Clinical Neuropsychology: Open Access
Open Access

Headache; Neurology; Women; Social

Introduction

Approximately 95% of the general population will experience a headache at some point in their lives, and nearly one in two adults will experience a headache in the course of the year. Headache accounts for him in one in ten doctor's visits, one in three neurology referrals, and one in five acute care referrals. The World Health Organization ranks headaches among the top 10 causes of disability, and for women, headaches rank among the top 5.5, similar to arthritis and diabetes, and worse than asthma. In the UK, for example, 25 million workdays are lost each year to migraine headaches alone, with an indirect cost to the economy of around £2 billion in emergency care. With 75% of patients reporting functional impairment during migraine attacks and 50% requiring help from family and friends, the impact on individual quality of life is difficult to quantify and social have a big impact on your life.

Secondary headache disorders

Headache is divided into primary headache and secondary headache. Secondary headaches are rare, but detecting them is very important because timely intervention can be life-saving.The most important aspect of headache diagnosis is the medical history [1, 2]. Most patients, including those with frequent secondary headaches, have no symptoms and rarely require testing to rule out secondary headaches. Additionally, about 8% of the population may have random anomalies unrelated to headache, so unnecessary investigations should be avoided. The most common secondary headaches primarily involve mass lesions of intracranial tumors involve central nervous system infections, primarily meningitis or encephalitis, subarachnoid hemorrhage, giant cell arteritis, cerebral venous thrombosis, idiopathic intracranial hypertension.

Brain tumors rarely cause headaches in the early stages when focal neurologic deficits or seizures are more likely. Headache may be the only symptom presenting in 3-4% of tumors at later stages.

Sudden onset of an explosive headache (thunderclap) that peaks within 1 minute, especially in the absence of history of such attacks, should be evaluated for subarachnoid hemorrhage. Patients may complain of neck pain and stiffness with severe photophobia and/or vomiting [3]. Thunderclap headache is also characteristic of pituitary apoplexy, intracranial hypotension, arterial dissection, and reversible intracranial vasospasm. Because the cause cannot be determined, such headaches are classified as idiopathic and are considered possible acute migraine episodes. Periodic thunderclap headaches are less likely to be severe, such as headaches during intercourse (orgasmic headaches or genital migraines) [4]. These can be treated satisfactorily with conventional migraine prophylaxis.

Headache with fever, rash, decreased or altered level of consciousness suggests central nervous system infection (meningitis or encephalitis) and requires urgent referral to an infectious disease or neurologist. If the diagnosis is suspected, a loading dose of antibiotics is given to avoid treatment delays. Patients over the age of 50 who have a new-onset headache with systemic symptoms such as fever, malaise, night sweats, insomnia, loss of appetite, and weight loss should alert their physician to the possibility of giant cell arteritis [5, 6]. Acute inflammatory markers such as erythrocyte sedimentation rate, plasma viscosity, and C-reactive protein are often, but not always, elevated. A temporal artery biopsy may be helpful, but if this cannot be arranged urgently, steroid treatment should be initiated if the diagnosis is strongly suspected.

Headaches due to cerebral vein thrombosis are common among young women, especially those who smoke or use oral contraceptives [7]. The risk increases immediately after childbirth and during dehydration. This condition causes increased intracranial pressure, leading to early morning headache, nausea, disturbed consciousness, papilledema, and seizures. Diagnosis is suspected clinically and confirmed by imaging studies with computed tomography venography or magnetic resonance angiography. A patient with normal imaging and high CSF pressure on her spinal tap has idiopathic intracranial hypertension and is usually obese. These patients are at risk of permanent vision loss and require visual field assessment and regular monitoring by an ophthalmologist. Headaches due to sinus disease are very rare in the absence of other suspicious symptoms, and chronic sinusitis does not cause headaches unless there is an acute exacerbation. Refractive errors are often overrated as a cause of headaches. In the absence of associated symptoms, there are suggestions that headaches should not be secondary to disorders of the teeth, neck, teeth, or temporomandibular joints [8, 9].

Primary headache disorders represent the majority of headache disorders, with migraine and tension-type headache (TTH) being the most common [10]. TTH affects 60-80% of the population and the prevalence of migraine is 15% (7.6% in men, 18.3% in women) is a secondary headache disorder, often associated with and often described as a primary headache disorder.

