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Headache diagnosis and treatment-now and the future PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Headache diagnosis and treatment: now and the future" by Paul Rolan MBBS MD FRACP FFPM DCPSA.
This medical PowerPoint presentation talks about the diagnosis and treatment of headache.
Headaches can have many causes, including tension, sinus issues, migraine, and other underlying medical conditions. The diagnosis and treatment of a headache depend on the type and cause of the headache.

Tags : Headache diagnosis, Headache treatment, tension, sinus issues, migraine, Neurology PowerPoint presentation

Published on : Mar 21, 2023 | Views : 1416 | Downloads : 1

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Slide 1-

Headachediagnosis and treatment :now and the future Paul Rolan MBBS MD FRACP FFPM DCPSA Professor of Clinical Pharmacology Senior Consultant, Pain Management Unit, RAH
Slide 2-

Headache in 99.9% of people with headache there is no sign of tissue damage injuring the brain itself does not cause pain – it causes altered brain function however the membrane and blood vessels of the brain are very pain sensitive
Slide 3-

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Slide 4-

Headache: causes Primary (99%+) Tension – type 69 Migraine 16 Stabbing 2 Exertional 1 Cluster 0.1 Due to something else (<1%) Systemic infection 63 Head injury 4 Vascular / bleeding 1 Brain tumour 0.1
Slide 5-

Headache diagnosis almost entirely on the patients story tests, scans etc rarely helpful.
Slide 6-

Headache: history How old were you when the headaches started? How often do they come? Do they come in relationship to anything else? At what time do they come on? How do they start? Where is the pain? How long does it last? How bad is it? Are there other symptoms? Does anything bring it on? What helps? How long does it last?
Slide 7-

Pattern recognition pick the odd one out
Slide 8-

Tension-type Headache Frequency chronic often daily Pain mild-moderate pressure, tightness Duration 30 mins - 7 days Location both sides whole head and neck Symptoms no light / sound sensitivity no aura Typical patient : any
Slide 9-

Typical patient : any
Slide 10-

Tension-type headache now thought to be due to increased brain sensitivity to normal sensory inputs few effective treatments : we are trialling a non-drug treatment
Slide 11-

Migraine (“half-head”) Frequency 1-2/year- 2-3/week Pain moderate - severe pulsating, throbbing Duration 4 hrs - 3 days Location usually one sided (but side can swap between attacks) Symptoms aura nausea, vomiting sensitive to light, sound, smells
Slide 12-

Typical migraine patient onset often as child / teenager / young adult but can start at any age 2-3 x more common in women than men typical patient : young woman (15% of all young women)
Slide 13-

What happens during a migraine?
Slide 14-

Migraine cause cause unknown but strongly inherited a lower threshold to spontaneously produce symptoms as if the head and brain had been injured many effective treatments
Slide 15-

Triggers foods : spices, wine , chocolate, citrus food additives : monosodium glutamate sleep : both too much and too little stress : mainly offset female hormones : fluctuating or falling oestrogen
Slide 16-

Migrainous Aura
Slide 17-

Migrainous Aura
Slide 18-

Migrainous Aura
Slide 19-

Medication overuse headache headache made WORSE by pain killers only occurs in people who already had headache mainly due to codeine-containing medicines or stronger morphine-like drugs need to stop responsible medicines : easier said than done we are trialling a new treatment for this
Slide 20-

Cluster Headache Frequency clusters – every time each year or season; then free Pain excruciating penetrating, boring continuous, non-throbbing Duration 15mins-3 hrs; same clock time each day (2am); several episodes / day Location ALWAYS the same side Symptoms watering eyes nasal stuffiness, runny nose red eye, swollen eyelids sweating Typical patient : middle aged male smoker
Slide 21-

Cluster Headache
Slide 22-

Trigeminal Neuralgia VERY short (<1 sec) severe pain Knife-like Local triggering : eating etc Typical patient : middle aged / elderly woman
Slide 23-

Other headaches Paroxysmal hemicrania “SUNCT” short lasting neuralgiform;conjunctival injection, tearing Stabbing headaches After head injury / head surgery Sexual headaches Altitude sickness
Slide 24-

Treatment Explanation, set realistic objectives Lifestyle change Treatment of the attack Treatment to reduce attack frequency
Slide 25-

Treatment of the attack General pain relievers Migraine-specific treatments - triptans and ergots Cluster specific treatment - oxygen - triptans
Slide 26-

General pain relievers : migraine, tension Not suitable : dextropropoxyphene “Doloxene; Di-Gesic” morphine, pethidine Additives : metoclopramide (nausea) caffeine
Slide 27-

Triptans : Imigran, Zomig, Naramig, Maxalt, Relpax FOR can be very effective : migraine, cluster (NOT tension) tablets, wafers, nasal spray, injection AGAINST feel strange, chest pain expensive, small supply overuse makes headaches more frequent constrict blood vessels
Slide 28-

Ergots : migraine, cluster FOR can be very effective when others fail nasal spray, suppository injection AGAINST hard to get overuse causes poor circulation and more headache not for tension
Slide 29-

Preventative drugs “mixed bag” of drugs used for other conditions found to be effective in headache usually by chance usually for high blood pressure, depression, epilepsy all work in somebody ; none works in everybody generally reduce frequency but do not change attacks key to success : trial and error : persist need to start at low dose and increase until effective or not tolerated about 50 % of patients will get 50% or more reduction in attacks
Slide 30-

Main migraine preventers
Slide 31-

Tension preventers
Slide 32-

Cluster preventers - balance of effectiveness and safety / tolerability
Slide 33-

Non drug Herbal feverfew – no butterbur – possibly Manual therapies physiotherapy – caution acupuncture – no Electrical occipital nerve stimulation : possibly Closure of hole in heart - no
Slide 34-

In the pipeline
Slide 35-

In the pipeline “vaccination” for migraine new classes of drugs
Slide 36-

Our research we are trialling a non-drug electrical therapy for tension-type headache we are trialling a completely new drug approach to medication overuse headache we may be trialling new agents for migraine in the near future
Slide 37-

http://www.adelaide.edu.au/painresearch/participate/