Recurrent and Chronic Headaches

The Neurophile (by Rutgers RWJMS Neurology)

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00:00 - Intro
00:32 - Objectives
00:58 - Case
05:36 - Basic features of headache clinical history
06:36 - Fundoscopy
08:16 - Anatomy of pain: The headache network.
12:31 - Differential diagnosis of primary headache
14:15 - S.N.O.O.P. mnemonic
16:13 - IHS diagnostic criteria for migraine
17:45 - Migraine aura
18:25 - Cluster
21:19 - Treatments for primary headaches
30:14 - Differential diagnosis of secondary headache
30:43 - Idiopathic intracranial hypertension
32:37 - Tumor headache
37:53 - Cerebral venous thrombosis
39:01 - Cervical arterial dissection
40:41 - Giant cell (temporal) arteritis
43:07 - Trigeminal neuralgia
44:58- Case wrap-up
46:56 - Summary: Treatment algorithm
This video is intended for medical students to understand the clinical presentation, differential diagnosis and treatment of primary headaches and the wider differential diagnosis of secondary headaches.
Created by:
Igor Rybinnik, MD
Neurology Clerkship Director
Rutgers Robert Wood Johnson Medical School
Produced and narrated by:
Igor Rybinnik MD
Special appreciation to my wife, Jane Shmidt PhD, who is a migraine sufferer, for narrating the patient history.
Content review:
Pengfei Zhang, MD
Headache Neurologist
Assistant Professor
Rutgers Robert Wood Johnson Medical School
Images, video clip and audio adapted from:
- Vislisel J, Venckus T . EyeRounds.org, University of IOWA, 2014.
- Li J, et al. Experimental and Therapeutic Medicine, 12, 1119-1124
- Netter FH. The Netter Collection of Medical Illustrations. 2nd ed. 2013, Saunders.
- Goadsby PJ, Besbitt AD. BMJ 2012;344:e2407
- Pathophysiology of migraine, Springer Healthcare IME, 2020.
- Parameswaran A, et al. J Oral Maxillofac Surg 2018-76,1873-81
- "Let the Real Estate Games Begin." Selling Sunset, season 2, episode 1. Created by Adam DiVello. Netflix, 2019.
- “Parzival” by William Rosati
- Mazzucco S, et al. Neurology 2006; 66:E19.
- Schievink WI. NEJM 2001;344(12):898
- Kandel ER, et al. Principles of Neural Science 5th Edition. McGraw Hill, 2012.
- Nucleus Medical Media, Inc.
- Haouimi A, Radiopaedia.org, rID: 72159.
- T Hines, Mayfield Clinic
Disclaimer: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation where appropriate. Also, the opinions of the presenters do not necessarily reflect those of Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, or Rutgers University as a whole.

Опубликовано:

6 авг 2024

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Комментарии : 114

@arminpalic7653 2 года назад

Best medical lecture series on a field of medicine on YT by far.

@theneurophile Год назад

Wow! Thank you for that.

@RaghiniRanganathan-rw6sg Месяц назад

43:00 'Do you have the attention span for one more thing?' The way you teach, I have the attention span for a thousand more things!

@vxp999 10 месяцев назад

the life style changes part got me dead🤣🤣| your the coolest neurologist ever and my roll model no doubt!

@theneurophile 10 месяцев назад

Oh wow. Thanks!

@eduardohita6523 2 года назад

Dude, this is pure gold! Thank you so much for these lectures!

@gagang5406 Год назад

What an amazing lecture!! This one's GOLD. Thank you so much Dr. Rybinnik.

@pedroinarionovaisaraujo1859 Год назад

The best lecture ever! PURE GOLD. Thanks from Brazil.

@annazinishina5836 2 года назад

Невероятные лекции с невероятным чувством юмора! Спасибо!

@user-qd2qv5wk1v Год назад

Thank you so much for your work Dr. Rybinnik. Looking forward to your next video!

