ENT

HEADACHE
Dr. Alberto Calderon FPSO-HNS
2nd Shifting/ August 19, 2010
Jam|Kris|Elysse|Keke|Karing|Mikko

CHRONIC IDIOPATHIC HEADACHE (CIH) TENSION-TYPE HEADACHE

 Possible areas of pain:
Social Impact of Headache o Upper back and neck
 Primary complaint in 10M consulting patients o Base of the head
 US$ 7B in annual lost labor o The ears
 10M physician office visits per year o Above the ears
 5-10% of population annually seeks medical help o The jaw
o Above the eyes
Pathogenesis of Migraine
 Painful dilatation of cranial vessels triggered by certain CLUSTER HEADACHE
factors (internal and external) mediated by several chemicals  Most painful type of CIH
(histamine, serotonin, etc.) and consummated by the  Predominantly male
trigeminal nerve (“headache nerve”  Onset usually in the late 20’s
 Attacks come in clusters, typically 1-2 years
Nice to know: Cephalalgia- medical term for headache   Bouts occur for 10 minutes to 2 hours and each cluster lasts
for 2-3 months
Syndrome of Daily Headache  Average remission is about 2 years
 Repeated therapeutic failure  1 or 2 attacks per day often nocturnal
 Multiple analgesic use and abuse  Pain in or around the eye (retroorbital)
 Codeine and barbiturate overuse  Conjunctival injection
 Associated depression  Lacrimation/tearing
 Female preponderance  Nasal congestion
 Rhinorrhea
Diagnosis of Migraine/Headache  Forehead and facial sweating
 No diagnostic test  Eyelid edema
 Only through symptomatology
 There are several types of migraine headache, but most are Treatment Options
characterized by severe pain on one or both sides of the Overview
head (which may move to the other side), nausea, dizziness  Avoid trigger factors
and visual disturbances caused by dilation and constriction  Symptomatic treatment
of the blood vessels in the head.  Prophylaxis
 Non-pharmacologic treatment
Criteria for Office Diagnosis of Tension-type Headache
 Headache pain accompanied by any 2 of the following: Trigger Factors
o Pressing or tightening (non-pulsating) quality  Stress 9family or work-related)
o Bilateral location  Depression
o Not aggravated by physical activities  Hormonal
o No nausea or vomiting  Hypoglycemia
o No photophobia or phonophobia  Fatigue
o No evidence of organic disease  Sleep factors (heat and cold)
 Food
Criteria for Office Diagnosis of Classic Migraine o Chocolates, coffee, colored soda, tea, MSG, flavor
 Headache pain accompanied by any 2 of the following: enhancers, red wine, nuts, nitrate-containing foods
o Pulsating quality
o Unilateral location Tension-type Headache
o Aggravated by physical activities  Identifying and eliminating trigger factors
o With nausea or vomiting  Optimum use of analgesics
o With photophobia or phonophobia  Using anti-depressants as prophylactic treatment after the
o No evidence of organic disease acute episode has been controlled

* Symptoms are the opposite of tension-type headache Pharmacologic Treatment of Acute Attacks of Migraine
 NSAID (i.e Naproxen, Ibuprofen)
 Ergot alkaloids (i.e Ergotamine)
 Tartrate (Avamigran)
 Anti-emetics
 Others [i.e. Sumatriptan (Imigran)]

Key to Successful Treatment of CIH

ANYA DYOSANG PIPAY FAIFAI WEB JOJO ARLS JESS AYKI JAM KRISETTE ELYSSE KEKE KARING MIKKO YEL EM BOK SHENG ANNE KRISTINE KUKIS CYNTHIA
KIWI NATHAN MIGGY MAYEE MACOY BONI ROD JEANS KATHY PENG BABY JI HOO CHACHA JAJA DEE AILA JERMIE CATH OJ MAI POYENG DET ELAINE
FAYE REUBEN LULU LELE YIMMY LEE THEA JEN MEYMEY DIA ANNE CRISTINE MAIKA MARC GELIQ DOP BEDA YEN
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HEADACHE
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 Explain rationale of therapy

 Give realistic expectations
 Dark and quiet room
 Stop nausea
 Allow patient to relax or sleep
 Treat at the earliest sign

Strategies for Symptomatic Relief

 Initiate medications as early as possible
 Initiate new medications at lowest dose
 Administer each dose over at least 3 attacks before
increasing dose
 Rest
 If ineffective
o Increase dose
o Change route of administration
o Change medications
o Add anti-emetic

Cluster Headache
 Oxygen (mega dose)→vasoconstricts (15L/min)
 Sumatriptan injection
 Lidocaine 4% (intranasal)
 Greater occipital nerve block

Prophylactic Treatment: Pharmacologic Agents

 Beta-blockers (Propranolol)
 Calcium antagonist
 5-HT2 antagonist (i.e. Pizotifen)

Non-Pharmacologic Treatment for CIH

 Relaxation techniques (i.e yoga)
 Acupuncture
 Diet
 Behavioral approach (i.e. Psychoanalysis/ Psychiatric
Approach)

Strategies for Prophylactic Treatment for CIH

 Initiate medications at lowest dose
 Avoid analgesic/ergotamine abuse
 Record headache symptoms/medications and occurrences
(report card)

“The treatment of headache is an art as much as it is a science.”

-AF Calderon MD