Objective: Clinical profile and management pearls of headache in patients attending a tertiary care center. 

Methods: In this observational study, demographics, radiological investigations, triggers, and treatment pattern in patients aged ? 14 years presenting with headache were recorded. By using Migraine Disability Assessment (MIDAS) score, Visual Analogue Scale (VAS), and Headache Impact Test (HIT-6), the disability and severity of headache were assessed. Patients were evaluated at baseline and after three- and six-months post-treatment.

Results: Out of 400 patients (60.25% females and 39.75% males), 277 (69.25%) had primary headache among whom 119 (42.96%) had migraine without aura. In our study the common triggers for migraine were stress, menstruation, fasting, and inadequate sleep. Nausea, vomiting, photo-phonophobia and neck pain were the most common accompanying symptoms in patients with headache. Out of 106 (38.3%) patients with tension-type headache, 68.9% were episodic. For aborting an acute attack, 130 (79.7%) patients were prescribed naproxen, domperidone, and sumatriptan. In 69 (42.3%) patients, valproic acid/divalproex was used for prophylaxis. Intracranial bleeds and cerebral venous sinus thrombosis were the most common causes of secondary headaches (30.75%). Most common abnormalities on computerized tomography were intracerebral hemorrhage, subarachnoid hemorrhage, sinusitis, and space-occupying lesions (SOLs).

Conclusion: In our study, the most common etiology of headache was migraine. Headache was more common in females than males, and primary headache was more common than secondary headache. Sodium valproate was the commonly used prophylaxis in migraine.

Santosh Kumar Swain has completed his MD Internal Medicine from SCB Medical College & Hospital, Cuttack under Utkal University, Bhubaneswar. He is the Associate Professor of Medicine Department at Shri Jagannath Medical College & Hospital, Puri, Odisha. He has over 10 publications. He has been a reviewer of several reputed journals.