The diagnosis of cluster headache is made by the patient history of
symptoms. The description of the pain and its clock-like recurrence is
usually enough to make the diagnosis. If examined in the midst of an
attack, the patient is usually in a pain crisis and may have the eye and
nose watering as described above. If the patient presents when the pain
is not present, the physical examination is normal and the diagnosis
again depends upon the patient history.
Cluster headaches may be very difficult to treat, and II make take trial and error to find the specific treatment
regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled , and additional headaches need to be prevented. Initial treatment options may include the following:
* inhalation of high concentrations of oxygen;
* injection of tryptan medications, for example, sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt) which are commonly used for migraine treatments as well
* injection of lidocaine, a local anesthetic, into the nostril;
* dihydroergotamine (DHE, Migranal), a medication that causes blood vessels to constrict and
* caffeine.
The International Headache Society lists eight categories of secondary headache. A few examples in each category are noted (this is not a complete list): Head and Neck Trauma
* Injuries to the head may cause bleeding in the spaces between the layers of tissue that surround the brain (subdural, epidural and subarachnoid bleeding) or within the brain tissue itself Concussions, where head injury occurs without bleeding A symptom of whiplash and neck
* injury Blood Vessel Problems in the Head and Neck
* Stroke or transient ischemic attack (TIA)
* Arteriovenous malformations (AVM) may cause headache before they leak.
The carotid artery in the neck can become inflamed and cause pain.
* Temporal arteritis (inflammation of the temporal artery).
* Brain tumors, either primary, originating in the brain or metastatic from a cancer that began in another organ.
* Seizures. Medications and Drugs (including withdrawal from those drugs) Infection
* Meningitis.
* Encephalitis.
* HIV/AIDS.
* Systemic infections (for example, pneumonia orJ influenza).
Changes in the Bodys Environment
* High blood pressure (hypertension).
* Dehydration.
* Hypothyroidism.
Problems with the Eyes, Ears.. Nose Throat, Teeth and Neck Psychiatric Disorders.
The patient history and physical examination providing the best means for determining the cause of secondry headaches. Therefore, it is extremely important that patient with severe headaches seek medical care and give their care practitioner an opportunity to assess their condition. Tests that may be useful in making the diagnosis of the underlying disease causing headaches include:
* Blood tests,
* computerized tomography (CT Scan), to detect bleeding, swelling, and tumor.
* magnetic resonance imaging (MRI) scans of the head, and
* lumbar puncture. Cerebro-spinal fluid, the fluid that surrounds the brain and spinal cord, can be obtained with a needle that is inserted into the spine in the lower back. In almost all cases, computerized tomography is done prior to lumbar puncture to make certain there is no bleeding, swelling, or tumor in the brain.
TREATMENT OF CLUSTER HEADACHES
Cluster headaches may be very difficult to treat, and II make take trial and error to find the specific treatment
regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled , and additional headaches need to be prevented. Initial treatment options may include the following:
* inhalation of high concentrations of oxygen;
* injection of tryptan medications, for example, sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt) which are commonly used for migraine treatments as well
* injection of lidocaine, a local anesthetic, into the nostril;
* dihydroergotamine (DHE, Migranal), a medication that causes blood vessels to constrict and
* caffeine.
WHAT DISEASES CAUSE SECONDARY HEADACHES?
The International Headache Society lists eight categories of secondary headache. A few examples in each category are noted (this is not a complete list): Head and Neck Trauma
* Injuries to the head may cause bleeding in the spaces between the layers of tissue that surround the brain (subdural, epidural and subarachnoid bleeding) or within the brain tissue itself Concussions, where head injury occurs without bleeding A symptom of whiplash and neck
* injury Blood Vessel Problems in the Head and Neck
* Stroke or transient ischemic attack (TIA)
* Arteriovenous malformations (AVM) may cause headache before they leak.
The carotid artery in the neck can become inflamed and cause pain.
* Temporal arteritis (inflammation of the temporal artery).
Non-Blood Vessel Problems of the Brain
* Brain tumors, either primary, originating in the brain or metastatic from a cancer that began in another organ.
* Seizures. Medications and Drugs (including withdrawal from those drugs) Infection
* Meningitis.
* Encephalitis.
* HIV/AIDS.
* Systemic infections (for example, pneumonia orJ influenza).
Changes in the Bodys Environment
* High blood pressure (hypertension).
* Dehydration.
* Hypothyroidism.
Renal dialysis.
Problems with the Eyes, Ears.. Nose Throat, Teeth and Neck Psychiatric Disorders.
EXAMS AND TESTS FOR SECONDARY HEADACHES
The patient history and physical examination providing the best means for determining the cause of secondry headaches. Therefore, it is extremely important that patient with severe headaches seek medical care and give their care practitioner an opportunity to assess their condition. Tests that may be useful in making the diagnosis of the underlying disease causing headaches include:
* Blood tests,
* computerized tomography (CT Scan), to detect bleeding, swelling, and tumor.
* magnetic resonance imaging (MRI) scans of the head, and
* lumbar puncture. Cerebro-spinal fluid, the fluid that surrounds the brain and spinal cord, can be obtained with a needle that is inserted into the spine in the lower back. In almost all cases, computerized tomography is done prior to lumbar puncture to make certain there is no bleeding, swelling, or tumor in the brain.
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