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    Chronic Idiopathic Headache

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    AnneCanapi
    1. Chronic idiopathic headache (CIH) is a common complaint that impacts millions of patients and costs billions annually. 2. CIH includes tension-type headaches, migraines, and cluster headaches. Tension-type headaches cause pain in the neck and head while migraines cause pulsating pain on one side of the head along with nausea. Cluster headaches are the most painful and predominantly affect men. 3. Treatment options for CIH include avoiding triggers, symptomatic treatment using medications, preventative treatment using medications or non-pharmacological methods, and strategies like treating early, changing medications if needed, and recording headaches. The treatment of CIH requires understanding triggers and giving patients realistic expectations.

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    Chronic Idiopathic Headache

    Uploaded by

    AnneCanapi
    22 views2 pages
    1. Chronic idiopathic headache (CIH) is a common complaint that impacts millions of patients and costs billions annually. 2. CIH includes tension-type headaches, migraines, and cluster headaches. Tension-type headaches cause pain in the neck and head while migraines cause pulsating pain on one side of the head along with nausea. Cluster headaches are the most painful and predominantly affect men. 3. Treatment options for CIH include avoiding triggers, symptomatic treatment using medications, preventative treatment using medications or non-pharmacological methods, and strategies like treating early, changing medications if needed, and recording headaches. The treatment of CIH requires understanding triggers and giving patients realistic expectations.

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    CHRONIC IDIOPATHIC HEADACHE

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    1. Chronic idiopathic headache (CIH) is a common complaint that impacts millions of patients and costs billions annually. 2. CIH includes tension-type headaches, migraines, and cluster headaches. Tension-type headaches cause pain in the neck and head while migraines cause pulsating pain on one side of the head along with nausea. Cluster headaches are the most painful and predominantly affect men. 3. Treatment options for CIH include avoiding triggers, symptomatic treatment using medications, preventative treatment using medications or non-pharmacological methods, and strategies like treating early, changing medications if needed, and recording headaches. The treatment of CIH requires understanding triggers and giving patients realistic expectations.

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    22 views2 pages

    Chronic Idiopathic Headache

    Uploaded by

    AnneCanapi
    1. Chronic idiopathic headache (CIH) is a common complaint that impacts millions of patients and costs billions annually. 2. CIH includes tension-type headaches, migraines, and cluster headaches. Tension-type headaches cause pain in the neck and head while migraines cause pulsating pain on one side of the head along with nausea. Cluster headaches are the most painful and predominantly affect men. 3. Treatment options for CIH include avoiding triggers, symptomatic treatment using medications, preventative treatment using medications or non-pharmacological methods, and strategies like treating early, changing medications if needed, and recording headaches. The treatment of CIH requires understanding triggers and giving patients realistic expectations.

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    of 2

    ENT

    HEADACHE
    Dr. Alberto Calderon FPSO-HNS
    2nd Shifting/ August 19, 2010
    Jam|Kris|Elysse|Keke|Karing|Mikko

