A Headache is defined as a pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes. There are three major categories of headaches:
- Primary headaches,
- Secondary headaches, and
- Cranial neuralgia, facial pain, and other headaches
Assessment of headache should be comprehensive for example to include
- Age at onset
- Presence or absence of aura and prodrome
- Frequency, intensity and duration of attack
- Number of headache days per month
- Quality, site, and radiation of pain
- Associated symptoms and abnormalities
Primary headache
Primary headaches include Migraine, tension, and cluster headaches, as well as a variety of other less common types of headache
Migraine Headache
This is characterized by a trial of paroxysmal headache, vomiting and focal neurological events (usually visual). It is more common in females than in males often there is a family history of migraine.
Associated precipitants include:-
- Dietary (cheese, chocolate or red wine)
- Psychological stress
General Measures
- Avoidance of precipitants
- Relaxation to reduce stress
Medicines
In acute attack give analgesics:
A: Paracetamol 1g immediately then every 4 hours; Max 4g per day OR
A: Aspirin 600mg, repeat after 4 hours if needed.
Plus
C:Metroclopramide oral/IM, 10 mg 3 times daily.
In severe attack give:
C: Ergotamine tartrate 1-2 mg, maximum 4mg in 24hours, not to be repeated at intervals less than 4 days.
For prevention purposes give:
C: Propranolol 80-160mg daily OR
C:Amitryptiline 10-50mg atnight.
Referral
- Patient with additional neurological signs or additional risk factors for an alternate diagnosis, such as immune deficiency. These patients require brain imaging
- Sudden onset of a first severe headache may indicate serious organic pathology, such as subarachnoid hemorrhage
- Acute migraine, not responding to treatment
- Recurrent migraine not controlled with prophylactic therapy