@theneurophile Год назад

It will be uploaded shortly. Almost done.

@thesnoringsleepapneacenter2200 2 года назад

What a headache review! I'm studying for my Orofacial Pain boards and loved that you had a sample case and paused a bit so I could come up with my own answer before you told me.

@asimzafar5015 2 года назад

one of the few productive things on you tube.thanks sir

@raminvakili1038 2 года назад

I am really appreciative for videos. As a neurologist I learned a lot and I recommended it to my friends. Thanks

@kyaw03 Год назад

So I don't usually leave comments on RU-vid often, but wow....i had to for this one! Very very very helpful!!! Very clear and concise! All of your videos are so helpful! PLEASE make more videos! PLEASE!

@johnbolger5955 2 года назад

Incredible, thank you so much. I am a MS1 and this was so helpful

@gentleman7951 2 года назад

Thank you dr rybinnik Greatest lectures 🌷❤

@Alfontanas 2 года назад

Please keep going with the lectures, you're awesome!

@ahmedthamir9531 2 года назад

Sir , it is a great gift for me to have stumbled upon your channel . best greetings for you sir !♥️♥️♥️

@damiensegers3555 Год назад

Final year med student applying neurology. Amazing youtube channel

@fatgezimbela7272 2 года назад

Thank you!

@rashadomar7330 Год назад

just excellent lecture as always, I am addicted to your videos,,,,, Thanks

@tomriddel2302 2 года назад

Thanks guys!

@sneakpeek9790 2 года назад

Million and Billion of Thanks♥♥❤ and appreciations♥♥♥for covering this wonderful neurological topic,I really enjoyed the whole lectures learning about different kinds of headaches. 👍👍👍🥳🥳🥳

@pixie89 2 года назад

Thank you

@cheemDr Год назад

Good job!

@designmaster5074 Год назад

you are the best!

@SharafEl-Dein 8 месяцев назад

Amazing ❤

@edgarivanpalominomendoza2713 11 месяцев назад

What a lecture, thank you for sharing this amazing content.

@theneurophile 11 месяцев назад

We are currently working on the prequel: Thunderclap headache. Stay tuned.

@ahmed086 2 года назад

I just love your videos

@goodvibesnerd3228 2 года назад

This is awesome

@hanakoaranilla1517 Год назад

I want to thank you sir and this channel for helping me get a 95 on my Neurology rotation. Whenever my classmates ask me where I learned what I knew during rotation, I always say “It’s Dr. Rybbinik, you should watch him on YT”. Your fresh take on teaching greatly helped. I’m graduating this July from Med school and hoping to take on Neurology/Psychiatry ỉn residency. Thank you so much!

@theneurophile Год назад

Wow. Good job on that grade!

@caiyu538 8 месяцев назад

Great

@termostat363 2 года назад

Best!

@sarahbamford2633 Год назад

Loved this! So informative but also engaging. A hard balancing act for my ADHD brain.

@simple25124 Год назад

Complex topics explained simply. So far the best tutorials on various neurological topics. This is how good medicine and teaching are made. Do you plan to post something about neurological infectious diseases as well? An of course: BIG THANKS :)

@theneurophile Год назад

Thank you. I would love to put out many more of these videos, but my dayjob as a Stroke neurologist keeps me busy. I will try to post as soon as I can.

@tomriddel2302 2 года назад

Very informativ :)

@bekirsamiozturk8365 2 года назад

Spontaneous intracranial hypotension:)) thank you so much for great videos👍

@theneurophile 2 года назад

Correct!

@ilqar887 2 года назад

The treatment?

@bekirsamiozturk8365 2 года назад

@@ilqar887 epidural blood patch

@sarahbamford2633 Год назад

Yes! I was right too :)

@kapiladahanayake2096 2 года назад

Thank you very much. Keep it up

@SirBenniMilesOne Год назад

Hi Dr Rybinnik, really impressed with your helpful and well presented videos! Would it be possible for you to make the algorithms available? Many thanks for your great work!