Short-duration versus long-duration headaches

An important first step in the diagnostic process is to differentiate between primary headaches based on duration. Classification is based on whether untreated headache episodes last less than or longer than his 4 hours. The majority of short-term headaches belong to a specific category of headache disorder called 'trigeminal autonomic headache' (TAC) [11], with cluster headache being the most common more on cluster headaches later. A long-lasting headache is either a migraine or a TTH.

Episodic versus chronic

This classification is based on the number of headache days a person experiences in a month. The International Headache Society (IHS) defines chronic headache or chronic daily headache (CDH) as a headache that affects him more than 15 days in a month [12, 13], affecting 4% of the population. I am giving The majority of episodic headaches are tension-type or migraine, which is less disabling than chronic headache.Chronic migraine is responsible for a significant number of CDH. Other subtypes include chronic TTH (CTTH), continuous migraine, and new daytime headache.

Migraine

Migraine is the second most common type of headache and is characterized by frequent recurring, throbbing or throbbing, moderate to severe, often unilateral pain lasting 4 to 72 hours and lasting until the next attack. (episodic). Headaches are associated with nausea, vomiting, and/or sensitivity to light, sound, or odors. Patients prefer to lie still in a dark, quiet room and avoid physical activity. Approximately one-third of patients experience aura, described as progressive focal neurological symptoms lasting 5-60 minutes [14]. Visual aura in the form of zigzag lines or widening scotoma (diminished vision) is most common, but unilateral sensory deficits and/or aphasia can occur simultaneously or sequentially. Aura without headache (equivalent to migraine) may occur, especially in older people, and should be distinguished from transient ischemic attacks. A migraine-like aura usually develops within minutes and moves from one area to another.

Approximately 1.3 to 2.4 migraine sufferers have chronic migraine, and the IHS states that he has 15 or more headache days per month, of which he has 8 or more migraine features. is defined as Chronic migraine is the most debilitating form of migraine with a significant impact on health-related quality of life, comorbidities, and common concomitants of substance abuse [15, 16]. Unlike episodic migraine, patients with chronic migraine are more likely to be unemployed, have relationship difficulties and family problems, and do not respond to conventional acute and preventive treatments.

Tension-type headache

This is often called a non-characteristic headache because there are no associated symptoms associated with migraines. This condition is often diagnosed but poorly understood. Pain is described as pain or pressure, as if the head were clamped in a vise or had a tight band around it [17]. TTH is often transient and rarely affects daily life. Chronic variants are rare and may be associated with substance abuse.

Cluster headache

Cluster headache is the most common headache disorder in TAC. It is a specific subtype of primary headache disorder characterized by a short-lived, strictly unilateral headache with concomitant autonomic features of lacrimation, rhinorrhea, conjunctival hyperemia, and ptosis. Cluster headaches are more common (65%) among young men who smoke (3.5:1) [18], the pain is excruciating and often referred to as 'suicide headaches'. Attacks he lasts from 15 minutes to 3 hours, every other day he occurs from 1 to 8 times a day. The patient is very restless and agitated and often sweats profusely. Circadian rhythms are striking and seizures occur at the same time each day. Alcohol causes seizures in almost all cases. Cluster headaches are episodic in 80-90% of cases, with attacks occurring daily for weeks to months and then at intervals of months to years [19]. The chronic form has attacks that last for a year or more with no interval between symptoms or remission periods of less than a month.

Medication-overuse headache

MOH often complicates primary headache disorders and is a common complication of various CDH disorders. It remains unclear whether MOH was the cause or consequence of his CDH and whether prophylactic treatment should be initiated before or after discontinuing the overused medication. MOH affects 1-1.5% of the general population and accounts for 50-80% of patients presenting to specialized headache clinics [20]. Females are affected three times as often as males. Approximately two-thirds of patients who overuse painkillers have migraines and 27% have tension-type headaches. Neurology services in the UK are unlike elsewhere in Europe where all aspects of neurological care are provided by trained neurologists. For example, in the Netherlands he has one neurologist for every 30,000 population, and in Italy he has one neurologist for every 10,000 population. By comparison, in the UK, neurologists serve between her population of 117,000 and 200,000.2 Most acute neurological services are provided by resident physicians or general practitioners. University center (hub and spoke model) 1-2 days per week [21]. Since the mid- 1990s, counseling positions have expanded without a significant increase in training positions. As a result, recruitment of neurologists has been very difficult over the past decade. Given the lack of additional funding for National Health Service (NHS) facilities, the situation is unlikely to change and could get worse. Headaches are very common and some are very debilitating, but few are severe or life-threatening. This may explain the general perception that it is less attractive to young trainees in terms of choice.Students, even in neuroscience internships, receive little training in headache disorders. Therefore, medical schools are unlikely to provide an accurate diagnosis of headache disorders. This is probably why about 50% of headache sufferers do not consult a doctor [22]. Currently, 9% of his headache patients being treated in primary care are referred and evaluated by general neurologists, and many are discharged with relief [23].

