Headache Types and Symptoms Quiz

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Questions and Answers

What is a characteristic duration for the symptoms of this type of headache?

30 seconds to 3 minutes

1 to 3 weeks

1 to 10 hours

30 minutes to 7 days (correct)

Which symptom is NOT typically associated with this type of headache?

Nausea or vomiting (correct)

Tenderness of cranial and neck muscles

Mild to moderate pain

Photo or phonophobia

What type of pain is typically experienced in cervicogenic headaches?

Random, intermittent pain

Sharp pain during neck movement (correct)

Constant, debilitating pain

Severe, throbbing pain

Which age group is most likely to experience structural changes leading to this type of headache?

40 years and older Signup and view all the answers

What could potentially be an observed sign in a patient with cervicogenic headache?

Head tilt Signup and view all the answers

What is a characteristic of benign, stable headaches?

Recurrent with pain-free periods Signup and view all the answers

Which age group is primarily affected by benign, stable headaches?

Teens and early 20s Signup and view all the answers

What is a common pathology associated with stable headaches?

Chronic sinusitis Signup and view all the answers

What aspect is NOT a stable feature of benign headaches?

Weather conditions Signup and view all the answers

What is a potential trigger for benign headaches?

TMJ issues Signup and view all the answers

Which type of headache is described as having a strong genetic component?

Migraine Signup and view all the answers

What factor may contribute to the second peak of headaches occurring in the 40s?

Structural body changes Signup and view all the answers

Which of the following is NOT a classification under ICHD-2?

Hemorrhagic stroke Signup and view all the answers

Which symptom is associated with a lack of fluid in the body leading to headaches?

Dull ache without facial pain Signup and view all the answers

What is a common symptom of dehydration?

Dry, sticky mouth Signup and view all the answers

Which group of people is at higher risk of dehydration?

Elderly people Signup and view all the answers

What could potentially indicate the presence of trigger points?

Low grade nausea Signup and view all the answers

Which of the following can increase local pain during the Valsalva manoeuvre?

Dehydration Signup and view all the answers

What is a possible nature of pain associated with cervicogenic headaches?

Constant pressure type pain Signup and view all the answers

Individuals participating in extreme activities should consider what for prevention?

Daily intake of 4-6 cups of water Signup and view all the answers

Which of the following describes a symptom accompanying dehydration?

Reduced or dark-colored urination Signup and view all the answers

What phase occurs 12-24 hours prior to a migraine attack?

Premonitory Signup and view all the answers

Which neurological finding is commonly associated with aura in migraines?

Flashing lights Signup and view all the answers

What is the primary treatment goal of abortive medications for migraines?

Reduce pain severity immediately Signup and view all the answers

Which of the following is NOT considered a common symptom of a migraine with aura?

Loss of taste Signup and view all the answers

How long do symptoms of a migraine aura typically last?

5-60 minutes Signup and view all the answers

Which treatment is categorized as preventative for migraines?

Calcitonin gene-related peptide blocker (Amiveg) Signup and view all the answers

What is a key characteristic of a migraine headache?

Pulsatile quality Signup and view all the answers

What is the term for the sensation experienced as a result of channelopathy during a migraine?

Aura manifestation Signup and view all the answers

What is a common symptom of acute sinusitis?

Headache around the eyes/forehead Signup and view all the answers

What are the typical signs associated with chronic sinusitis?

Painful forward flexion of neck Signup and view all the answers

Which factor is NOT commonly linked to temporomandibular joint (TMJ) disorders?

Migraine headaches Signup and view all the answers

Which symptom indicates a potential TMJ disorder?

Tight, dull headache around the temples Signup and view all the answers

What can lead to headache pain when analgesic medication wears off?

Caffeine use Signup and view all the answers

What distinct sign might accompany jaw movement in TMJ disorders?

Clicking or popping noises Signup and view all the answers

Which aspect is characteristic of acute sinusitis?

Self-limiting up to 3 weeks Signup and view all the answers

What is a common cause of chronic jaw pain related to TMJ disorders?