    CHRONIC IDIOPATHIC HEADACHE (CIH) TENSION-TYPE HEADACHE


     Possible areas of pain:
    Social Impact of Headache o Upper back and neck
     Primary complaint in 10M consulting patients o Base of the head
     US$ 7B in annual lost labor o The ears
     10M physician office visits per year o Above the ears
     5-10% of population annually seeks medical help o The jaw
    o Above the eyes
    Pathogenesis of Migraine
     Painful dilatation of cranial vessels triggered by certain CLUSTER HEADACHE
    factors (internal and external) mediated by several chemicals  Most painful type of CIH
    (histamine, serotonin, etc.) and consummated by the  Predominantly male
    trigeminal nerve (“headache nerve”  Onset usually in the late 20’s
     Attacks come in clusters, typically 1-2 years
    Nice to know: Cephalalgia- medical term for headache   Bouts occur for 10 minutes to 2 hours and each cluster lasts
    for 2-3 months
    Syndrome of Daily Headache  Average remission is about 2 years
     Repeated therapeutic failure  1 or 2 attacks per day often nocturnal
     Multiple analgesic use and abuse  Pain in or around the eye (retroorbital)
     Codeine and barbiturate overuse  Conjunctival injection
     Associated depression  Lacrimation/tearing
     Female preponderance  Nasal congestion
     Rhinorrhea
    Diagnosis of Migraine/Headache  Forehead and facial sweating
     No diagnostic test  Eyelid edema
     Only through symptomatology
     There are several types of migraine headache, but most are Treatment Options
    characterized by severe pain on one or both sides of the Overview
    head (which may move to the other side), nausea, dizziness  Avoid trigger factors
    and visual disturbances caused by dilation and constriction  Symptomatic treatment
    of the blood vessels in the head.  Prophylaxis
     Non-pharmacologic treatment
    Criteria for Office Diagnosis of Tension-type Headache
     Headache pain accompanied by any 2 of the following: Trigger Factors
    o Pressing or tightening (non-pulsating) quality  Stress 9family or work-related)
    o Bilateral location  Depression
    o Not aggravated by physical activities  Hormonal
    o No nausea or vomiting  Hypoglycemia
    o No photophobia or phonophobia  Fatigue
    o No evidence of organic disease  Sleep factors (heat and cold)
     Food
    Criteria for Office Diagnosis of Classic Migraine o Chocolates, coffee, colored soda, tea, MSG, flavor
     Headache pain accompanied by any 2 of the following: enhancers, red wine, nuts, nitrate-containing foods
    o Pulsating quality
    o Unilateral location Tension-type Headache
    o Aggravated by physical activities  Identifying and eliminating trigger factors
    o With nausea or vomiting  Optimum use of analgesics
    o With photophobia or phonophobia  Using anti-depressants as prophylactic treatment after the
    o No evidence of organic disease acute episode has been controlled

    * Symptoms are the opposite of tension-type headache Pharmacologic Treatment of Acute Attacks of Migraine
     NSAID (i.e Naproxen, Ibuprofen)
     Ergot alkaloids (i.e Ergotamine)
     Tartrate (Avamigran)
     Anti-emetics
     Others [i.e. Sumatriptan (Imigran)]

    Key to Successful Treatment of CIH


    ANYA DYOSANG PIPAY FAIFAI WEB JOJO ARLS JESS AYKI JAM KRISETTE ELYSSE KEKE KARING MIKKO YEL EM BOK SHENG ANNE KRISTINE KUKIS CYNTHIA
    KIWI NATHAN MIGGY MAYEE MACOY BONI ROD JEANS KATHY PENG BABY JI HOO CHACHA JAJA DEE AILA JERMIE CATH OJ MAI POYENG DET ELAINE
    FAYE REUBEN LULU LELE YIMMY LEE THEA JEN MEYMEY DIA ANNE CRISTINE MAIKA MARC GELIQ DOP BEDA YEN
    ENT
    HEADACHE
    Page 2 of 2

     Explain rationale of therapy


     Give realistic expectations
     Dark and quiet room
     Stop nausea
     Allow patient to relax or sleep
     Treat at the earliest sign

    Strategies for Symptomatic Relief


     Initiate medications as early as possible
     Initiate new medications at lowest dose
     Administer each dose over at least 3 attacks before
    increasing dose
     Rest
     If ineffective
    o Increase dose
    o Change route of administration
    o Change medications
    o Add anti-emetic

    Cluster Headache
     Oxygen (mega dose)→vasoconstricts (15L/min)
     Sumatriptan injection
     Lidocaine 4% (intranasal)
     Greater occipital nerve block

    Prophylactic Treatment: Pharmacologic Agents


     Beta-blockers (Propranolol)
     Calcium antagonist
     5-HT2 antagonist (i.e. Pizotifen)

    Non-Pharmacologic Treatment for CIH


     Relaxation techniques (i.e yoga)
     Acupuncture
     Diet
     Behavioral approach (i.e. Psychoanalysis/ Psychiatric
    Approach)

    Strategies for Prophylactic Treatment for CIH


     Initiate medications at lowest dose
     Avoid analgesic/ergotamine abuse
     Record headache symptoms/medications and occurrences
    (report card)

    “The treatment of headache is an art as much as it is a science.”


    -AF Calderon MD

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