Head pain is a common health problem with a global prevalence of 47% (symptoms occurring at least once in the past year) and women are disproportionately affected (3:1). Many factors, like stress, anxiety, injury and migraine can lead to headaches. In European populations, the annual sex-adjusted prevalence for tension-type headache is 35%, for migraine is 38%, but for cluster headache is only 0.15%. Consequently, sometimes the high frequency and intensity of headaches affects a patient’s quality of life and a diagnosis and effective treatment make a huge difference to the patient and can be very rewarding for the clinician.
Most Common Syndromes
Cluster headache (CH) is a primary headache disorder, belonging to the trigeminal autonomic cephalalgias (TACs). As compared to other disorders within the TAC category, patients with cluster headache experience multiple attacks of relatively short-lasting severe headaches. The headaches are characteristically excruciating, unilateral, and commonly involves the first division of the trigeminal nerve, over the peri- and retro-orbital regions and in the temple. The quality of the pain is severe, intense, sharp, and burning and it is commonly described to be worse than childbirth.
Tension-type headache (TTH) is the most common form of headache. It can be categorized into three subtypes. TTH comprises headache attacks with mild to moderate pain intensity and is often described as having a pressing or tightening (nonpulsating) quality. The pain lasts for at least several hours to days and is predominantly felt bilaterally.
Paroxysmal hemicrania (PH) is a primary headache disorder belonging to the group of trigeminal autonomic cephalalgias(TACs). Patients typically experience intense lateralized headaches with pain primarily in the ophthalmic trigeminal distribution (V1) associated with superimposed ipsilateral cranial autonomic features. PH is distinguished from other TACs by an exquisite responsiveness to therapeutic doses of indomethacin. Patients may need to be maintained on indomethacin for several months before trials of reduction can be attempted.
Short‑lasting unilateral neuralgiform headache attacks (SUNHA) is characterized by sudden brief attacks of severe unilateral head pain in orbital, periorbital, or temporal regions, accompanied by ipsilateral cranial autonomic symptoms. There are two subtypes: short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). In SUNCT, the ipsilateral autonomic symptoms must consist of both conjunctival injection and lacrimation.
We have a team expert in diagnosis and management of the head.
Botulin Toxin Injection
Botulinum toxin is a potent neurotoxin that inhibits release of acetylcholine at the neuromuscular junction.
Pharmacological management pain is commonly part of the treatment and a wide range of drugs can be used to manage pain.
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