WHAT IS THE HEADACHE.
A painful sensation in any part of the head, ranging from sharp to dull, that may occur with other symptoms.acute headache and Chronic headache.chronic headache is migraine.
Headache is among the most common reasons patients seek medical
attention, on a global basis being responsible for more disability than
any other neurologic problem.
Diagnosis and management are based
on a careful clinical approach augmented by an understanding of the
anatomy, physiology, and pharmacology of the nervous system path-
ways mediating the various headache syndromes.
ANATOMY AND PHYSIOLOGY OF HEADACHE
Pain usually occurs when peripheral nociceptors are stimulated in
response to tissue injury, visceral distension, or other factors
In such situations, pain perception is a normal physiologic response
mediated by a healthy nervous system.
Pain can also result when
pain-producing pathways of the peripheral or central nervous system
(CNS) are damaged or activated inappropriately. Headache may origi-
nate from either or both mechanisms.
Relatively few cranial structures
are pain-producing; these include the scalp, meningeal arteries, dural
sinuses, falx cerebri, and proximal segments of the large pial arteries.
The ventricular ependyma, choroid plexus, pial veins, and much of the
brain parenchyma are not pain-producing.
MANY RESION OF HEADACHE
• The large intracranial vessels and dura mater and the peripheral
terminals of the trigeminal nerve that innervate these structures
• The caudal portion of the trigeminal nucleus, which extends into
the dorsal horns of the upper cervical spinal cord and receives input
from the first and second cervical nerve roots (the trigeminocervical
• Rostral pain-processing regions, such as the ventroposteromedial
thalamus and the cortex
• The pain-modulatory systems in the brain that modulate input from
trigeminal nociceptors at all levels of the pain-processing pathways
and influence vegetative functions, such as hypothalamus and
The innervation of the large intracranial vessels and dura mater by
the trigeminal nerve is known as the trigeminovascular system. Cranial
autonomic symptoms, such as lacrimation, conjunctival injection, nasal
congestion, rhinorrhea, periorbital swelling, aural fullness, and ptosis, are
prominent in the trigeminal autonomic cephalalgias (TACs), including
cluster headache and paroxysmal hemicrania, and may also be seen
in migraine, even in children.
CLINICAL EVALUATION OF ACUTE, NEW-ONSET
The patient who presents with a new, severe headache has a differ-
ential diagnosis that is quite different from the patient with recurrent
headaches over many years. In new-onset and severe headache, the
probability of finding a potentially serious cause is considerably
greater than in recurrent headache.
Patients with recent onset of pain
require prompt evaluation and appropriate treatment. Serious causes
to be considered include meningitis, subarachnoid hemorrhage, epi-
dural or subdural hematoma, glaucoma, tumor, and purulent sinusitis.
When worrisome symptoms and signs are present rapid
diagnosis and management are critical.
A careful neurologic examination is an essential first step in the
evaluation. In most cases, patients with an abnormal examination or a
history of recent-onset headache should be evaluated by a computed
tomography (CT) or magnetic resonance imaging (MRI) study of the
As an initial screening procedure for intracranial pathology in
this setting, CT and MRI methods appear to be equally sensitive. In
some circumstances, a lumbar puncture (LP) is also required, unless
a benign etiology can be otherwise established. A general evaluation
of acute headache might include cranial arteries by palpation; cervical
spine by the effect of passive movement of the head and by imaging;
the investigation of cardiovascular and renal status by blood pressure
monitoring and urine examination; and eyes by funduscopy, intraocular
pressure measurement, and refraction.
The psychological state of the patient should also be evaluated
because a relationship exists between head pain, depression, and anx-
iety. This is intended to identify comorbidity rather than provide an
explanation for the headache, because troublesome headache is seldom
simply caused by mood change. Although it is notable that medicines
with antidepressant actions are also effective in the preventive treat-
ment of both tension-type headache and migraine, each symptom must
be treated optimally.
Underlying recurrent headache disorders may be activated by
pain that follows otologic or endodontic surgical procedures. Thus,
pain about the head as the result of diseased tissue or trauma may
reawaken an otherwise quiescent migraine syndrome. Treatment of the
headache is largely ineffective until the cause of the primary problem
Serious underlying conditions that are associated with headache are
described below. Brain tumor is a rare cause of headache and even less
commonly a cause of severe pain. The vast majority of patients present-
ing with severe headache have a benign cause.
SECONDARY HEADACHE or CHRONIC HEADACHE
The management of secondary headache focuses on diagnosis and
treatment of the underlying condition.
Acute, severe headache with stiff neck and fever suggests meningitis.
LP is mandatory. Often there is striking accentuation of pain with eye
movement. Meningitis can be easily mistaken for migraine in that the
cardinal symptoms of pounding headache, photophobia, nausea, and
vomiting are frequently present,
Acute, maximal in <5 min, severe headache lasting >5 min with stiff
neck but without fever suggests subarachnoid hemorrhage. A rup-
tured aneurysm, arteriovenous malformation, or intraparenchymal
hemorrhage may also present with headache alone. Rarely, if the
hemorrhage is small or below the foramen magnum, the head CT scan
can be normal. Therefore, LP may be required to diagnose definitively
BEST HOMOEOPATHIC TREATMENT OF ACUTE AND CHRONIC HEADACHE.
1) BELLADONNA 30 CH 2 drops every 1 hours during Acute headache
Chronic headache : BELLADONNA 30 CH 2 drops used 3 times a day
2) GLONOINUM 30 CH: 2 drops 3 times a day.
3) VERATRUM VIRIDE : 30 CH used.
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