英文Headache.ppt

Instruction Primary headache In most patients No physical signs Diagnosis is made entirely from the history Secondary headache The other disorders affecting the head and the neck Sometimes it is the predominantly symptom of serious intracranial disease, usually vascular , infective, or neoplastic Instruction Pain may be referred from the ears, eyes, nasal passage, teeth, sinuses, facial bones, and cervical spine. It is conveyed by the fifth, seventh, ninth, tenth cranial nerves, and the upper three cervical roots. Structure of the anterior and middle cranial fossa ---- anterior two-thirds of the head ---- the trigeminal nerve Structure of the posterior fossa --- back of the head and neck ---- the upper cervical roots Differential diagnosis The approach to assessing a patient with headache should be based on the temporal pattern of symptoms , especially the mode of onset and subsequent course , this may be: Recurrent and episodic Chronic and daily Subacute onset Acute onset Recurrent and episodic Recurrent and episodic headache is usually benign and is very rarely due to structure or progressive pathology Migraine Cluster headache Trigeminal neuralgia Benign exertional /cough headache Intermittent hydrocephalus Paroxysmal hypertension Recurrent and episodic Migraine Unilateral throbbing headache Exacebated by movement Accompanied by nausea, vomiting ,photo-,phona-and osmophobia +/- aura symptoms Recurrent and episodic Cluster headache Severe unilateral retro-orbital +/- temporal pain Ipsilateral conjunctival injection , lacrimation Partial Horner’s syndrome Nasal blockage , rhinorrhoea Attacks last 15-180minutes and occur several times a day for about 2-3 months at a time Recurrent and episodic Trigeminal neuralgia Jabs of severe unilateral pain in the 2nd and 3rd distribution of the trigeminal nerve Triggered by actions such as chewing ,brushing teeth, talking ,cold wind B