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Headache at 30 weeks of gestation - Coggle Diagram

- - - - Worsens with stress and in the evening
      - Typical descriptions: "a tight band around my head"
      - May develop in association with neck or back pain/ facial neuralgias
      - May sometimes comes with photo- or phonophobia
      - Not associated with nausea and vomiting
      - Often dull, diffuse, bilateral and non-pulsating
      - Not affected by activity
        (contrary to migraine: worsens with activity)
      - May be localized to either head or neck
      - Typically pressing or tightening in quality
      - Precipitating factors: lack of sleep, stress, do not eat on time
      - The pain is usually experienced as a band extending bilaterally back from the forehead across the sides of the head to the occiput.
  - - - Frequent
        
        More than 12 days and less than 180 days per year
        
        Less than 15 days per month for at least 3 months
      - Infrequent
        
        Less than 12 days per year
    - - More than 180 days per year
      - More than 15 days per month for at least 3 months
  - - - Detailed clinical history and careful physical and neurological exam
        
        Neurological evaluation: rule out any serious intracranial pathology (Specifically, cranial nerve defects, cerebellar dysfunction, papilledema or absent venous pulsations on fundal examination, visual field defects, or motor or sensory deficits should be considered.
        These findings may suggest occult brain tumors, hemorrhage, or increased cerebrospinal fluid pressure.
        
        Physical examination: Palpation of the head may reveal tenderness in the pericranial muscles and tension in the nuchal musculature or trapezius.
  - - - For patients with frequent episodic tension-type headache: simple analgesics and NSAIDs are the mainstay in acute therapy.
        e.g. Aspirin (500 mg and 1000 mg), Acetaminophen (1000 mg) and NSAIDs such as Ibuprofen
        The most efficacious drug for preventing recurrent ETTH is amitriptyline.
        (It should be started on low dose (10 mg to 25 mg per day) and gradually increased if needed.)
      - Caffeine, codeine, sedatives, or tranquilizers combined with NSAIDs should be avoided because of the risk of dependency, abuse, and chronification of the headache.
      - drug overuse should be identified and stopped
    - - Physical therapy
        
        It is the most commonly used non-pharmacologic treatment of TTH.
        Its components include: improvement of posture, relaxation, exercise programs, hot and cold packs, ultrasound, and electrical stimulation.
        A controlled study combining various techniques, such as massage, relaxation, and home-based exercises found a modest effect.
        Adding craniocervical training to classical physiotherapy may be better than physiotherapy alone.[46]
      - Psychologic therapy
        
        Components:
        
        Relaxation training
        
        EMG biofeedback
        
        Cognitive-behavioral therapy.
- - - - Primigravida
      - Age >40 years
      - Pregnancy interval >10 years
      - BMI >35 kg/m² at first visit
      - Family history of PE
      - Multiple pregnancy
    - - Hypertensive disease during previous pregnancy
      - Chronic kidney disease
      - Autoimmune disease such as SLE or APS
      - Type 1 & type 2 DM
      - Chronic hypertension
- - - - speech problems
      - blurring of vision
      - difficulty moving parts of the body
      - hearing disturbance
      - seizure
- - - - Migraine with aura (complicated migraine)
      - Migraine without aura (common migraine)
      - Status migrainosus
        
        Rare and severe type of migraine that can last longer than 72 hours. The headache pain and nausea can be extremely bad
      - Hemiplegic migraine
        
        rare and severe form of migraine that causes temporary paralysis sometimes lasting several days
    - - Aura
        
        A group of sensory, motor and speech symptoms that usually act like warning signals that a migraine headache is about to begin. E.g. bright flashing dots, sparkles, lights, tinnitus, numb or tingling skin.
      - Headache attack
        
        starts gradually and builds in intensity. pain can move from one side of your head to the other.
      - Prodrome
        
        Symptoms occur up to 24 hours prior to developing a migraine. E.g. food cravings, unexplained mood changes (depression or euphoria), urinary frequency.
      - Postdrome
        
        exhausted or confused following a migraine. The postdrome period may last up to a day before people feel healthy again.
  - - - women > men
    - - Depression, anxiety, bipolar disorder, sleep disorders, and epilepsy
  - - - Increase levels of the neurotransmitter serotonin in the brain. Serotonin causes blood vessels to constrict and lowers the pain threshold
    - - Propranolol