. ContributorsIshaq Abu-Arafeh Anne MacGregorConsultant Paediatrician Director of Clinical ResearchStirling Royal InrmaryThe City of London Migraine ClinicStirling, UK London, UKDavid W. DodickR. Allan PurdyProfessor of Neurology Professor of Medicine (Neurology)Mayo Clinic ArizonaDalhousie UniversityScottsdale, Arizona, USHalifax, Nova Scotia, CanadaAlison FrithClinical Research SisterThe City of London Migraine ClinicLondon, UKvi 6. CHAPTER 1 Approach to Headaches Anne MacGregor OVERVI EW provide the most effective treatment. For most medical ailments the suspected diagnosis can be conrmed with tests, but no diag- Most headaches can be managed in primary care nostic test can conrm the most common headaches, such as The history is a crucial step in the correct diagnosismigraine or tension-type headache. This means that unless the Funduscopy is mandatory for anyone presenting with headache headache is obvious, diagnosis is largely based on the history. In Diary cards aid diagnosis and managementaddition, the examination of people with primary headaches is The presence of warning symptoms in the history and/oressentially normal. Consequently, the diagnosis is not always easy, physical signs on examination warrant investigation and may particularly if several headaches coexist, confusing both patient and indicate appropriate specialist referraldoctor. In a study of patients with a diagnosis of migraine who were referred to a specialist migraine clinic, nearly one third had a head- ache additional to migraine. Failure to recognize and manage the additional headache was the most common cause of treatmentIntroduction failure.Nearly everyone will experience headaches at some time in their It is not always possible to conrm the diagnosis at the rst visit.lives. Most headaches are trivial, with an obvious cause and minimal A structured history, followed by a relevant examination, can iden-associated disability. However, some headaches are sufciently tify patients who need immediate investigations or referral fromtroublesome that the person seeks medical help. Headache accountsthe non-urgent cases. Management and follow-up will depend onfor 4.4% of consultations in primary care (6.4% females and 2.5% whether the diagnosis is condently ascertained or is uncertainmales). Unless a correct diagnosis is made, it is not possible to(Figure 1.1). NOW MR JONES, JUST WHAT EXACTLY DO YOU THINK IS THE CAUSE OF YOUR HEADACHES?ABC of Headache. Edited by A. MacGregor &amp; A. Frith. 2009 Blackwell Publishing, ISBN 978-1-4051-7066-6.1 7. 2 ABC of Headache 1st consultation HistoryExclude warning featuresIf present:ExaminationExclude warning clinical signsinvestigate or referIf absent Confident diagnosis Uncertain diagnosis Symptomatic RxDiary cards Preventive Rx Review 46 weeks Diary cards (earlier if symptoms progress) Review 612 weeks 2nd consultationReview diary cards HistoryExclude warning features If present: Examination (ifExclude warning clinical signs investigate or refer indicated)If absent Confident diagnosis Uncertain diagnosis Symptomatic RxInvestigate or refer Preventive Rx Diary cardsFigure 1.1 An approach to headache in Review as necessaryprimary careTable 1.1 An approach to the headache history1. How many different headache types does the patient experience?Separate histories are necessary for each. It is reasonable to concentrate on the most bothersome to the patient but others should always attract someenquiry in case they are clinically important.2. Time questionsa) Why consulting now? b) How recent in onset? c) How frequent and what temporal pattern (especially distinguishing between episodic and daily or unremitting)? d) How long lasting?3. Character questions a) Intensity of pain? b) Nature and quality of pain? c) Site and spread of pain? d) Associated symptoms?4. Cause questions a) Predisposing and/or trigger factors? b) Aggravating and/or relieving factors? c) Family history of similar headache?5. Response to headache questionsa) What does the patient do during the headache? b) How much is activity (function) limited or prevented? c) What medication has been and is used, and in what manner?6. State of health between attacks a) Completely well, or residual or persisting symptoms? b) Concerns, anxieties, fears about recurrent attacks and/or their cause?Source: Steiner TJ, MacGregor EA, Davies PTG. Guidelines for All Healthcare Professionals in the Diagnosis and Management of Migraine, Tension-Type, Clusterand Medication Overuse Headache (3rd edition, 2007). criteria have helped to ascertain headache prevalence,Historywhich is useful for understanding the likelihood of any headacheThe history is a crucial step in diagnosis of headaches (Table 1.1).presenting in clinical practice (Tables 1.2 and 1.3).A separate history is required for each type of headache reported, A headache history requires time. In the emergency settingin particular noting the course and duration of each. The Interna-particularly, there may not be enough time to take a full history.tional Headache Society has developed classication and diagnosticThe rst task is to exclude a condition requiring more urgentcriteria for the majority of primary and secondary headachesintervention by identifying any warning features in the history(Box 1.1). Although this is primarily a research tool, standardized (Box 1.2). 8. Approach to Headaches 3Box 1.1 The International Classication of Headache Disorders (2nd edition)Primary headache1. Migraine, including: Migraine without aura Migraine with aura Childhood periodic syndromes that are commonly precursors of migraine Cyclical vomiting Abdominal migraine Benign paroxysmal vertigo of childhood2. Tension-type headache, including: Infrequent episodic tension-type headache Frequent episodic tension-type headache Chronic tension-type headache3. Cluster headache and other trigeminal autonomic cephalalgias, including: Cluster headache Paroxysmal hemicrania Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing4. Other primary headaches, including: Primary cough headache Primary exertional headache Primary headache associated with sexual activity Primary thunderclap headacheSecondary headache5. Headache attributed to head and/or neck trauma, including: Chronic post-traumatic headache6. Headache attributed to cranial or cervical vascular disorder, including: Headache attributed to subarachnoid haemorrhage Headache attributed to giant cell arteritis7. Headache attributed to non-vascular intracranial disorder, including: Headache attributed to idiopathic intracranial hypertension Headache attributed to low cerebrospinal uid pressure Headache attributed to non-infectious inammatory disease Headache attributed to intracranial neoplasm8. Headache attributed to a substance or its withdrawal, including: Carbon monoxide-induced headache Alcohol-induced headache Medication-overuse headache Triptan-overuse headache Analgesic-overuse headache9. Headache attributed to infection, including: Headache attributed to intracranial infection 10. Headache attributed to disorder of homoeostasis 11. Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures, including: Cervicogenic headache Headache attributed to acute glaucoma 12. Headache attributed to psychiatric disorderNeuralgias and other 13. Cranial neuralgias and central causes of facial pain including:headaches Trigeminal neuralgia 14. Other headache, cranial neuralgia, central or primary facia...</p>