Headache

Headache is one of the commonest problems to face the family doctor and hospital practitioners. Though migraine and tension headaches are the most common, other types could reflect serious underlying structural causes. Accurate diagnosis can usually be made from a complete history and examination. However, referral of some patients to a specialist clinic is inevitable.     

Headache

The patient who presents with headache can be diagnosed quickly and efficiently once the correct pattern has been identified. Most patients will have migraine, and treatment is based on the severity and disability. If the identified patient has significant disability, a medication that treats comorbidity should be prescribed. Patients who have a serious underlying disorder can be recognized by a thoughtful history and careful examination and can be worked up accordingly. Patients who have an acute new onset headache problem that requires immediate attention can be triaged and treated once their pattern and history are clear. Hopefully, increasing comfort levels with diagnosing headaches will allow the primary care practitioner to treat headache patients more effectively and efficiently.     

Headache

The most common chronic recurrent headaches are vascular headache of the migraine type or muscle-contraction headache, or a combination. Pharmacotherapy is used for acute attacks and often for prophylaxis. Treating the usually large underlying psychologic component is of major importance.     

Bath-Related Headache

Purpose of Review

The purpose of this review is to summarize the most up-to-date literature on bath-related headache, a rare disorder.

Recent Findings

Initially described in middle-aged Asian women, it is now reported in a wider demographic. More information is available about the pathophysiology of bath-related headache, including its classification as a subtype of reversible cerebral vasoconstriction syndrome (RCVS). Nimodipine can be effective in patients both with and without vasospasm.

Summary

Bath-related headache is a rare form of thunderclap headache. Although its mechanism is still unclear, it is associated with vasospasm and RCVS. Controlled trials investigating the use of nimodipine and other agents may be useful in furthering our understanding of and treatment of this phenomenon.

     

Chiari Headache

Purpose of Review

Chiari malformations (CM) are a group of neuroanatomical pathologies resulting from overcrowding of the hindbrain. The purpose of this review is to characterize Chiari headache (CH) and describe diagnosis and treatment of the condition.

Recent Findings

Recent research has helped solidify the criteria for diagnosis of CH. Imaging studies have expanded our understanding of the morphological features producing them and helped to better characterize the pathophysiology. Additionally, identifying this unusual headache disorder accurately has helped with specific treatment options.

Summary

CH is a disabling condition which can effect multiple domains of a patient’s life. The diagnostic criteria has improved, and we now have a better understanding of the pathophysiology and imaging findings associated with CH. Future research is warranted to find new treatment options for individuals suffering from this condition.

     

Headache angina

The initial recognition of acute myocardial infarction at the time of the emergency department (ED) visit may be difficult in the absence of typical presentations such as chest pain, diaphoresis, and radiation tenderness. Headache angina, although reported in several instances in the past with variable patient outcomes, is still an uncommon phenomenon in patients with acute myocardial infarction. We report a patient with inferior myocardial infarction who presented to the ED with a complaint of severe headache and subsequent cardiogenic shock secondary to ventricular fibrillation.     

Lithium-Induced Headache

A 23-year old woman developed headache and papilledema due to benign intracranial hypertension (BIH) while taking lithium carbonate for only seven months because of manic-depressive disease. Having discarded other causes, drug ingestion was the most likely etiology of the syndrome since it was observed that symptoms improved upon lithium withdrawal and worsened when the treatment was restarted. This report shows that BIH may appear as a side-effect of relatively short-term therapy with lithium and, therefore, funduscopic exams should be performed in every patient receiving this drug.     

Ranitidine Headache

SYNOPSIS
Five patients developed severe headaches in close association with the use of ranitidine. Two required hospitalization and three had recurrence of headaches on rechallenge. One had exacerbation of classic migraine. Headaches varied from intermittent and throbbing to steady and continuous, and onset was 12 hours to several months after beginning treatment; but all patients improved dramatically within 48 hours after ranitidine was discontinued. The great variability of ranitidine headache has important clinical and theoretical implications.