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Surat Tanprawate, MD, MSc(Lond.), FRCPT Division of Neurology Chaing Mai University
15/13/2011
Outline of headache
Why we got headache? The headache classication Headache approach Common headache diagnosis
Scalp, galea (epicranial aponeurosis), fascia, muscles: --150 observations, 30 subjects --thermal,chemical, mechanical, electrical stimulation
Ventricles, aqueduct of Sylvius, Choroid plexuses --24 observations, 4 subjects --a balloon placed through a small opening into anterior horn and body of lateral ventricle Dural artery (middle meningeal artery): --96 observations, 11 subjects --stimuli: faradizing, distending, stroking, stretching, crushing
http://ihs-classication.org
Red ag signs
(+)
Investigation
Red ag signs or alarming signs
(-)
(+)
Migraine headache
Focal neurologic s/s other than typical visual or sensory aura Papilledema Neck stiffness
Concurrent event
Provoking activity
Age> 50
Pregnancy, post partum -Cerebral vein thrombosis, carotid dissection, pituitary apoplexy
Headache with cancer, HIV, systemic illness (fever, arteritis, collagen vascular disease)
Migraine
Unilateral Throbbing
Blur vision
Nausea
Sensitive to light
Population-based study
Only migraine without aura Only migraine with aura Both types
Migraine Aura
99% 31%
18%
n=163
Michael B. R. et al. Brain 1996: 119, 355-361
Teichopsia
(Greek for town wall vision)
Prevalence of Migraine
Adjusted prevalence of migraine by geographic area and meta-analysis of studies using IHS criteria
Clinical Picture
Genetic
Trigger factors
Migraine triggers
Diet
Chronobiologic
Physical exertion
Exercise Sex
Environmental factors
Hormonal change
Menstruation
Tension-type headache
Tension-type headache
Most common headache type Featureless headache, uncertain pathophysiology (mental or muscular cause?) HRQoL of Headache
When migraine become chronic, the headaches characters are similar to TTH
Excruciating headache
Unilateral headache
Cluster headache
Cluster headache and others TACs
ICHD-II Cephalalgia.2004
Cranial neuralgias
Cranial Neuralgias
The presence of sudden, sharp, aching,
lancinating, burning, and stabbing pain lasting from only a few seconds to less than 2 min and recurring repeatedly within short periods of time, which is often triggered by sensory or mechanical stimuli
ICHD-II, 2004
Trigeminal Neuralgia
brief electric shock-like pains abrupt in onset and termination limited to the distributions of the trigeminal nerve commonly stimuli: mechanical
Vertigo/Dizziness
Introduction
is a very common problem in clinical
practice
vertigo, and imbalance is 5-10%, and it reaches 40% in patients older than 40 years
Vertigo is...
an illusion of movement of body or environment; spinning, rotating, moving
vestibular disorder
Dizziness is...
very broad term...feeling off balance, rocking sensation, lightheadedness
disease of vestibular system (non-acute stage), psychogenic disorder, general medical condition
+++ +/Normal
+++ +/-
++ +/-
Causes of vertigo
Peripheral vertigo
Infection/inammation
Peripheral vestibulopathy
Vestibular neuritis, acute neurolabyrinthitis Localized: CN7+8 affected: Ramsay Hunt syndrome Systemic: mump, measle, IM, URI
Central vertigo Common is Tumor: CP angle tumor Demyelinating: MS Vascular: ischemia(VBI) Posterior fossa lesion Migraine Vertigenous epilepsy
Endocrine disease
Diabetes, hypothyroidism
Time course-onset
Lasting for day or longer Peripheral: vestibular neuritis Central: brainstem stroke, MS Lasting for hours or minute Peripheral: Menieres disease Central: TIA, migraine, seizure Lasting for second Peripheral: BPPV
Surat Tanprawate, MD, MSc(Lond.), FRCP(T) CertHE(Hist Med) Neurology staff, Division of Neurology, CMU The Northern Neuroscience Center, CMU