generate barcode in c# asp.net PRINCIPAL VARIETIES OF HEADACHE in Microsoft Office

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PRINCIPAL VARIETIES OF HEADACHE
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There should be little dif culty in recognizing the acute headaches of migraine, glaucoma, purulent sinusitis, subarachnoid hemorrhage, and bacterial or viral meningitis and the subacute headache of brain tumor provided that these sources of headache are kept in mind A fuller account of these types of headache may be found in later chapters of this book, where the underlying diseases are described When the headache is chronic, recurrent, and unattended by other symptoms and signs of neurologic disease, the physician faces a more dif cult diagnostic problem The following types of headaches should then be considered (Table 10-1) In general, the classi cation of these headaches and other types of craniofacial pain follow the plan outlined by the International Headache Society (see Olesen) One area of controversy in classi cation concerns the status (and indeed the existence) of tension headache A currently held view, with which the authors do not entirely agree, is that there is a continuum between migraine and tension headache This relationship is considered further on
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Migraine
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Migraine is a ubiquitous familial disorder characterized by periodic, commonly unilateral, often pulsatile headaches that begin in childhood, adolescence, or early adult life and recur with diminishing frequency during advancing years Two closely related clinical syndromes have been identi ed, the rst called migraine with aura and the second, migraine without aura (terminology of the International Headache Society) For many years the rst syndrome was referred to as classic or neurologic migraine and the second as common migraine The ratio of classic to common migraine is 1:5 Either type may be preceded by vague premonitory changes in mood and appetite (a prodrome) Migraine with aura, the term now used to denote classic migraine, is ushered in by an evident disturbance of nervous function, most often visual, followed in a few minutes by hemicranial or, in about one-third of cases, by bilateral headache, nausea, and sometimes vomiting, all of which last for hours or as long as a day or two Migraine without aura is characterized by an unheralded onset over minutes or longer of hemicranial headache or, less often, by generalized headache with or without nausea and vomiting, which then follows the same temporal pattern as the migraine with aura Sensitivity to light and noise attends both types, and intensi cation with movement of the head is common If the pain is severe, the patient prefers to lie down in a quiet, darkened room and tries to sleep The hemicranial and the throbbing (pulsating) aspects of migraine are its most characteristic features in comparison to other headache types; each patient displays a proclivity for the pain to affect one side or the other of the cranium, but not exclusively The genetic nature of classic migraine is apparent from its occurrence in several members of the family of the same and successive generations in 60 to 80 percent of cases; the familial frequency of common migraine is slightly lower Twin and sibling studies have not revealed a consistent mendelian pattern in either the classic or common form; the inheritance in all likelihood is
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Table 10-1 Common types of headache
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CLINICAL CHARACTERDIURNAL PATTERN LIFE PROFILE AGE AND SEX ISTICS PROVOKING FACTORS ASSOCIATED FEATURES TREATMENT
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TYPE
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Migraine without aura (common migraine)
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Frontotemporal Uni- or bilateral
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Throbbing (pulsatile); worse behind one eye or ear Becomes dull ache and generalized Scalp sensitive Same as above Family history frequent Same as above Same as above
Upon awakening or later in day Duration: 4 24 h in most cases, sometimes longer
Irregular intervals, weeks to months Tends to decrease in middle age and during pregnancy
Bright light, noise, tension, alcohol Relieved by darkness and sleep
Nausea and vomiting in some cases
148 Adolescent and adult males (90%) Intense, nonthrobbing Usually nocturnal, 1 2 h after falling asleep Occasionally diurnal
Migraine with aura (neurologic migraine)
Same as above
Adolescents, young to middle-aged adults, sometimes children, more common in women Same as above
Same as above
Ergotamine sumatriptan, nonsteroidal anti-in ammatory agents Propranolol or amitriptyline for prevention Same as above
Cluster (histamine headache, migrainous neuralgia)
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