HEADACHE
Karolína Skorkovská
Headache – patient´s history
• Frequency
• Location of headache
• Duration
• Intensity
• Course
• Triggers
• Family history
Migraine
• Women affected more often
• With / without „aura“
• One half of head affected
• Often after awakening and exercise
• Sensitivity to light and noise – patients seek peace,
silence and darkness
• Nausea or vomiting
• Triggering factors can be found in 90% of patients
• Migraine lasts 4-72 hours and usually goes away after
night sleep
Migraine
• Patophysiology: inflammatory reaction around blood
vessels in dura mater due to changes of activity of the
trigeminal nucleus
Migraine
• Visual Aura
– photopsia, zig-zag lines, colour vision disturbances, …
– Lasts 5-60 minutes, usually followed by headache
• Therapy:
– Supervised by neurologist
– Prophylactic if too frequent
– Acute treatment of individual attacks
Tension headache
• Pain of the whole head
• Low to medium intensity
• Only small sensitivity to noise or light
• Sometimes nauzea, vomiting never, aura never
• Intermediate or chronic headache
• In 40-60% of the population
• Again women affected more often
• Therapy: analgesics, in chronic headaches neurological
medication
Differential diagnosis of tension
headaches
• Sinusitis
• Brain tumors
• Subdural hematoma
• Pseudotumor cerebri
• Hypertension
• Infection (meningitis…)
• Alcohol or drugs consumption
Headache in ophthalmology
• Astenopeic problems (uncorrected
presbyopia)
• Dry eye disease
• Angle closure glaucoma (primary, secondary)
• Decompensated eterophoria