Diğer Birincil Baş Ağrıları
Özet
Nöroloji polikliniklerine en sık başvuru nedeni olan baş ağrıları, Uluslararası Baş Ağrısı Derneği'nin (IHS) Ocak 2018 sınıflamasına göre ayrılmaktadır. Bu metinde, altta yatan yapısal bir neden olmaksızın belirli durumlarda ortaya çıkan seyrek primer (birincil) baş ağrısı tipleri incelenmiştir. Öksürük, ıkınma veya Valsalva manevrasıyla tetiklenen ve indometazine iyi yanıt veren primer öksürük baş ağrısı genellikle 40 yaş üstü erkeklerde görülür. Gençlerde ve fiziksel aktivite sırasında/sonrasında oluşan pulsatil karakterli primer egzersiz baş ağrısı, ısınma hareketleri ve profilaktik ilaçlarla önlenebilir. Cinsel aktivite ile ilişkili primer baş ağrısı genellikle bilateral ve patlayıcı tarzda olup orgazm döneminde şiddetlenir. Kısa sürede maksimum şiddete ulaşan ani başlangıçlı primer gök gürültüsü baş ağrısında ise serotonin agonistlerinden kaçınılmalıdır. Soğuk uyaran baş ağrısı, soğuğa dıştan maruz kalma veya soğuk bir şey yeme/içmeyle tetiklenirken; eksternal bası baş ağrısı şapka, baret gibi aksesuarların basısıyla frontal bölgede sıkıştırıcı tarzda oluşur. Trigeminal alanda yer değiştirebilen primer saplanıcı baş ağrısı birkaç saniye süren bıçak saplanması hissi yaratır. Özellikle 50 yaş sonrasında uykudan uyandıran hipnik baş ağrısı "saat alarmı" olarak bilinir ve kafein ya da lityumla tedavi edilir. Kafa derisinde küçük, para şeklinde sınırlı bir alanda hissedilen nummuler baş ağrısı kronikleşme eğilimindedir. Son olarak, başlangıç zamanı net hatırlanan ve 3 aydan uzun süren yeni günlük ısrarlı baş ağrısı (NDPH) ise tedavisi oldukça dirençli bir türdür.
Headaches, which are the most common reason for admission to neurology outpatient clinics, are classified according to the January 2018 classification of the International Headache Society (IHS). This text examines rare primary headache types that occur under specific conditions without an underlying structural cause. Primary cough headache, triggered by coughing, straining, or Valsalva maneuvers and highly responsive to indomethacin, is typically seen in men over the age of 40. Primary exertional headache, which occurs in young individuals during or after physical activity with a pulsatile character, can be prevented with warm-up exercises and prophylactic medications. Primary headache associated with sexual activity is generally bilateral and explosive, intensifying during orgasm. In primary thunderclap headache, which is an abrupt-onset pain reaching maximum intensity within short periods, serotonin agonists must be avoided. Cold-stimulus headache is triggered by external cold exposure or ingesting/inhaling cold materials, while external pressure headache presents as a pressing-type pain in the frontal region due to the compression of accessories like hats or helmets. Primary stabbing headache, which can shift within the trigeminal area, creates a sharp, ice-pick sensation lasting only a few seconds. Hypnic headache, known as the "alarm clock" headache because it awakens patients from sleep particularly after the age of 50, is managed with caffeine or lithium. Nummular headache, felt within a small, coin-shaped circumscribed area on the scalp, tends to become chronic. Lastly, new daily persistent headache (NDPH), which has a distinctly remembered onset and lasts longer than 3 months, represents a highly treatment-resistant type.
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