RT Book, Section A1 Chan, Yvonne A1 Goddard, John C. SR Print(0) ID 1172367862 T1 Related Neurology and Neurosurgery T2 K.J. Lee’s Essential Otolaryngology: Head and Neck Surgery, 12e YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9781260122237 LK accesssurgery.mhmedical.com/content.aspx?aid=1172367862 RD 2024/03/29 AB Headache syndromesMigraineaka trigeminovascular syndromeParoxysmal headache (HA) associated with multiple signs and symptoms that can overlap with sinus symptomsUnilateralThrobbing pulsatile headache in the frontotemporal or orbital areaAuraCan arise before or during the HAUsually visual but can be sensory or motorPain builds over 1 to 2 hours and progresses posteriorlyHeadache lasts 4 to 72 hoursPhotophobia, phonophobiaNausea—80%, vomiting—50%, anorexia and food intolerance and light headednessSignsCranial/cervical tendernessHorner syndromeConjunctival injectionTachycardia or bradycardiaHypertension or hypotensionHemisensory changes or hemiparesisAdie’s-like pupil (light-near dissociation)DiagnosisTwo of the following characteristicsUnilateral locationPulsating qualityModerate to severe painAggravated or caused by physical activityDuring the HA patient must have one of the followingNausea and/or vomitingPhotophobia and phonophobiaImagingDiagnostic imaging is not necessary in patients with stable history of migraine headaches and a normal neurologic examination.Management recommendationsCT is not recommended for headache evaluation when MRI is available, unless in an emergency situation.Persistent over-the-counter (OTC) pain medication for the treatment of unrelenting headache is not advised as this symptom may indicate underlying brain pathology.First-line treatment of migraine should not include opioid or butalbital-containing medications.Lifestyle modificationsAvoidance of carrying heavy purses or bags over one shoulderAvoidance of certain foodsMaintaining hydration statusSleep hygieneLimit stressIntegrative medicineMagnesiumRiboflavinCoenzyme Q10Abortive medicationsThese medications aim to reverse or at least stop the progression of a headache.Most effective when given within 15 minutes of symptom onset when the pain is mild.TypesTriptans: selective serotonin receptor agonistsErgot alkaloids: ergotamine, dihydroergotamineAnalgesics and nonsteroidal anti-inflammatory drugs (NSAIDs)Combination medicationsAcetaminophen, aspirin, and caffeine (ie, Excedrin)Butalbital, aspirin, and caffeine (Fiorinal)Isometheptine, dichloralphenazone, acetaminophen (Midrin, Duradrin, and others)AntiemeticsProphylactic medicationsIndicationMore than two headaches per monthDuration of headache is more than 24 hoursSignificant disability for equal to or more than 3 daysAbortive therapy fails or is overusedAbortive medications used more than twice a weekTypesAntiepileptic drugsBeta blockersTricyclic antidepressantsCa2+ channel blockersBotulinum toxin: up to nine treatment cycles for progressive improvement in symptomsTension headacheMost common type of recurring headache thought to be related to muscular factors and psychogenic forces (stressful event).Throbbing quality with onset more gradual than migraines; usually tension headaches are more constant and less severe.Headaches can last up to 7 days.Not associated with nausea or vomiting, photophobia, and/or phonophobia.Diagnostic criteriaTwo of the following must be present:Tightening in frontal-occipital locationsOccipitonuchalBifrontalBilateralMild to moderate intensityNot aggravated by physical activityManagementImaging is only required if headache pattern changes and is not a common primary headache disorder, such as migraine, cluster or tension headacheTreatmentMassage, relaxation techniquesLifestyle modification: regular exercise, balanced meals, adequate sleepTrigger points injection/occipital nerve blockNSAIDsTricyclic antidepressants, muscle relaxersCluster HeadacheGroup of headaches (known as histamine headaches) with multiple characteristicsSevere unilateral pain that is orbital, supraorbital, or temporal.Each headache lasts 15 to 180 minutes and can occur eight times a day or every other day.The HA may occur 1 to 8 times a day for as long as 4 months.HA are often nocturnal, during sleep or early morning hours.Associated with one or more of the following ipsilateral signs:Conjunctival injectionLacrimationNasal congestionRhinorrheaFacial hydrosisMiosisPtosisTwo main forms of cluster headachesEpisodic: at least two cluster headache phase that last 7 days to 1 year are separated by a cluster-free interval of 1 month of longer.Chronic: cluster occurs more than once a year without ...