In the current financial situation, the NHS has to make tougher decisions to deliver quality services with limited resources. The trend is to move non-emergency care services into primary care and bring health care closer to home. Some outpatient work wills likely shift to the community in many specialties, with secondary and tertiary services limited to emergency care and consultation for more complex and rare cases. Most neurological disorders are treated on an outpatient basis, and headaches account for more than a third of his cases. In the new NHS more headaches may be treated progressively by primary care or GPs. The most important aspect of headache management is an accurate diagnosis so that we can prescribe the most appropriate medications and refer only those who would most benefit from expert advice. Effective history taking alone, no special investigation required in the majority of patients. Most primary care physicians are aware of the treatment options available and their effective diagnostic skills enable them to adequately treat most headache disorders [24]. This can be achieved through dedicated headache education programs for those who are likely to meet headache sufferers.

The availability of modern technologies such as the Internet and mobile communications has made it easier for patients to obtain information about their condition, but patients find it difficult to interpret the information and lack knowledge. Being limited, you are more likely to worry about your own diagnosis. Public education is therefore becoming increasingly important to set the future direction of healthcare and to make the best use of scarce resources.

Tension-type headaches

TTHs, both acute and chronic, are rarely disabling and OTC analgesics such as paracetamol and ibuprofen are an effective treatment strategy for infrequent episodes. Those occurring more frequently may be prevented by the use of tricyclic antidepressants, such as amitriptyline, for a few months.

Migraine

The first line treatment for a migraine attack includes paracetamol gm or ibuprofen 600–800 mg or aspirin 900 mg with or without antiemetics such as domperidone 10–20 mg.These are available OTC and patients are advised to take them as soon as they know they have migraine. Those with aura should take the treatment at the start of the headache phase. Critics argue that early treatment when the headache is mild may lead to medication overuse; therefore, such advice is best for those who can differentiate migraine from non-migraine headaches. Other NSAIDs, such as naproxen and diclofenac, are equally effective but are prescription-only medications. Combination analgesics with caffeine and barbiturates and opioids must be avoided and the intake of acute medications must be restricted to less than 2 days/doses per week. Those who fail to respond or are unable to tolerate the first line are given triptans (stepped-care approach) although they may be used as the first line if it is judged to be the most appropriate acute treatment. Various commercially available triptans. Some have a rapid onset of action, such as: zolmitriptan 5 mg, rizatriptan 10 mg, and eletriptan 40 or 80 mg. However, due to its short half-life, recurrence of symptoms within 24 hours is problematic. Others, such as naratriptan and frovatriptan, have a slower onset of pain relief but are better at preventing relapses. Combinations of triptans and NSAIDs, such as naproxen, are more effective than when used alone. There is evidence that a patient who has three migraine attacks and is unresponsive to one triptan may be responsive to another triptan, and about one-third of patients are unresponsive to triptans. Oral agents In addition, some triptans may be suitable for people with severe vomiting early in a migraine attack.

Conclusion

Headache is one of the most common symptoms in the general population. Migraines and tension-type headaches predominate and can be diagnosed and treated with minimal education and training in primary care or by GPs and emergency physicians working in acute care. By training GPs through partnerships with headache clinics, we can look at some of the more complex patients and exclude only rare or infrequent referrals to specialized headache clinics for intractable treatments. You can develop a local champion (Specialty or Level 2 GP). This provides the basis for a cost-effective three-step headache treatment in the general population, as the NHS cannot cope with the majority of headache referrals to secondary and tertiary care in its current financial position.

1. Stovner L, Hagen K, Jensen R, Katsarava Z, Lipton R, et al.(2007) The global burden of headache: a documentation of headache prevalence and disability worldwide.Cephalalgia27: 193-210.

