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There should be little dif culty in recognizing the acute headaches of migraine, glaucoma, purulent sinusitis, subarachnoid hemorrhage, and bacterial or viral meningitis and the subacute headache of brain tumor provided that these sources of headache are kept in mind A fuller account of these types of headache may be found in later chapters of this book, where the underlying diseases are described When the headache is chronic, recurrent, and unattended by other symptoms and signs of neurologic disease, the physician faces a more dif cult diagnostic problem The following types of headaches should then be considered (Table 10-1) In general, the classi cation of these headaches and other types of craniofacial pain follow the plan outlined by the International Headache Society (see Olesen) One area of controversy in classi cation concerns the status (and indeed the existence) of tension headache A currently held view, with which the authors do not entirely agree, is that there is a continuum between migraine and tension headache This relationship is considered further on

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Migraine is a ubiquitous familial disorder characterized by periodic, commonly unilateral, often pulsatile headaches that begin in childhood, adolescence, or early adult life and recur with diminishing frequency during advancing years Two closely related clinical syndromes have been identi ed, the rst called migraine with aura and the second, migraine without aura (terminology of the International Headache Society) For many years the rst syndrome was referred to as classic or neurologic migraine and the second as common migraine The ratio of classic to common migraine is 1:5 Either type may be preceded by vague premonitory changes in mood and appetite (a prodrome) Migraine with aura, the term now used to denote classic migraine, is ushered in by an evident disturbance of nervous function, most often visual, followed in a few minutes by hemicranial or, in about one-third of cases, by bilateral headache, nausea, and sometimes vomiting, all of which last for hours or as long as a day or two Migraine without aura is characterized by an unheralded onset over minutes or longer of hemicranial headache or, less often, by generalized headache with or without nausea and vomiting, which then follows the same temporal pattern as the migraine with aura Sensitivity to light and noise attends both types, and intensi cation with movement of the head is common If the pain is severe, the patient prefers to lie down in a quiet, darkened room and tries to sleep The hemicranial and the throbbing (pulsating) aspects of migraine are its most characteristic features in comparison to other headache types; each patient displays a proclivity for the pain to affect one side or the other of the cranium, but not exclusively The genetic nature of classic migraine is apparent from its occurrence in several members of the family of the same and successive generations in 60 to 80 percent of cases; the familial frequency of common migraine is slightly lower Twin and sibling studies have not revealed a consistent mendelian pattern in either the classic or common form; the inheritance in all likelihood is.

CLINICAL CHARACTERDIURNAL PATTERN LIFE PROFILE AGE AND SEX ISTICS PROVOKING FACTORS ASSOCIATED FEATURES TREATMENT

The term peripheral is typically used to refer to external and internal computer components that are not essential for system operation On a PC, virtually any device that is not memory or CPU can be considered a peripheral Interestingly enough, monitors are external devices and are not considered a peripheral Keyboards, mice, and external devices such as a scanner or Zip drive are considered peripherals Disk drives, floppy drives, network cards, and other devices that are installed internally to the PC are considered internal peripherals Many peripheral devices use a proprietary interface or connection to the system, though the trend is to use standardized interfaces as much as possible

DATA_AND_INDEX This value turns on the following settings for data and index blocks:

Migraine without aura (common migraine)

Throbbing (pulsatile); worse behind one eye or ear Becomes dull ache and generalized Scalp sensitive Same as above Family history frequent Same as above Same as above

148 Adolescent and adult males (90%) Intense, nonthrobbing Usually nocturnal, 1 2 h after falling asleep Occasionally diurnal

There are several types of keyboards, including 84- and 101-key designs Newer keyboards might include a variety of additional keys for accessing the Internet, using Microsoft Windows, and other common functions Some keyboards even include a pointing device, such as a mouse or touch pad There are also several keyboard layouts The keyset on an ergonomic keyboard (see Figure 1-7) is split in half and slants outward to provide a more relaxed, natural hand position The placement of the keys themselves can also vary Typical keyboards have a QWERTY layout, the name of which is taken from the first six letters on the second row of the keyboard The Dvorak keyboard has an entirely different key layout (shown in Figure 1-8) and is designed to allow faster typing speeds

Migraine with aura (neurologic migraine)

Ergotamine sumatriptan, nonsteroidal anti-in ammatory agents Propranolol or amitriptyline for prevention Same as above

DB_BLOCK_CHECKSUM to FULL DB_BLOCK_CHECKING to FULL DB_LOST_WRITE_PROTECT to TYPICAL This value turns on the following settings only for

Cluster (histamine headache, migrainous neuralgia)

Scintillating lights, visual loss, and scotomas Unilateral paresthesias, weakness, dysphasia, vertigo, rarely confusion Lacrimation Stuffed nostril Rhinorrhea Injected conjunctivum Ptosis

FIGURE 1-7

Ergotamine before anticipated attack, O2, sumatriptan Methysergide, corticosteroids, verapamil, valproate, and lithium in recalcitrant cases

Pressure (nonthrobbing), tightness, aching Intense, steady deep pain, may be worse in neck Variable intensity May awaken patient Steady pain Lasts minutes to hours; worse in early AM, increasing severity Persists for weeks to months None Once in a lifetime: weeks to months None Sometimes position Single episode None Neck stiff on forward bending Kernig and Brudzinski signs

For meningitis or bleeding (see text)

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DATA_ONLY data blocks:

Intermittent, then Throbbing, then continuous persistent aching and burning, arteries thickened and tender

Papilledema Vomiting Impaired mentation Seizures Focal signs Loss of vision Polymyalgia rheumatica Fever, weight loss, increased sedimentation rate

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