@theneurophile Год назад

Yes, I will start making them available with subsequent videos.

@hairballjones8451 2 года назад

Hi Dr R- I live in the heart of another Big10 country- but if I lived in New Jersey I would be honored to have you for my instructor at Rutgers. Right now my neurologist seems to be flipping a coin between Migraine, IIH and Nornal Pressure Hydrocephalus- a few more tests Including an MRI, already had a Lumbar Puncture, CT, EEGs, tra tra la- maybe when I cross paths in July I will hear they have also consulted with a Witch Doctor. Anything fine with me; at 76- this perpetual headache gets me very worn out. Have A Happy and Successful Day, Doctor

@theneurophile 2 года назад

I am sorry to hear about your troubles. I hope you feel better soon.

@frogprincessss Год назад

Hi Dr Rybinnik, my suggested topic includes: Aphasias, Optic nerve anatomy and clinical correlates, and basics of localization. I am bingewatching your videos... really love your lectures. I admire your passion for medical education. Very inspiring!

@theneurophile Год назад

Thank you. A massive localization talk is in the works.

@Lesgrandslivres Год назад

@@theneurophile when will it be available, I have exams next month 🥺

@theneurophile Год назад

@@Lesgrandslivres I wish I could work that fast. Unfortunately for now I am a team of one, and I have clinical responsibilities :(

@Lesgrandslivres Год назад

@@theneurophile understandable... Thank you for your work though, really the best neuro lectures :)

@beu2426 2 года назад

Thank you so much for this lecture! Is it possible to talk about cervical vertebral trauma? And thank you so much!!!

@stevevet3652 2 года назад

I'll second the need for cervical vertebra trauma that includes arachnoid cyst at the top of the spine.

@josemoreira50 2 года назад

You HAVE to make this stuff for other specialties (cardiology). Its pure gold

@theneurophile 2 года назад

I would love to, but I am a Neurologist. So, unfortunately I am not qualified to comment on other specialties.

@mercypower8002 5 месяцев назад

amazing 👏....thank you .....can you please make a video about neurolocalization ( resident level ) thanks

@theneurophile 5 месяцев назад

Yep. It’s in the works.

@ramazantemel6405 2 года назад

I am really astonished by how beautifully designed this PowerPoint presentation and your skills of making easy to understand. I wonder which website or application that you are using for your slight

@theneurophile 2 года назад

Thank you. I am just using Powerpoint

@baveshsiva7393 2 года назад

Please make videos on these topics doc :) 📌 Surgical Management of Strokes (Bleeds, Infarcts, Aneurysms, AVMs) 📌 Management of Increased Intracranial Pressure 📌 Neurorehabilitation 📌 Management of Seizures & epilepsy 📌 Hyperkinetic Movement Disorders 📌 Management of Parkinson’s Disease & other Extrapyramidal syndromes And this video was amazing 😇🫂

@theneurophile 2 года назад

Excellent suggestions. Management of increased intracranial pressure is part of the "Coma" talk on this channel. I am slowly making the videos on all these other topics.

@baveshsiva7393 2 года назад

Thank you doc :)

