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Primary headaches

tension-type headache
1. features
  1. symmetrical
  2. onset
    1. gradual
  3. description
    1. tightness
    2. a band
    3. pressure
migraine w/o aura
1. accounts for 90%
2. episodes may last 1-72h
3. often bilateral
  1. but may be unilat
4. site
  1. temporal or frontal area
5. assoc sx
  1. unpleasant GI disturbance
    1. nausea
    2. vomiting
    3. abdominal pain
    4. photophobia
    5. phonophobia
6. exacerbating factors
  1. physical activity
migraine w/ aura
1. 10% of migraine
2. headache preceded by an aura
  1. visual
    1. commonest aura
    2. -ve phenomena
      1. hemianopia
        loss of half the visual field
      2. scotoma
        small areas of visual loss
    3. +ve phenomena
      1. e.g. fortification spectra
        seeing zigzag lines
  2. sensory
  3. motor
3. features
  1. absence of probs btw episodes
  2. freq presence of premonitory sx
    1. tiredness
    2. difficulty concentrating
    3. autonomic features
  3. duration
    1. few hours
      1. spent lying down in a quiet, dark place
  4. relieving features
    1. sleep
4. unilat sensory or motor sx
  1. rare
sx of tension-type headache or a migraine often overlap
1. probably part of same pathophysiological continuum
  1. evidence suggests they both come from primary neuronal dysfuncn
    1. incl channelopathies
    2. w/ vascular phenomena as secondary events
  2. genetic predisposition
    1. 1st & 2nd degree relatives often affected
  3. triggers
    1. disturbance of biorhythms
      1. late nights
      2. early rises
      3. stress
      4. winding down after stress at home or school
    2. food
      1. cheese
      2. chocolate
      3. caffeine
      4. rarely a trigger
    3. in girls
      1. menstruation
      2. oral contraceptive pill
uncommon forms of migraine
1. familial
  1. linked to Ca2+ channel defect
  2. dominantly inherited
2. sporadic hemiplegic migraine
3. basilar-type
  1. vomiting w/ nystagmus
    1. and/or
      1. cerebellar signs
4. periodic syndromes
  1. often precursors of migraine
  2. cyclical vomiting
    1. recurrent stereotyped episodes of vomiting
    2. intense nausea
      1. assoc w/ pallor or nausea
  3. abdominal migraine
    1. idiopathic recurrent disorder
    2. episodic midline abdo pain
      1. bouts lasting 1-72h
      2. moderate to severe intensity
      3. assoc sx
        vasomotor sx
        nausea
        vomiting
    3. child well in btw episodes
  4. benign paroxysmal vertigo of childhood
    1. heterogeneous disorder
    2. brief episodes of vertigo
      1. occur w/o warning
      2. resolving spontaneously in otherwise healthy kids
    3. btw episodes neuro examn, audiometric & vestibular funcn are normal

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Primary headaches

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	Created by v.djabatey over 10 years ago