Category:

Diagnosing and Managing Headaches (Test Only)

Course Outline

It has been estimated that from 60 to 70 million Americans have experienced some form of headache. This universal problem has prompted the National Institutes of Health to conduct epidemiologic surveys to determine the populations affected by headache and its impact on the economy. In a survey of 15,000 households in Washington County, Maryland, 10,169 residents between the ages of 12 and 29 years responded to specific questions about headaches. Of this group, 57.1% of the males and 76.5% of the females experienced a headache in the previous 4 weeks. Four or more headaches in the prior month were described by 6.1% of the males and 14.0% of the females. If these data hold true for the rest of the nation, headache is one of the more prevalent problems to be confronted by the practicing physician.

Many headache sufferers will not consult a physician for the occasional tension-type headache. However, it is estimated that over $4 billion is spent annually on over-the-counter remedies for headache pain. If we add the monies spent on prescription drugs, the expense of lost workdays, fees for numerous visits to physicians’ offices and emergency departments, and repeated hospitalizations, the fiscal impact is staggering.

For the clinician treating the patient with headaches, it is essential to be aware of the various causes of this problem. The clinician should always be alert for the patient presenting with recent onset of headaches—a signal that a careful workup is needed to rule out organic, and possibly morbid, causes of the headache problem.

To effectively treat the patient with headache, an accurate diagnosis must be established. A headache history is important in evaluating the patient with headaches. A complete and thorough physical and neurology examination will facilitate the diagnosis, and the clinician should be cognizant of the specific diagnostic tests used in headache workups. Finally, the clinician should be aware that adequate preventive therapy is available for patients and he/she is not limited to prescribing pain-relief measures.

The purpose of this text is to serve as a reference for the practitioner who will encounter headache patients more frequently than anticipated. The book is enhanced by flow charts to assist the clinician in establishing the diagnosis and selecting the appropriate therapy.

About the Authors

Dr. Seymour Diamond is Director Emeritus and Founder of the Diamond Headache Clinic and the Diamond Inpatient Headache Unit, St. Joseph Hospital, Chicago, Illinois. He is Adjunct Professor, Department of Cellular and Molecular Pharmacology and Clinical Professor, Department of Family Medicine at the Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois. He serves as Executive Chairperson of the National headache Foundation.

Dr. Merle Diamond is Co-Director of the Diamond Headache Clinic. She is Clinical Assistant Professor, Department of Medicine, the Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Il

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Learning Objectives

After completing this course you’ll be able to:

  1. Describe the three types of headaches.
  2. Discuss several aspects of history taking when diagnosing a headache.
  3. Describe a physical workup when diagnosing a headache.
  4. Compare the CT scan and magnetic resonance imaging.
  5. Discuss other procedures and tests to diagnose headaches.
  6. Define a “traction headache.”
  7. Describe the types of headaches associated with tumors.
  8. List symptoms associated with a hematoma.
  9. Describe the symptoms of a subarachnoid hemorrhage.
  10. Describe the causes and symptoms of a brain abscess.
  11. Describe the causes and symptoms of infections.
  12. Describe causes and symptoms of chronic and marked increases in intracranial pressure.
  13. Define cranial arteritis and list the symptoms.
  14. Describe the major neuralgias and their symptoms.
  15. Discuss the causes of a migraine.
  16. Compare the diagnostic and clinical features of a migraine.
  17. List the various types of migraine.
  18. Describe general treatment measures for a migraine, including the tyramine-restricted diet.
  19. Describe the use of triptans.
  20. Discuss the analgesics used for a migraine.
  21. State the criteria for prophylactic therapy.
  22. Discuss several medications used in prophylactic therapy.
  23. Discuss the use of biofeedback in migraine treatment.
  24. Define a cluster headache.
  25. Discuss symptoms and occurence of cluster headaches.
  26. Describe abortive therapy for cluster headaches.
  27. Compare migraine and cluster headaches according to Table 5.1
  28. Describe prophylactic therapy for cluster headaches.
  29. Describe the tension-type headache.
  30. Discuss over the counter treatment for a tension-type headache.
  31. List several prescription medications for tension-type headaches.
  32. Describe the coexisting migraine and tension-type headache.
  33. State the treatment for coexisting migraine and tension-type headache.
  34. Discuss epidemiological studies of children with headaches.
  35. Describe various causes of headaches and the symptoms.
  36. Describe the migraine in children.
  37. Describe the complicated migraine in children.
  38. Discuss the chronic tension-type headache in adolescents.
  39. Describe the various types of headache in the elderly.
  40. Describe the various types of headaches in women.
  41. Discuss treatment for the menstrual migraine.
  42. Discuss the treatment for headaches during pregnancy and lactation.
  43. Compare the acute headache and the chronic post-traumatic headache.
  44. Discuss the research by Brenner in the 1940s on head injuries.
  45. Define the “footballer’s migraine.”
  46. Define dysautonomic cephalgia.
  47. Discuss the incidence and types of headache in patients visiting the ED.
  48. Discuss organic causes of a headache.
  49. Define the “thunderclap” headache.
  50. Describe the hypertensive headache.

Table of Contents

  1. Classification and Etiology
  2. Diagnosis
  3. Headaches Due to Organic Causes
  4. Migraine Headaches
  5. Cluster Headaches
  6. Tension-Type Headaches/Coexisting Migraine and Tension-Type Headaches
  7. Special Patient Considerations
  8. Headaches in Women
  9. Post-Traumatic Headache
  10. Emergency Treatment of a Headache

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