Headache!!!

             Fening? sakit kepala? is it headache? in history taking of headache, use SRCOPDSARA (emphasis in distribution, duration, character and ass factor) ...what diffential diagnosis that you consider?: (think of structure and pathology)

• migrain, tension headache, compound headache
• nerve- trigeminal neuralgia
• artery - giant cell arteritis
• infection 
• increase intracranial pressure (eg tumour, haemorrhage) -pappilodema
• eye and eye glaucoma, sinusitis
• drug (opiod overdose, analgesic, rebound headache - bifrontal headache)

Tension headache

• acute onset lasting from hours to days.
• describe bilateral of band tight headache, non pulsating.
• precipitate by emosion. On examintion, neck and scalp tenderness.
• believed is due to irritation of neurovascular  and scalp muscle.

Migraine

• acute onset lasting from hours to days.(72hr)
• aura bfr (visual, sensory and aphasia)
• describe it as unilateral (usually) pulsating.
• aggrevated by physical activity.
• precipitated by food, light, premenstrual sysmp, ocp(eg choc, cheese)
• ass w nausea and vomitting.
• recurrent.
• F.hx
• coz by dilatation of of blood vessel.

Trigeminal Neuralgia

• acute onset lasting for mins
• involve 1 or more distribution of trigeminal nerve
• clue usually not cross midline.
• decribe it as instense, sharp and stabbing pain.
• no neurological deficit.

Giant cell arteritis.

• acure onset of pulsating headache
• may hav sudden visual disturbance (eg: amaurosis fugax)
• ass with malaise, fever and tiredness
• older age
• on examination.tender in scalp and temporal/occipital area
• due to inflammatory granulomatous arteritis of large arteries which occurs which occurs in association with polymyalgia rheumatica.
• ix: increase ECR and CRP, artery biopsy.
• tx: high dose of corticosteroid