Why do human heads hurt so much?


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Why do human heads hurt so much?

  • Why do human heads hurt so much?









Secondary headache is rare. Primary headache is very common.

  • Secondary headache is rare. Primary headache is very common.

  • Brain tumour virtually never presents as headache to a secondary care neurology clinic



Tension type headache is even rarer than headache secondary to brain tumour in a neurology clinic

  • Tension type headache is even rarer than headache secondary to brain tumour in a neurology clinic



Migraine

  • Migraine

  • Tension

  • Cluster

  • CPH

  • SUNCT

  • Idiopathic stabbing

  • Hypnic





What do you do (or want to do) when you get a headache?

  • What do you do (or want to do) when you get a headache?

  • (Not does light bother you)



What was the headache like when it first started?

  • What was the headache like when it first started?

  • No, think carefully – did it come and go…did you feel sick…did you have to take painkillers regularly to stop the bad headaches



Does anyone in the family have bad headaches where they feel sick and have to go to bed?

  • Does anyone in the family have bad headaches where they feel sick and have to go to bed?





Dietary triggers are over rated.

  • Dietary triggers are over rated.

  • Prodrome often includes specific food cravings and these may be successful in aborting the migraine, but when they fail we blame the food.



Put the fire out early

  • Put the fire out early

  • If infrequent – then take analgesia as soon as you think ‘I’m not having a headache am I’

  • Dispersible aspirin 1g

  • Consider anti-emetic to aid gastric absorption





Avoid painkillers on more than 2 days per week

  • Avoid painkillers on more than 2 days per week



No more effective than simple analgesia but work in some patients where simple analgesia ineffective. Preferable to opiates.

  • No more effective than simple analgesia but work in some patients where simple analgesia ineffective. Preferable to opiates.

  • Rarely work when there is ‘allodynia’.

  • Very safe.

  • Triptan sensations.

  • Sumatriptan, rizatriptan, zolmitriptan, naratiptan, almotriptan, frovatriptan.



Amitryptiline

  • Amitryptiline

  • Propanolol/Metoprolol

  • Topiramate

  • Valproate





In chronic headache aim for 50% reduction in headache in 6 months.

  • In chronic headache aim for 50% reduction in headache in 6 months.

  • Impatience leads to effective medication being discarded too early





All headache is sudden onset

  • All headache is sudden onset

  • 2 minutes, 1 hour.

  • Can a primary or secondary headache syndrome be diagnosed?

  • How often have they had it?

  • How long does it last?







Cluster (30-120 minutes)

  • Cluster (30-120 minutes)

  • Paroxysmal Hemicrania (2-30 minutes)

  • SUNCT/SUNA (10-240 secs)



Powerful NSAID

  • Powerful NSAID

  • Switches off Chronic Paroxysmal hemicrania

  • Suggest trying in patients with refractory side locked headache



Never

  • Never

  • Ever

  • Or at least the risk of considering the diagnosis exceeds the benefits.



But almost certainly not with normal PVisc, CRP and platelets.

  • But almost certainly not with normal PVisc, CRP and platelets.



Exeter headache clinic

  • Exeter headache clinic

  • OUCH UK






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