Headache. By Dr. Andrew Gutwein. We all get ‘em!. So why do patients come to the doctor? Severity Worried about brain tumor. Headache History. Be mute! Its all pattern recognition. Headache Physical.
By Dr. Andrew Gutwein
Its all pattern recognition.
Not your internists general physical exam! It’s not about the lungs, heart, and abdomen!
neurologic, not vascular vasoconstriction and vasodilation. It is the spreading depression/ depolarization of neurons across the cortex that results in a release of neurotransmitters which causes normal vascular pulsation to be felt as nociception.
3 Keys to the history:
Timeline: Lasts 4 hours to 3 days
Any hemicranial HA, any pulsating headache, and any neurologic phenomenon lasting over 20 minutes may also help clue you in on this diagnosis. 10% of migraine patients have aura and 50% of the time the aura is not followed by HA. When this happens it is called the dissociated migraine.
Treatment of mild to moderate Migraine:
2/3 of patients with migraine headache have mild migraine and never come to complain to you about the headache.
They self treat with: massage, relaxation techniques, avoiding light, going to bed, acetaminophen, low dose NSAIDs, or combination products like Excedrin Migraine which has aspirin, acetaminophen and caffeine in it.
These medications work well for many people but be wary of using any of these (especially ones with caffeine) too frequently for too long.
Acute treatment of the moderate to severe Migraine:
Who needs prophylaxis against migraines headaches?
Chronic prophylaxis against moderate to severe Migraine:
Taking medications for their headache!
People think the pills help the headache - the pills cause the headache.
These are people that may have started out with tension type or migraine headaches but now have almost daily headaches, frequently the whole day long.This is really rebound headache. CDH can be caused by any analgesic taken too frequently. It is worse in drugs with caffeine added (Fioricet, Excedrin) .