generate barcode in c# HEADACHE AND OTHER CRANIOFACIAL PAINS in Microsoft Office


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(2 mg orally) Inhalation of 100% oxygen for 10 to 15 min at the onset of headache may also abort the attack, but this is not always practical Intranasal lidocaine, or sumatriptan (or zolmitriptan as for migraine, see above) can also be used to abort an acute attack In other patients, ergotamine given once or twice during the day, at times when an attack of pain is expected, has been helpful With regard to prevention during a cluster, if ergotamine and sumatriptan are not effective or become ineffective in subsequent bouts, most headache experts prefer to use verapamil, up to 480 mg per day Ekbom introduced lithium therapy for cluster headache (600 mg, up to 900 mg daily) and Kudrow has con rmed its ef cacy in chronic cases Lithium and verapamil may be given together, but lithium toxicity is a frequent problem Methysergide (2 to 8 mg daily) has also been successful as a prophylactic measure but has potential secondary effects that make it less appealing than the alternatives A course of prednisone, beginning with 75 mg daily for 3 days and then reducing the dose at 3-day intervals, has been bene cial in many patients Usually it can be decided within a week if any of these medications is effective Indomethacin (Indocin, 75 to 200 mg/day) has reportedly been ef cacious in the chronic form of cluster headache but was ineffective in several of our patients Propranolol has been suggested as prophylaxis by some headache experts In brief, no method is effective in all cases, but the best initial approach probably involves the use of one of the sumatriptan compounds Rare cases of intractable cluster headache, in which the syndrome persists for weeks or longer without remission, have been treated by partial section of the trigeminal nerve, as described by Jarrar and colleagues
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Tension Headache
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This, the most common variety of headache, is usually bilateral, with occipitonuchal, temporal, or frontal predominance or diffuse extension over the top of the cranium The pain is usually described as dull and aching, but questioning often uncovers other sensations, such as fullness, tightness, or pressure (as though the head were surrounded by a band or clamped in a vise) or a feeling that the head is swollen and may burst On these sensations, waves of aching pain are superimposed These may be interpreted as paroxysmal or throbbing and, if the pain is more on one side, the headache may suggest a migraine without aura However, absent in tension headache are the persistent throbbing quality, nausea, photophobia, and phonophobia of migraine Nor do most tension headaches seriously interfere with daily activities, as migraine does The onset is more gradual than that of migraine, and the headache, once established, may persist with only mild uctuations for days, weeks, months, or even years In fact, this is the only type of headache that exhibits the peculiarity of being present throughout the day, day after day, for long periods of time The term chronic tension-type headache is used to signify this type of chronic daily headache, which is often associated with anxiety and depression, as noted below Although sleep is usually undisturbed, the headache is present when the patient awakens, or it develops soon afterward, and the common analgesic remedies have little or no bene cial effect if the pain is of more than mild to moderate severity The incidence of tension headache is certainly greater than that of migraine However, most patients treat tension headaches themselves and do not seek medical advice Like migraine, tension headaches are more common in women than in men Unlike migraine, they infrequently begin in childhood or adolescence but are more likely to occur in middle age and to coincide with anxiety,
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fatigue, and depression in the trying times of life In the large series of Lance and Curran, about one-third of patients with persistent tension headaches had readily recognized symptoms of depression In our experience, chronic anxiety or depression of varying degrees of severity is present in the majority of patients with protracted headaches Migraine and traumatic headaches may be complicated by tension headache, which, because of its persistence, often arouses fears of a brain tumor or other intracranial disease However, as Patten points out, not more than one or two patients out of every thousand with tension headaches will be found to harbor an intracranial tumor, and in our experience, the discovery of a tumor has been most often accidental (see further on) In a substantial group of patients, the headache, when severe, develops a pulsating quality, to which the term tension-migraine or tension-vascular headache has been applied (Lance and Curran) This is particularly the case in patients with protracted and chronic daily headaches Observations such as these have tended to blur the sharp distinctions between migrainous and tension headaches in some cases For many years it was taught that tension headaches were due to excessive contraction of craniocervical muscles and an associated constriction of the scalp arteries However, it is not clear that either of these mechanisms contributes to the genesis of tension headache, at least in its chronic form Until recently it has been felt that in most patients with tension headache, the craniocervical muscles are quite relaxed (by palpation) and show no evidence of persistent contraction when measured by surface electromyographic (EMG) recordings Anderson and Frank found no difference in the degree of muscle contraction between migraine and tension headache However, using an ingenious laser device, Sakai et al have reported that the pericranial and trapezius muscles are hardened in patients with tension headaches Recently, nitric oxide has been implicated in the genesis of tension-type headaches, speci cally by creating a central sensitization to sensory stimulation from cranial structures The strongest support for this concept comes from several reports that an inhibitor of nitric oxide reduces muscle hardness and pain in patients with chronic tension headache (Ashina et al) At present, these are interesting but speculative ideas Treatment of Tension Headache Simple analgesics, such as aspirin or acetaminophen or other NSAIDs, may be helpful, but only for brief periods Tension headaches respond best to the cautious use of one of several drugs that relieve anxiety or depression, especially when these symptoms are present Stronger analgesic medication should be avoided Raskin reports success with calcium channel blockers, phenelzine, or cyproheptadine Ergotamine and propranolol are not effective unless there are symptoms of both migraine and tension headache Some patients respond to ancillary measures such as massage, meditation, and biofeedback techniques Relaxation techniques may be helpful in teaching patients how to deal with underlying anxiety and stress (Lance)
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