Headache

Headache is a common illness I’ll encounter almost everyday at the Neurology Department outpatient clinic. I can even now claim myself as a headache specialist! (sebab hari2 ade je patient yang dtg complain sakit kepala!). When a new patient came (known as OB here. OB stands for Orang Baru) they will straight come to Dokter Muda (me and my team friends), we have our own room to actually history taking and examine our patients *wink*wink. All the SOAP (Subjective complain, Objective, Assessment and Planning) will be written in order in the patients’ medical records.

For me to actually diagnose what type of headache, I’ll need to collect as much data as possible and match them with the physical examination. It is important to determine the character, severity, site, duration, frequency, radiation, aggravating and relieving factors and the associated symptoms. And from that, i'll need to figure out weather the pain is vascular or muscular in origin.


Four type of headaches according to their frequencies are: Tension-type headache, migraine headache, sinus headache, headache with systemic infection (Eg meningitis) and head trauma. Of these, tension-type headache is the most to be encountered in an outpatient clinical practice (You’ll only find head trauma in the ER rather than in outpatient! ;p).


What is headache? Headache is pain or discomfort between the orbits (your eyes) and occiput (an area near the back of your neck), arising from pain sensitive structures. Pain sensitive structures inside your scull are : venous sinuses, cortical veins, basal arteries, dura of anterior, middle and posterior fossa.

The commonest type of headache, experienced by 70% males and 90% females at some time of their lives, is Tension-type headache. It is also known as muscle-contraction headache. It is caused by sustained contraction of the muscles around your head and caused by such trivial issues as stress, fatigue and lack of sleep. Unless frequent, if not daily, people is unlikely to come for medical attention because the headache can be relieved simply by over-the-counter nonprescription analgesics.

Treatment : the most correct treatment is muscle-relaxants (because it is caused by muscle contraction so we treat by giving mucle-relaxants.) such as Carisoprodol 350 mg, Chlorzoxazone 500 mg or Metaxalone 800 mg. But most people will be comfort enough with 2 panadols due to analgesics property of the drug. In Rumah Sakit Saiful Anwar, these patients will usually be given a combination of Paracetamol 400mg, Diazepam 2 mg, Amitriptilin 5mg and Cafein 30mg.



Next is migraine. Migraine headache is divided into migraine with aura and without aura. An aura is a warning of visual, sensory or motor type. Patients will complain that they will start to see a flash of lightening, zig-zags, sudden visual loss or hear something just minutes before they have migraine attack. These headache is also assosiated with pallor, coldness of the hands and feet, nausea, vomiting and diarrhea.


What is the cause? It is caused by arterial vasodilation (pembuluh darah anda mengembang dan menekan saraf-saraf di kepala) in combination with neurogenic inflammation, preferentially involving the frontal branch artery of the superficial temporal artery, giving rise to the throbbing pain in the temple (rasa sakit berdenyut yang bersamaan dengan denyut pembuluh darah di daerah berdekatan telinga di kepala anda).

People tend to have migraines after having coffee (kandungan caffein), dark chocolate (kandungan phenylethtylamine) or MSG (ajinomoto) in food. So please avoid these! In some woman, migraine usually occur in relation to her menstrual cycle.

Treatment : Almotriptans, Electriptan, Zolmitriptan and other triptan drugs.

Ok, hopefully this will be informative for readers, till the next entry!!

Source : My kitab Manual of Neurologic Therapeutics 7th Edition and Adam's =)