Transcript Headache
Headache Zheng Dongming 跳转到第一页 The most common symptom in clinic the causes are myriad. 1.intracranial disease 2.extracranial disease 3.functional or psychological disease 跳转到第一页 Pathophysiology of headache Pain-sensitive structure: periosteum of the skull,skin,subcutaneous tissues muscles,blood vessels venous sinuses,dural arteries,arteries at the base of the skull. The trigeminal,glossopharyngeal,vagus,the second and third cervical nerves 跳转到第一页 Principle : 1.history is very important in the diagnosis of headache. 2.physical examinatin 3.CT ,MRI,lumbar puncture. 跳转到第一页 Migraine Migraine is characterized by an episodic unilateral throbbing headache . It is a common idiopathic headache seen in clinic. 2/3~3/4 women onset early. 55% 20 years of age 90% 40 family histry 跳转到第一页 Etiology Genetics:approximately three-quarters of patients who suffer from migraine have close relatives similarly affected. Endocrine and metabolic factors:menstruation. Cheese, chocolate, sherry and red wine are common precipitants. Others:bright lights ,loud noise ,exercise ,hunger,emotional stress and anxiety 跳转到第一页 Pathogenesis vascular theory:some studies e.g. PET scans of migraineurs, suggest that the aura is due to an spreading area of vascoconstriction over the brain .there is some evidence that the headache in migraine is due to subsequent vasodilatation of blood vessels .the association of stroke with migraine supports a vascular aetiology. neuronal theory: aura are associated with spreading neuronal inhibition which does not respect vascular territories .neuronal dysfunction could be the cause of the spreading vasoconstriction 5-HT.etc 跳转到第一页 Clinical features A.migraine with Aura(classic Migraine) prodrome : a vague change in mood or appetite,sensitivity to light and sound aura : visual disturbance: Scintillating scotoma, the visual symptoms usually occupying one visual field, described as zigzag patterns, flashing lights, crescents, motor or sensory disturbance.mins~1 hour headache : the headache is often pulsatile and over one side , nausea and vomiting ,4~72 hours. Resolution:weekness 跳转到第一页 Clinical features B.migraine without Aura(commonic Migraine) most common one headache : the headache is often pulsatile and over one side , nausea and vomiting ,4~72 hours. C.special type basilar artery migraine hemiplegic migraine ophthalmoplegic migraine late onset migraine migraine equivalents 跳转到第一页 ophthalmoplegic migraine With ophthalmoplegic migraine syndrome, the headache localises around one eye and it is followed hours later by a IIIrd or VIth nerve palsy on that side. The nerve palsy gradually improves over several days or weeks. 跳转到第一页 basilar artery migraine Basilar artery migraine is a variety of classical migraine seen most commonly in young women and has an aura that is believed to be due to vertebro-basilar ischaemia. Features of the aura may include:vertigo,dysarthria ,ataxia,diplopia ,bilate ral visual impairment or sensory symptoms. The proceeding headache is usually occipital. 跳转到第一页 hemiplegic migraine Hemiplegic migraine is a term used to describe the migraine syndrome that is associated with a weakness or sensory loss of the limbs on one side of the body. The headache usually precedes the weakness by a day or more. The limbs gradually return to normal over several days.Often there is a family history of this type of migraine, usually with an autosomal dominant inheritance. It is a rare form of migraine. 跳转到第一页 Diagnosis 1. Migraine is characterized by periodic headaches which are typically unilateral and are often associated with visual disturbance and there is usually freedom of symptoms between attacks. 2. There is often a family history of migraine. 3. The nervous system examination is normal. CT,MRI,MRA:normal. 4. Ergotamine is probably effective. 跳转到第一页 Diagnostic criteria of common migraine Migraine are episodes of headache lasting 4-72 hours with the following features: two of the following: unilateral pain throbbing quality aggravated by movement moderate/severe pain one of the following: nausea/vomiting photo- or phonophobia 跳转到第一页 differential diagnosis The differential diagnosis of migraine is large, but includes cluster headache carotidynia painful ophthalmoplegia hypertention,hypotention ,arteriovenous malformations dental caries ,sinusitis in the elderly, transient ischaemic attacks epilepsy tumours 跳转到第一页 Treatment Mild:Aspirin,ibuprophen severe:Ergotamine,dihydroergotamine,code ine,clorpromazine. prophylactic treatment:propranolo,flunarizine, Ergotamine,etc.precipitating factors. 跳转到第一页