Headache

Introduction to Clinical Neurology

Daniel Lowenstein, MD

Andy Josephson, MD

Wade Smith, MD, PhD

Dan Lowenstein, MD

Potential Conflicts of Interest

- None

Robert B. and Ellinor Aird Professor of Neurology

Director, UCSF Epilepsy Center

Department of Neurology, UCSF School of Medicine

Learning Objectives

Learning Objectives

o Describe the major clinical features of migraine, tension

headache, cluster headache, and trigeminal neuralgia.

o Explain the principles of acute and prophylactic therapy for

primary headache disorders.

o Describe the clinical features of the worrisome headache.

o Describe the presentation and acute therapeutic

considerations for patients with giant cell (temporal) arteritis,

tumor-associated headache with intracranial hypertension,

and subarachnoid hemorrhage.

Introduction

The t reatment of headache in 1200 BC

Cartoon drawn by P. Cunningham, from Lance, Mechanism and Management of Headache, Butterworths, 1982

o Global prevalence among adults of current headache disorder

(symptomatic at least once within the last year) is 47%.

o Half to three quarters of the adults aged 1865 years in the world have had headache in the last year and among those individuals,

more than 10% have reported migraine.

o Headache on 15 or more days every month affects 1.74% of the worlds adult population.

o Despite regional variations, headache disorders are a worldwide

problem, affecting people of all ages, races, income levels and

geographical areas.

From the Wor ld Heal th Organizat ion (2012)

The most important question of al l !

Old

Migraine Tension-type Cluster Trigeminal neuralgia

Tumor-associated Giant cell (temporal) arteritis Subarachnoid hemorrhage

Primary Headache Disorders

Secondary Headache Disorders