Pressure from teeth grinding Signup and view all the answers

What type of evidence is reported for spinal manipulation in treating tension-type headaches?

Inconclusive evidence Signup and view all the answers

Which technique is associated with moderate positive evidence for cervicogenic headaches?

Mobilisation techniques Signup and view all the answers

What characterizes cluster headaches?

Recurrent attacks of unilateral severe headache Signup and view all the answers

Which of the following is NOT a secondary headache cause listed?

Migraines Signup and view all the answers

What is the duration of a typical cluster headache attack?

15-180 minutes Signup and view all the answers

Which symptom is typically associated with cluster headaches?

Ipsilateral nasal congestion Signup and view all the answers

What is the likely time frame for remission periods in cluster headaches?

Months to years Signup and view all the answers

Which treatment has been mentioned as potentially effective for cluster headaches?

Greater occipital nerve stimulation Signup and view all the answers

Study Notes

Pre-Learning Benign Headache

Benign headaches are characterized by stable symptoms, recurring, and pain-free periods.
Common triggers include stress, muscle tension, and poor posture.
Headaches often start in the teens and early 20s with a second peak in the 40s.
Headaches are repetitive and have identifiable location, quality, intensity and duration patterns.

Employability Skills in Neurology Module

Employability skills like problem-solving, communication, teamwork and professional knowledge/skills are enhanced in the clinical neurology module.
Important skills are enhanced for practice and patient awareness by the neurology module.

Lecture Outcomes

Students will understand the characteristics of benign, stable headaches.
Students will learn to recognize common pathologies causing stable headaches.
Students will learn key questions for differentiating headache causes.
Students will understand the role of chiropractic treatment in headaches.

Stable Headache Principles

Many benign, stable headaches start in the teens or early 20s with a second peak among people in their 40s.
These headaches are repetitive, alternating with pain-free periods.
Stable headaches have specific characteristics:
- Location
- Pain quality
- Pain intensity
- Triggers
- Duration and frequency
- Associated symptoms

VINDICATES for Stable Headaches

V - chronic sinusitis
I - chronic sinusitis
N - tension headache
D - cervicogenic HA: osteoarthritis, myofascial referral
I - rebound headache
C - migraine (with/without aura)
A - migraine (with/without aura), cervicogenic HA: facet syndrome
T - cervicogenic HA: facet syndrome
E - menstruation, menopause, diabetes, hypoglycaemia, dehydration, TMJ, eye strain, anxiety/depression
S - dehydration, TMJ, eye strain, anxiety/depression

Differential Diagnoses for Headaches

Vascular
Infection
Metabolic
Traumatic/toxic
Referred
ICP
Psychogenic

Migraine

A benign, recurrent neurovascular headache type, leading to severe pain.
Commonest severe, episodic recurrent headache.
Classified into 20 sub-categories (ICHD-2).
Has a strong genetic component, often beginning in the teens/early twenties.
Can begin in older populations but should be investigated due to potential "big bads" if atypical onset.

Migraine – Pathophysiology

Neurovascular, possibly due to channelopathy (calcium channels over-excited), vasospasm, and cortical dysfunction (aura).
Phases:
- Premonitory (12-24 hours, vague symptoms).
- Aura (visual, sensory, motor, or speech symptoms).
- Headache period (may be accompanied by nausea, photophobia, phonophobia).
- Resolution/recovery (post-dromal).

Migraine Aura

Indicates a localizable site of channelopathy onset.
Exhibits specific neurological symptoms (e.g., visual changes, sensory loss, weakness, speech deficits).
Symptoms are consistent for each individual and last no longer than one hour before resolution.

Migraine – Symptoms

Unilateral pain, around an eye.
Pulsating quality.
Severe pain, inhibiting ADLs (activities of daily living).
Requires lying down in a dark room.
Nausea or vomiting.
Photophobia.
Phonophobia.
Duration: 4-72 hours.
Aura (if present) precedes headache by typically 5 minutes.

Migraine – Treatment

Abortive: NSAIDs, triptans, dopamine antagonists.
Preventative: Avoid triggers, small studies suggesting chiropractic for prevention, Amiveg (calcitonin gene-related peptide blocker).
50% reduction in frequency/duration of headaches considered a good outcome.

