Headache Types and Symptoms

Headache Classification

• Primary headaches are not associated with an underlying illness.
  • Examples include tension-type headaches, migraines (with or without aura), and cluster headaches.
• Secondary headaches are caused by an underlying condition.
  • Examples include headaches due to head trauma, stroke, infection, or substance withdrawal.

Chronic vs. Episodic Tension Headaches

• Chronic tension headaches occur 15 or more days per month for at least 3 months.
• Episodic tension headaches occur less than 15 days per month.

Medication-Overuse Headache

• A medication-overuse headache can result from using headache medications more than twice per week for 3 months or longer.
• The headache may occur within hours of stopping the medication.
• Relief from the headache may follow when taking the same medication again.

Acute Sinusitis Symptoms

• Facial tenderness/pain
• Nasal congestion
• Nasal discharge (purulent)
• Pressure-like headache
• Symptoms are typically worsened by bending forward or blowing the nose.

Headache Characteristics

Aura and Migraine Headaches

• Aura is not always followed by a migraine headache.

Caffeine Use in Headache Treatment

• Caffeine can be helpful when combined with analgesics (like aspirin or acetaminophen), especially for tension-type headaches and migraines.
• Overuse of caffeine can lead to withdrawal symptoms and medication-overuse headaches.

Medication Effectiveness

• Aspirin and acetaminophen are equally effective for pain, but aspirin might be better for inflammatory pain.
• Ibuprofen and aspirin are equally effective, while ibuprofen may be safer (less gastrointestinal irritation and bleeding).
• Acetaminophen and ibuprofen are equally effective, however acetaminophen lacks anti-inflammatory properties.
• Naproxen is effective but lasts longer (8-12 hours) compared to ibuprofen (4-6 hours).

Statements about Medications

• Children over 12 years old can use naproxen for self-treating headaches.
• Aspirin or other salicylates should not be used in children and teenagers with chickenpox or the flu-like symptoms unless directed by a doctor to prevent Reye's syndrome.
• Acetaminophen is often the preferred choice for managing mild to moderate pain in the elderly.

Follow-Up Recommendations

• For episodic headaches, follow up if the headache persists longer than 10 days or worsens despite treatment.
• For chronic headaches, follow up if the frequency or intensity of the headaches increases or doesn't improve with self-treatment.

When to Seek Medical Attention

• Severe head pain, especially the first or worst headache experienced.
• Headaches lasting more than 10 days.
• High fever or signs of infection.
• Neck stiffness.
• Neurological symptoms (visual problems, seizures etc.)
• Headaches in people with cancer, HIV, or pregnancy.
• Symptoms of migraine without a formal diagnosis.
• History of liver disease or excessive alcohol use.
• Visual changes, scotoma without a headache. (Possible retinal migraine)
• Headaches that worsen when lying down.