الفهرس 
MigraineOnly 14 pages are availabe for public view
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Abstract
There are many causes of headache that affect women in different life stages these causes include migraine, cluster headache, tension headache, cerebral sinus thrombosis, CNS vasculitis, pseudotumor cerebri, meningioma and choriocarcinoma.
Migraine occurs more commonly in women than men. Hormonal fluctuations during menstruation, pregnancy, postpartum, and menopause are the key factor in the increased prevalence of migraine in women. The principal diagnostic features of migraine are throbbing pain, unilateral pain, duration from 4 to72 hours, nausea, photophobia, phonophobia and exacerbation by routine physical activity. Migraine treatment begins with making a diagnosis, explaining it to the patient, and developing a treatment plan that considers co-existent conditions. Pharmacotherapy may be acute or preventive, and patients may require both approaches. Acute treatment can be specific (ergots and triptans), or nonspecific (analgesics and opioids). Nonspecific medications control the pain of migraine or other pain disorders, while specific medications are effective in migraine and certain other headache attacks but are not useful for non-headache pain disorders.
Cluster headache seems to be increasing in women, which may be secondary to women taking on the occupations and vices of men. The disorder in women is not exactly the same as in men. It seems to start earlier in life in women. Menstruation, use of oral contraceptives, pregnancy, and menopause had a limited influence on attacks of cluster headache. The aim of treatment of cluster headache is prevention of attacks. During clusters, alcohol is prohibited ergotamine can be given and if ergot is unsuccessful sumatriptan, or methysergide or verapamil are useful alternatives. Also Oxygen at the onset is often effective. Lithium is useful in the chronic variant if other methods fail. In intractable cases, a short course of steroids often provides relief. Surgery is seldom indicated.
Tension-type headache is the most common of human complaints. Its prevalence ranges from 1.3% to 65% in men and 2.7% to 86% in women. In tension-type headache pain is diffusely felt all over the head, often located on the vertex, or may start in the forehead or in the neck. Tension-type headache is psychogenic its mechanisms are not wholly understood. It is commonly bilateral, but may be unilateral. Patients characteristically complain of pressure, a feeling of tightness, or a heavy weight pressing on the crown. Tension-type headache is associated with stress and the treatment strategy should allow maintaining normal daily activities while coping with headache. The goal is to reduce the frequency of headaches. Women with tension-type headache benefit from a supportive approach with counseling, stress management, and medication.
Cerebral venous and sinus thrombosis (CVST) is more common in women than men with a ratio of approximately 3 to one. This is due to gender-specific risk factors, especially oral contraceptives, and to a lesser extent pregnancy, puerperium, and hormone replacement therapy. The most frequent symptom of sinus thrombosis is severe headache, which is present in more than 90 percent of adult patients. Diagnosis can be confirmed by MR imaging in most cases. Early recognition of the condition and instigation of appropriate therapy probably reduces mortality and morbidity.
Headache is a common initial symptom of CNS vasculitis which affects women in different life stages. Giant cell arteritis (GCA) affects mostly women aged over 50 yr. Benign angiopathy of CNS (BACNS) occurs four to five times more frequently in women than in men with a mean age of onset of 40 years. Neuroimaging (CT, MRI, angiography, CSF analysis and brain biopsy) is needed. Treatment includes corticosteroids and immunosuppressive therapy.
Idiopathic intracranial hypertension (IIH) is a condition of increased intracranial pressure of unknown cause that occurs with a frequency of 19.3 per 100,000 in obese women of childbearing age. Both pregnancy and exogenous estrogens are thought to promote or worsen IIH. It has also been speculated that polycystic ovarian disease (PCOS) associated with obesity and extreme obesity can promote IIH. More commonly, symptoms of IIH that reflect generalized intracranial hypertension include headache, pulsatile intracranial noises, and double vision. Less frequently, neck pain, back and shoulder pain, or radicular pain. To diagnose IIH, the lumbar CSF opening pressure should be greater than 250 mm also neuroimaging is needed. Not all patients with IIH require treatment. Therapy is initiated in the presence of visual acuity or visual field loss, moderate to severe papilledema or persistent headaches. Treatment is always indicated when patients are aware of their visual deficit. Diuretics and corticosteroids can be used also surgical treatment if needed.
Meningiomas are the second most common adult neoplasm of the CNS. Overall incidence is greater in females with a 2:1 ratio. Risk factors include hormone replacement therapy, oral contraceptives, association with breast cancer, head truma, family history, and ionizing radiation. Headache is common and usually unassociated with other symptoms suggestive of raised intracranial pressure, reflecting the slow growth of these tumors. Diagnosis of meningiomas has been improved by the availability of modern cross-sectional imaging methods, namely magnetic resonance imaging (MRI) and multi-detector computed tomography (MDCT). Treatment includes pharmacologic interventions for relief of symptoms referable to meningiomas and chemotherapeutic regimens that attempt to reduce tumor growth or cause tumor necrosis also surgical resection can be done.
Choriocarcinoma is a vascular tumor with high incidence of metastases. Central Nervous System (CNS) metastases from gestational choriocarcinoma have been reported to range from 3 to 28%. Headache, intracranial metastases of choriocarcinoma can present with intracranial and subarachnoid haemorrhages, seizures, and focal neurologic deficits in women who have been pregnant. Also neuroimaging is important for diagnosis. Treatment includes chemotherapy and radiotherapy also surgery is considered a second option in patients with local, chemotherapy-resistant metastasis and in recurrences.