Headache

Headache is a common complaint requiring emergency evaluation when it is associated with neurologic deficit

Primary headache syndromes include migrain with or without aura,tension headaches,and cluster headaches.Posttraumatic,exertional,cough and cold-induced,and fleeting ice pick headaches are also considered within the same category after underlying structural lesions have been excluded.The etiology of primary headache syndromes is poorly understood.

Migraines are commonly unilateral ,pulsating or throbbing,with associted nausea ,vomitting,and phonophotophobia,duration varies from 4-72hours.They tend to build over minutes to hours.Longer spells constituate intractable migraines or " status migrainosus" The aura of classics migraine is a transient visual,motor,sensory,cognitive,or psychic disturbance that usually lasts minutes and precedes or coincedes with the headaches.Provoking factors may be identified and include stress, hunger, fatigue,sleep deprivation or excess,physical exertion,bright light,alcohol,menstruation,pregnancy,oral contraceptive,foods (cheese,chocolate),food additives (monosodium glutamate,nitric),and nitroglycerine,migraines occur more commonly in females,and the first episode usually occurs before 30years of age.

Tension headaches is often diagnosed when headaches are chronic , bilateral,constricting ,non pulsatile,and associated with neck muscle regidity.Stress and anxiety are common aggravating factors. Migranous symptoms often overlap and can be difficult to seperate from tension headache . Tension headaches typically occur daily ,begin later in the day,and wax and wane in intensity.

Cluster headaches are more common in males,excruciatingly painful,unilateral,orbital,and periorbital or temporal in location;lasts 0.5-2.0 hours ; and are associted with unilateral autonomic disfunction (lacrimation,ptosis,myosis,nasal congestion,or conjunctival injection).Alcohol and nitroglycerin are known precipitants of cluster headaches.Most sufferers assume an upright position to alleviate the discomfort (as opposed to napping in a darkened room as with migraines).Periodicity is a hallmark of cluster headaches,with pain often recurring daily at about the same hours."Cluster "lasts days to weeks and recur at interval of months to years .In contrast,chronic cluster headaches recur at interval of 4-5 years.