@enkidu001 2 года назад

what about one year of headaches , getting worse now in the last 2 months. Severe fatigue, sometimes i really want to sleep 1 hour after i woke up. I try without success to fall asleep, sadly. Low energy. Location: if i feel this correct its exactly in the centre of my head. Geometrical centre. Level of pain?... around 3...or 4 out of ten. History?... i went vegetarian in my 20s for ethical reasons. Had big health issues because i was naive, had no idea i have to add a few things, not just throw away so many :) and after 10 years started eating fish again. Rare, but i did. Now i am 46 and try fasting, low carb diet, experiment, but no success. My doc sent me to a set of analysis because i had very high B12 levels. When i told him the level is actually very low, he masked his lack of interest and said a bluffing and amazing: we are doing the same set anyway. Really. Anyway. Can't get help from him, he seems to be non human. Anyone ?:)Thanks. Another few facts: i did sports in my youth, started again last year (because of the fatigue), , 1.86 m height , 77 kg, little bellyfat, my vision is weakening slowly in the last months. And maybe an important element: i lost something 3 years ago. And all that kept me alive was gaming. I threw myself totally into an extremely stressing game, where i reached top levels. I do that around 12 -14hours/day wihtout pause, day after day (i don't need an income, survive from old savings. When they' ll be over...well... we'll see.) Last 2 monthis i kinda stopped. Some days i do not play at all, other days a few hours...but nothing changes. Sorry for the long story. Really. But i am lost :) I am in a country where docs don't give a flying fuck. Thanks again

@theneurophile 2 года назад

I’m sorry that you are feeling badly. It is very challenging to diagnose people based on an internet post. I suggest you continue working with your doctor to find a solution.

@enkidu001 2 года назад

Thanks for being nice:) Peace (And sorry again for the long comment)

2 года назад

Please Dr., some talk about fMRI and differents types of paradigms and it's implementation in mental disorders. Greets and thanks.

@theneurophile 2 года назад

There is an MRI video on this channel.

@pvermehren Год назад

Pathophysiology of dissection has more recently been shown to be rupture of vasa vasorum in intimal layers causing intramural hämatoma in most cases, not intimal tear and flap formation

@theneurophile Год назад

Thank you. Please include a reference for that statement.

@pavolskacik5064 2 года назад

Could you make a talk about antitrombotic therapy and Its indications/contraindications in vascular neurology?

@theneurophile 2 года назад

Sure, will try.

@drchalo7170 2 года назад

So good lecture Dr. Rybinnik. How could I email you?

@potatonail7463 2 года назад

Great video!, I wonder though about tension type headache? Why is it excluded from this video?

@theneurophile 2 года назад

There is great debate among the headache specialists whether tension headache is a separate entity or really on a continuum with migraine. So to keep things simple, we didn't discuss it.

@potatonail7463 2 года назад

@@theneurophile I see. Thankyou 😊

@Neurologi 2 года назад

Thank you for a very nice review on this topic! Just wondering - why is tension-type headache not mentioned?

@theneurophile 2 года назад

Although tension headache is a defined entity in the IHS, the existence of muscle tension has never been proven, and some headache neurologists (at least the ones that trained me) believe that it is on the continuum with migraine. So for the purposes of this talk, consider tension as part of migraine.

@Neurologi 2 года назад

@@theneurophile Very interesting! I agree that the pathophysiology of tension type headache is still not well understood and it is true that migraine and tension type headache often do co-exist. However, the treatment (at least here in Denmark where I work) is rather different! In cases with primary tension type headache, we tend to recommend physiotherapy, avoiding medication overuse and prophylactic amitriptylin (70mg), mirtazapin (30mg) or venlafaxin (150mg).

@Neurologi 2 года назад

@@theneurophile By the way: thank you for your awesome videos!

@theneurophile 2 года назад

@@Neurologi Thank you for that insight. I generally find headache difficult to treat given the vast number of disorders and paucity of data. I'm hoping these videos will give medical students an overview of the topic, so that they can be inspired to dig deeper.

@rahulpramanik7889 Год назад

in that case can i tell this cvst problem

@rupindergill94 2 года назад

Answer Headache attributed to low cerebrospinal fluid (CSF) pressure

@AnniePharm Год назад

The woman in the case is literally me (even the blurry vision details), that's surprising.

@theneurophile Год назад

Migraines are unfortunately common. I hope yours are not too terrible.

@AnniePharm Год назад

@@theneurophile They are very mild, I never thought it was a case of migraine because I always believed migraines can only be really painful.

@theneurophile Год назад

@@AnniePharm Good to hear. Migraines can certainly occur without pain.

