Headache:Headache:

When to see a When to see a physicianphysician

Morris Levin, MDSection of NeurologyDartmouth Medical School

Head Pain - sourcesHead Pain - sources

MeningesBrain veins and arteriesPain nervesPeriosteumScalpScalp musclesScalp blood vesselsSinusesEyesEarsTeeth, TMJArteries of the neckNeck spine Neck muscles

IHS Classification - 2003 IHSIHS Classification - 2003 IHSPrimary HA

1. Migraine2. Tension-type3. Cluster4. Exertional

Secondary HA5. Post-traumatic6. Blood vessel disease7. Brain tumor 8. Substances9. Infection10. Medical problems11. Neck, Eyes, SInuses12. Psychiatric 13. Neuralgias

Primary HeadachesPrimary Headaches

MigraineMigraine

– severe, one-sided,severe, one-sided,

– nauseanausea

Tension-TypeTension-Type

– milder, more diffuse, milder, more diffuse,

– no nausea

ClusterCluster

– brief, around the eye, brief, around the eye,

– occurs in cyclesoccurs in cycles

Warning Signs in Headache Warning Signs in Headache

Sudden Sudden Brought on by exertion Brought on by exertion New kind of headache, or change in pattern New kind of headache, or change in pattern Onset in middle age or laterOnset in middle age or later FeverFever Change in behavior or thinkingChange in behavior or thinking Changes in sensation, strengthChanges in sensation, strength Setting of systemic disease - eg Cancer, AIDSSetting of systemic disease - eg Cancer, AIDS

Medical Evaluation of Medical Evaluation of HeadachesHeadaches

History of the HA problemHistory of the HA problem

General medical historyGeneral medical history

General examination General examination

Diagnostic testingDiagnostic testing

Medical EvaluationMedical Evaluation

History

– Where, WhenWhere, When– What Triggers, what helpsWhat Triggers, what helps– What other symptomsWhat other symptoms– Family historyFamily history– Medical problems and Medical problems and

medicationsmedications

Medical EvaluationMedical Evaluation

Examination Examination

– Head and NeckHead and Neck– General examGeneral exam– Neurological examNeurological exam

Mental functionMental function

VisionVision

Motor functionMotor function

SensationSensation

CoordinationCoordination

Options:

Blood tests

X-rays

MRI, CT

Lumbar Puncture

TestingTesting

Medical EvaluationMedical Evaluation

MRI

Brain Tumors and HABrain Tumors and HA

50% of Brain neoplasms present with HA50% of Brain neoplasms present with HA

< .1% of HA sufferers have brain neoplasm< .1% of HA sufferers have brain neoplasm

Vascular problemsVascular problemsArteriovenous malformation aneurysm

InfectionsInfections

Brain abscess Cysticercosis

IHS Classification - 2003 IHSIHS Classification - 2003 IHS

Primary HA1. Migraine2. Tension-type3. Cluster4. Exertional

Secondary HA5. Post-traumatic6. Blood vessel disease7. Brain tumor 8. Substances9. Infection10. Medical problems11. Neck, Eyes, SInuses12. Psychiatric 13. Neuralgias

However –

Recurring headaches are usually primary (migraine or tension-type headache)

Headache - Headache - When to see a PhysicianWhen to see a Physician

ConclusionsConclusions

Headache can be a warning sign Headache can be a warning sign

of serious illnessof serious illness

Most correctable causes of Most correctable causes of

headache can be found headache can be found

Most headache problems are due Most headache problems are due

to “primary headache”to “primary headache”