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.
Patients may have both migraines
and tension type headaches,
a heightened sensitivity to pain pathways
is thought to play a role in tension
type headaches, which can be episodic
or chronic in nature.
Migraines may precipitate tension type
headaches and vice versa.
Tension type headaches are often
relieved with over-the-counter
analgesics, such as acetaminophen,
ibuprofen and naproxen.
may also respond to these medications.
It's important to avoid overuse
of over-the-counter analgesics and assess
patients for analgesic abuse,
although these are not addictive.
Overuse can lead to chronic daily
headaches, which are defined on the slide.
headaches do not respond to ergot
amines, and opioids are not recommended.
Preventative management for tension type
headaches includes behavioral therapies
This may include counseling and stress
Regular relaxation, meditation, exercise
and avoidance of excess
caffeine or alcohol are also important
in reducing tension type headaches.
In addition to these healthy lifestyle
recommendations, prophylactic medications
may be needed.
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.