A 'common migraine' or 'tension-like' headache may arise after head injury and accompany other symptoms including light-headedness, irritability, difficulty in concentration and in coping with work. Although once thought to have a purely 'psychological' origin, especially with impending, litigation, it is now recognised that injuries severe enough to cause loss of consciousness or a period of post-traumatic amnesia result in some neuronal damage and abnormalities of evoked responses. A headache similar to migraine can occur after neck injury and responds to propranolol.
Treatment: As for tension headache.
GIANT CELL (TEMPORAL) ARTERITIS
Giant cell arteritis, an autoimmune disease of unknown cause, presents with headache in the elderly. This is severe and throbbing in nature and overlies the involved vessel - usually the superficial temporal artery, although the condition may affect any extra-or intracranial vessel.
Palpation reveals a thickened, tender, but nonpulsatile artery.
Neurological symptoms: strokes, hearing loss, myelopathy and neuropathy may result. Jaw claudication: pain when chewing or talking due to ischaemia of the masseter muscles is pathognomonic and occurs in a high proportion of patients.
Visual symptoms are common with blindness (transient or permanent) or diplopia. Associated systemic symptoms - weight loss, lassitude and generalised muscle aches -polymyalgia rheumatica in one-fifth of cases.
Duration: the headache is intractable, lasting until treatment commences. Mechanism:
Large and medium-sized arteries undergo intense 'giant cell' infiltration, with fragmentation of the lamina and narrowing of the lumen, resulting in distal ischaemia as well as stimulating pain sensitive fibres. Occlusion of important end arteries, e.g. the ophthalmic artery, may result in blindness; occlusion of the basilar artery may cause brain stem or bilateral occipital infarction.
Diagnosis: ESR usually high. Blood film shows anaemia or thrombocytosis. C-reactive protein and hepatic alkaline phosphatase elevated. Biopsy of 1 cm length of temporal artery is often diagnostic.
Treatment: Urgent treatment, prednisolone 60 mg daily, prevents visual loss or brainstem stroke, as well as relieving the headache. If complications have already occurred e.g. blindness, give parenteral high dose steroids. Monitoring the ESR allows gradual reduction in steroid dosage over several weeks to a maintenance level, e.g. 5 mg daily. Most patients eventually come off steroids; 25% require long-term treatment and if so, complications commonly occur.
Thickened wall with giant cell infiltrate
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Headache Happiness! Stop Your Headache BEFORE IT STARTS. How To Get Rid Of Your Headache BEFORE It Starts! The pain can be AGONIZING Headaches can stop you from doing all the things you love. Seeing friends, playing with the kids... even trying to watch your favorite television shows. And just think of how unwelcome headaches are while you're trying to work.