Headache Pain Outlines Topics Nociception: Transduction Nociception: Transmission Nociception: Modulation The ANS Pain measurement Epidemiology of mental illness Deafferentiation pain Peripheral neuropathies and neuralgias Sympathetic dystrophies Central pain syndromes Post-herpetic neuralgia Extremity pain Low back pain Headache Pediatric pain Antidepressants Anticonvulsants Neurolytic blocks Celiac plexus block Neurosurgical procedures Epidural steroids Local anesthetics Psychological techniques Spinal stimulation TENS

1. Mechanisms of head pain
   1. direct pressure
   2. traction or distortion
   3. excessive generalized or local vasodilatation
   4. muscle contraction
   5. inflammation
   6. neuralgia
   7. disorder of the nociceptive system
   8. psychiatric/ behavioral disorder

   
   

2. History

   1. Family history is important. Migraine runs in families, but muscle contraction and brain tumors do not.

   
   

3. HPI

   H/A with fever / stiff neck, H/A after injury, Possible signs of organic disease, change in character of H/A, H/A with unconsciousness, change in response to TMT, no PMH of H/A, H/A with HTN, H/A with neurologic changes, H/A with coughing, straining, H/A with onset after age 50.

   
   

4. Possible lab studies

   MMPI EEG cognitive testing CT scan, MRI skull X-ray sleep studies neck X-ray arteriogram doppler blood flow lumbar puncture

   
   

V. Classification of Headache

Headache Classification Quickmenu Vascular Muscle-contraction Combined Nasal vasomotor reaction Delusional, hypochondriacal Nonmigrainous vascular Traction Cranial inflammation

1. Vascular headache of migraine type
2. Muscle-contraction headache
3. Combined headache: vascular and muscle contraction
4. Headache of nasal vasomotor reaction
5. Headache of delusional, conversion, or hypochondriacal states
6. Nonmigrainous vascular headache
7. Traction headache
8. Headache due to overt cranial inflammation
9. -XIII
   Headache due to disease of ocular, aural, nasal and sinusal, dental or other cranial or neck structures.

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