@gabbiet9138 2 года назад

I know another cause of headaches .. Botox prior auths! Haha 😅 We do see great response from patients though.

@gpetrolli Год назад

In a case of cerebral venous thrombosis, should we just anticoagulate the patient or interrupt anticoagulation to perform relief punctures?

@theneurophile Год назад

Lumbar punctures do not really work to reduce intracranial pressure in venous sinus thrombosis. As of now, aggressive anticoagulation is the primary treatment. If cerebral edema progresses despite anticoagulation, then surgical decompression may be necessary.

@gpetrolli Год назад

@@theneurophile Thanks!

@ilqar887 2 года назад

How do you treat cervical headache?

@theneurophile 2 года назад

That’s a tough question to answer since it depends highly on the cause. Most cases are treated conservatively.

@hairballjones8451 2 года назад

What about normal pressure Hydrocephalus? You touch on IIH but not this? J- u- s-t wondering

@theneurophile 2 года назад

Normal pressure hydrocephalus typically does not present with headache (this is a headache talk). Please refer to the “Hydrocephalus” talk on this channel for that discussion.

@ericreece2639 Год назад

Last was csf leak.. Right?

@theneurophile Год назад

Yep

@zuhairyassin505 2 года назад

high dose corticosteriods could you tell us how many mg/kg ??

@theneurophile 2 года назад

For prednisone, it would typically be 1mg/kg daily to start.

@zuhairyassin505 2 года назад

@@theneurophile thanks

@ilqar887 2 года назад

@@theneurophile is not Prednisone bad for you?

@juancolores 11 месяцев назад

Cephalea related IgG4

@theneurophile 11 месяцев назад

Are you referring to the thumbnail? That’s actually just intracranial hypotension.

@konosmgr 2 года назад

What about new persistent daily headaches?

@theneurophile 2 года назад

You may have to read about that one. It didn't fit into the talk.

@konosmgr 2 года назад

@@theneurophile Thanks for replying, perhaps you got any specific reading material to recommend?

@user-ju7bs6me3c 3 месяца назад

😅😅😅

@lindafreudiger8022 Год назад

Good thing I went to medical school so I can understand this-NOT AT ALL😢

@theneurophile Год назад

Oh no! I hope you understood at least something.

@danyelPitmon 2 года назад

I really wish you would not have just briefly went past the possibility of CSF leaks because there are many people who have migraines as well as parts that also have CSF leaks many neurologist and doctors are just brushing that aside and not even considering that at all and your video you just did the same thing which is a disservice to many that have severe migraine problems and I am very dissatisfied with this video because you did not address that particular issue but yet you weren’t right word but all other neurologist and doctors have done is go right to tumors and didn’t even consider the Souter tumor which is a CSF leak which can be very debilitating to ask you to please review redo and put out a new video that encompasses this problem because I have severe migraines and I mean severe debilitating migraines but also seem to have a positional issue with fluid increase in the frontal lobe of my brain I see it being an impossibility that positions and neurologist are not asking in that direction one lady that I know and I follow on RU-vid went for years without getting the right diagnosis and finally went to a clinic in Texas by video conferencing and found out her suspicion was correct that she had a suitor tumor her medication regimen and things have changed to take that into account with her migraines and her pots thank you for reading this comment especially are you students that are study in this area please take into account that some people may actually have increased or decreased cerebral fluid to the brain because of recent CAT scan that I had done when I went into the emergency room for a migraine showed that I do have a reduced fluid level and one section of my brain has reduced blood flow included as well I also have a history of Trumatic brain injury which could also cause weakening of the Durham around the brain and the brain stem leaking fluid thank you goodbye

@theneurophile 2 года назад

I’m sorry to hear that you are suffering. You are absolutely right that low pressure from CSF leaks is a very real problem. Unfortunately it is impossible to cover every disorder in one video (there are over 84 types of headaches). I will try to make a video about low pressure headaches when I have some time.