Headache Management and Treatment

Headache

• Headache is a symptom of pain anywhere in the head or neck region, not a disease state.
• Two-thirds of non-prescription analgesic use may be for headache.

Types of Headaches

• Primary headaches (~90% of headaches) are not associated with an underlying illness.
• Examples of primary headaches include:
  • Episodic and chronic tension-type headaches
  • Migraine headaches with and without aura
  • Cluster headaches

Primary Headaches

Tension-type Headaches

• Also known as stress headaches, often appear in response to stress, anxiety, depression, and emotional conflicts.
• Can be either episodic or chronic.
• Chronic headaches occur 15 or more days per month for at least 3 months.
• The most common type of primary headache.
• Clinical Presentation:
  • Severity of pain is highly variable.
  • Shivering or cold temperatures may increase pain.
  • Associated with sleep disturbances, shortness of breath, constipation, weight loss, fatigue, decreased sexual drive, palpitations, and menstrual changes.
  • Pain is described as tightness or a weight pressing down on the head.
  • Pain is gradual in onset and tends to worsen progressively throughout the day.
  • Pain is normally mild to moderate and not aggravated by movement.

Migraine

• The second most common type of primary headache.
• Recurrent, often life-long, and characterized by recurring attacks.
• Migraine with aura (neurologic symptoms that precede the head pain) occurs almost twice as frequently as migraine without aura.
• Up to 70% of patients with migraine have family histories of migraine, suggesting a hereditary influence.
• Triggers:
  • Stress, fatigue, and irregular sleep patterns.
  • Fasting or a missed meal, vasoactive substances in food, caffeine, alcohol, cheeses, salty foods, chocolate, and citrus fruits.
  • Changes in female hormones.
  • Changes in barometric pressure and altitude.
  • Lights, odor, neck pain, and exercise.
  • Medications (e.g., reserpine, nitrates, oral contraceptives, and postmenopausal hormones).
• Menstrual migraines appear at the menstrual stage of the ovarian cycle and occur in approximately 60% of women with migraine.