Indexed at, Google Scholar, Crossref

2. https://www.mstrust.org.uk/sites/default/files/files/Local%20adult%20neurology%20services%20for%20the%20next%20decade.pdf
3. https://www.researchgate.net/publication/233526171_Setting_up_a_Specialist_Headache_Clinic_in_Primary_Care_General_Practitioners_with_a_Special_Interest_GPwSI_in_Headache, https://www.rcpe.ac.uk/college/journal/acute-neurology-twenty-first-century-district-general-hospital
4. https://apps.who.int/iris/handle/10665/42390
5. Solomon GD, Price KL (1989)Burden of migraine: a review of its socioeconomic impact.Pharmacoeconomics11: 1-10.

Indexed at, Google Scholar, Crossref

6. Terwindt GM, Ferrari MD, Tijhuis M, Groenen SM, Picavet HS, et al. (2000)The impact of migraine on quality of life in the general population: the GEM study.Neurology55: 624-629.

Indexed at, Google Scholar, Crossref

7. Steiner TJ, Scher AI, Stewart WF, Kolodner K, Liberman J, et al. (2003) The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity.Cephalalgia23: 519-527.

Indexed at, Google Scholar, Crossref

8. Clarke CE, MacMillan L, Sondhi S, Wells NE (1996)Economic and social impact of migraine.Q J Med 89: 77-84.

Indexed at, Google Scholar, Crossref

9. www.bash.org.uk
10. Kernick D, Stapley S, Goadsby PJ, et al. (2008)What happens to new-onset headache presented to primary care? A case cohort study using electronic primary care records.Cephalalgia28: 1189-1195.

Indexed at, Google Scholar, Crossref

11. Kurtzke JF (1984)Neuroepidemiology.Ann Neurol16: 265-277.

Indexed at, Google Scholar, Crossref

12. Harle DE, Evans BJ (2006)The correlation between migraine headache and refractive errors.Optom VisSci83: 82-87.

Indexed at, Google Scholar

13. Ekbom K, Svensson DA, Pederson NL, Waldenlind E (2006)Lifetime prevalence and concordance risk of cluster headache in the Swedish twin population.Neurology67: 798-803.

Indexed at, Google Scholar, Crossref

14. Katsarava Z, Dzagnidze A, Kukara M, Mirvelashvili E, Djibuti M, et al.(2009) Prevalence of cluster headache in the republic of Georgia: results of a population-based study and methodological considerations.Cephalalgia29: 949-952.

Indexed at, Google Scholar, Crossref

15. Bahra A, Goadsby PJ (2004)Diagnostic delays and mis-management in cluster headache.Acta Neurol Scand109: 175-179.

Indexed at, Google Scholar, Crossref

16. https://journals.sagepub.com/doi/10.1111/j.1468-2982.2003.00824.x
17. https://Indexed at.ncbi.nlm.nih.gov/16686915/
18. Castello J, Munoz P, Glitera V, Pascual J (1999) Kaplan Award 1998: epidemiology of chronic daily headache in the general population.Headache39: 190-196.

Indexed at, Google Scholar, Crossref

19. Blumenfield AM, Varon SF, Wilcox TK, Buse DC, Kawata AK, et al. (2011)Disability, HRQoL and resource use among chronic and episodic migraineurs; results from the International Burden of Migraine Study (IBMS).Cephalalgia 31: 301-315.

Indexed at, Google Scholar, Crossref

20. Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, et al. (2008)Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study.Headache41: 303-309.

Indexed at, Google Scholar, Crossref

21. https://www.semanticscholar.org/paper/THE-CHANGING-FACE-OF-CHRONIC-MIGRAINE%3A-WHO-TO-HOW-Goadsby-Ahmed/75996b8519586cced4be4ba676ccc66c2f664417
22. Bigal ME, Serrano D, Reed M, Lipton RB(2008) Chronic migraine in the population: burden, diagnosis, and satisfaction with treatment.Neurology71: 559-566.

Indexed at, Google Scholar, Crossref

23. Nesbitt AD, Goadsby PJ (2012)Cluster headache.BMJ344: e2407.

Indexed at, Google Scholar

24. https://journals.sagepub.com/doi/10.1111/j.1468-2982.2006.01172.x