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Headache: the varieties, like the treatment methods, are endless

– Headache is one of the most common causes of patients seeking neurological care. According to the international classification of headaches, primary forms of GB are distinguished, that is, migraine, tension GB, trigeminal vegetative cephalalgia, other rare forms of primary GB – primary cough GB, hypnetic GB and others; and secondary forms of this disorder. Their causes can be injuries, vascular lesions, tumors, the use of various substances, infectious diseases. Despite the fact that in the vast majority of patients, GB is benign, the attention of a neurologist is primarily aimed at eliminating GB associated with potentially dangerous conditions. A thorough collection of complaints and medical history, as well as data from a neurological examination, are sufficient diagnostic methods in most cases. Additional diagnostic methods are required only in cases where there are alarming symptoms, the so-called “danger signals”, or changes in neurological status. These signals are described by a system of so-called “red and yellow flags”.

– Please explain what it is?

– The system of “red flags” is a complex of symptoms that makes one doubt the benign or primary nature of the pain and their presence requires further examination of the patient. A very common “red flag” or symptom of danger in hypertension is a head or neck injury.

– And what are the “yellow flags”?
-This is a system of factors that indicate a high probability of the transition of acute and subacute pain into chronic. This, for example, is an “alarm” GB, that is, associated with sleep disturbance, otherwise it is called sleep apnea syndrome, as well as headaches that arose against the background of progression of uncontrolled hypertension. Head trauma, dissection, intracranial aneurysm, lung tumor can cause the appearance of such a “yellow flag” as a newly arising, clearly localized GB.

– How is one or another type of GB diagnosed?

– The diagnosis of the form of GB is primarily based on the clinical approach, which includes the collection of complaints, medical history and neurological examination. At the first stage of the clinical examination, secondary GB is excluded using the following algorithm.

First of all, it involves identifying signs of a systemic disease. It should be ascertained whether the patient has fever, chills, night sweats, myalgia, weight loss. In the case of a positive response, it is necessary to exclude the presence of giant cell arteritis, infectious diseases, and neoplasms. Next, you need to ask a question about the history of cancer, immunodeficiency, HIV infection. Particular attention should be paid to the diagnosis of headaches with a sudden onset. To quantify the time of development of GB in a patient, one must ask how long the intensity of GB has increased from its onset to a peak in intensity. The sudden onset of GB is characterized by an increase in pain intensity over a split second, similar to a lightning strike. Thundering GB is most characteristic of vascular episodes, such as stroke. Let me remind you that primary GB rarely debut at the age of over 50. If such disorders nevertheless appear in an elderly patient, it is necessary to exclude neoplasms, inflammatory and infectious diseases of the central nervous system, and giant cell arteritis.

What are the criteria for diagnosing migraine?
– The diagnosis can only be made after at least five seizures have met that meet the international criteria for migraine. The duration of the attacks is 4-72 hours without treatment or with ineffective treatment.

GB has at least two of the following characteristics: one-way localization; pulsating character; moderate to significant pain intensity; GB worsens from normal physical activity or requires the cessation of normal physical activity, for example, walking up stairs. GB is accompanied by at least one of the following symptoms: nausea and / or vomiting; photo – or phonophobia … GB is not related to other reasons.

– What headache is characteristic for SUNCT syndrome?

– These forms are characterized by unilateral GB, accompanied by severe vegetative symptoms: lacrimation, redness of the eyes, nasal congestion, rhinorrhea, Horner’s syndrome, swelling, redness or blanching of the face on the side of pain

– What are the principles of stopping GB?

– Despite the high prevalence of GB tension in the population, patients with migraine often seek medical help, since self-management of a migraine GB attack is not always effective. According to European guidelines for managing patients with the most common forms of GB, simple analgesics can be used to stop a migraine attack. The choice of an anti-migraine agent is carried out individually, taking into account the frequency and severity of migraine attacks, the degree of violation of the patient’s daily activity, the severity of concomitant symptoms.

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