Let’s take a look at brain tumors,
part of your chronic
There’s no classic headache syndrome
that defines a tumor, or even a mass.
So, it’s about suspicion,
and that could be a little
dangerous because not everyone,
not all doctors are going
to be as astute as you are.
Typically of insidious onset,
though could be sudden.
Be careful with
May be diffuse or localized, but
localization does not necessarily
imply tumor location.
May be worse in the morning or waken
patient at night due to raised ICP,
Focal deficit may be present,
and obviously, imaging
must be done initially.
Most common variety
of headache is this.
May limit but not prohibit activities.
often with occipital,
temporal, frontal band.
You wear a band around your head
if you’re running, exercising.
That’s what this particular description
is, bandlike predominance.
Typically dull and aching,
but pressure is not infrequent.
Onset is more gradual
than with migraine.
even though it’s a chronic headache,
we’re talking about 30 minutes
in which all of a sudden,
it becomes very,
Here, with tension, it’s more gradual.
Mild nausea may be present.
Associated symptoms are absent or mild.
And here, it’s important that
you pay attention to tenderness
in the cervical paraspinal
or temporalis muscle,
may be seen but is not
common nor diagnostic.
Just keep that in mind as being, perhaps,
a presentation that you’ll be given.
Typically respond to your
Tylenol, Advil, Aleve.
OTC stands for over-the-counter analgesics.
Clear? Tension headaches.
This is when you start
worrying about this patient
who becomes addicted to such
just because we say
over-the-counter, you know
that the number one cause of some of these
issues in the liver in such, or kidney.
It could be some of these
NSAIDS or acetaminophen.
Cautious use of OTC,
absolutely, must be exercised.
Opioids should be avoided
because once again,
this is how the patient is
going to develop addiction,
and this is a huge problem in our society.
You have far too many doctors who
wish to take care of the patient by
negligibly administering opioids
and not understanding or not wishing
to accept the addictive nature of it.
IV ketorolac effective for severe episodes.
And ergotamines are
not effective here.
In migraines, ergotamines
might be given, but remember,
you’re worried about gangrene as
being a possible adverse effect.
Now, without the treatment,
tends to persist for days,
often recurring after walking each morning,
and worsening during late
afternoon or evening.
There’s a recurrence after
walking each morning,
and worsening during later
afternoon or evening.
Welcome to tension headache,
not a good place to be.
Beta blockers are not
In migraines, quite or could.
Treat underlying anxiety and depression
really is what it comes down to.
These patients tend to be stressed
out about something, huh?
And for each individual, now this
is where it becomes interesting,
is the fact that we all have
different threshold for stress.
Some of us, even the little bit of
“anxiety” is enough of a threshold
in which the patient
develops tension headache.
For others, the
threshold is limitless.
So, you want to be quite familiar
with the psychology of your patients.
Psychotherapy is the most effective
because you’re looking for
that underlying stress
that the patient doesn’t even know
that he or she is experiencing,
and it could be something, just
driving or work, relationships,
whatever it may be,
but this oftentimes, will be
helpful in refractory cases.