Headache Definition and Analysis

Study Notes

Headache

Headache is a common symptom in clinical practice, affecting 93% of males and 99% of females.
It is a symptom of an underlying disease that requires further investigation.

Classification of Headache

Migraine
Tension type headache
Cluster headache
Headache associated with vascular disorders
Headache associated with head trauma
Cranial neuralgia
Headache associated with non-vascular intracranial disorders
Headache referred from diseases of the skull bone, neck, etc.

Migraine

More common in females (15-20%) than males (5-10%)
Strong family history is present
Onset: at or shortly after puberty
Frequency: may occur 2-3 times/week, decreasing with age
Precipitating factors: excitement or excessive work, menses, bright light, extra sleep, strong smells, certain diets
Diagnostic criteria:
- A. At least 5 attacks fulfilling B-D criteria
- B. Headache attacks lasting 7-48 hours
- C. Headache has at least two of the following: unilateral, pulsating, moderate/severe, aggravated by walking
- D. During headache, at least one of the following: nausea and/or vomiting, photophobia and phonophobia

Management of Migraine

General measures: avoidance of stressful situations, mental and physical fatigue, precipitating diet elements, dealing with other precipitating factors
Medical measures: during the attack, strong analgesics (e.g., aspirin, paracetamol), ergot preparation (e.g., Migranil) oral, IM or suppository

Tension Type Headache

Frequently associated with anxiety, depressive disorders, and insomnia
The commonest type of headache (68% of males and 88% of females)
Each attack lasts from 30 minutes up to 7 days
At least two of the following: pressing/tightening quality, mild or moderate, bilateral location, no aggravation as in migraine
No nausea or vomiting, no phonophobia or photophobia
May be associated with spasm of or tender pericranial muscles
Usually precipitated by stressful situations, associated with insomnia, lost appetite
Treatment: analgesics, muscle relaxants, antidepressants, anxiolytics

Cluster Headache

Severe unilateral orbital, supra-orbital, and/or temporal pain
Lasting 15-180 minutes
Recurrent attacks over the day and may awaken the patient from sleep
Headache is associated with at least one of the following on the pain side:
- Lacrimation
- Nasal congestion
- Miosis
- Eyelid edema
- Conjunctival injection
- Rhinorhea
- Ptosis
- Forehead and facial sweating

Description

A comprehensive overview of headaches, including the definition, symptoms, and diagnostic approach. Learn about the essential questions to ask patients and the key aspects to consider during diagnosis.