Tension Headache

A recurrent headache caused by trigeminal nerve stimulation, with pressure around the head, classified by frequency (infrequent to chronic), often chronic.
Most common type of benign headache.
Often originates from stress, muscle tension, and poor posture.
Characteristics include:
- Duration (30 minutes-7 days), usually bilateral, band-like
- Mild to moderate pain
- Not aggravated by routine physical activity
- May not have photophobia or phonophobia
- May be tender cranial or neck muscles

Cervicogenic Headache

Originates from neck structures (e.g., facet joints, muscles, ligaments).
Characterized by:
- Moderate to severe, unilateral neck and back of head (occipital) pain.
- Pain may increase with neck movement or sustained posture
- Stiffness, achy pain
- Potential for other symptoms (dizziness, arm pain).

Myofascial Headache

Trigger point referral.
A subtype of cervicogenic headache, often accompanied by neck/shoulder pain.
Trigger points can cause pain in areas like temples, eyes, frontal region.
Perceived as persistent, pressure-like pain around the head.
Often occurs in people susceptible to migraine or tension headaches.

Dehydration Headaches

Headaches caused by a lack of fluid in the body, leading to temporary brain contraction.
Brain tissue pulling away from the skull causes tension and dura mater pain.
Symptoms:
- Mild to intense dull ache.
- Potential for more widespread pain rather than localized to a specific area of the head.
- May feel similar to a severe migraine.
Associated symptoms may include extreme thirst, reduced/dark urine, confusion, dizziness, dry mouth, loss of skin elasticity in the form of a skin pinch test and increased heart rate.
People with chronic diseases/athletes/infants/those in higher altitudes or hot climates have increased risk.

Sinusitis

Caused by viral or bacterial infection affecting the sinuses.
Viral sinusitis is typically self-limiting (up to 3 weeks).
Bacterial sinusitis often requires treatment.
Symptoms include headache around the eyes/forehead, nasal congestion, and a thick, potentially discoloured mucous discharge, requiring attention to the jaw and teeth.
Chronic sinusitis is a more persistent form of sinusitis, showing symptoms like persistent headache, pain worse on neck flexion and pain on percussion of sinus.

Temporomandibular Disorder (TMD)

Joint disorder affecting the jaw (temporomandibular joint), causing pain.
Symptoms: tight, dull, achy headache around temples and jaw, generally unilateral, aggravated by chewing, relieved with rest.
Possible associated symptoms: clicking/popping or grinding noises when opening or closing the jaw, difficulty fully opening mouth, jaw locking.
Often misdiagnosed as tension or migraine.

Medication Overuse Headache (MOH)

Results from prolonged use of pain relievers, including caffeine.
Symptoms tend to be more generalized/non-specific.
Chronic headache when medication wears off.
Characterized by persistent headache pain, often around the forehead, that gets worse when medication is not consumed and responds to a dose increase to resolve pain.

Endocrine Headaches

Caused by hormonal fluctuations associated with conditions such as hypo/hyperglycemia (diabetes), menstruation, menopause.
Symptoms include headaches which are often described as dull or throbbing, occurring with repetitive/periodic episodes.
Associated factors/triggers for headaches include hormones and could be cyclical/unresponsive.

Cluster Headaches

Repetitive, severe, unilateral headaches with accompanying symptoms.
Symptoms:
- Very severe pain/unilateral
- Clustered events
- Lasts 15-180 minutes.
- Potential for recurrent attacks.
- Potential for ipsilateral eye redness/lacrimation, nasal congestion, rhinorrhea, forehead/facial sweating, miosis (pupil constriction), or ptosis (drooping eyelid).

Headache Assessment - Red Flags

New headaches necessitate immediate referral, especially in children and adults older than 50 years of age.
Progressive pain escalation or pain that changes quality or location also warrants further evaluation.
Pain worsening during recumbent (lying down) position is suggestive of increased intracranial pressure.
Neurological symptoms like vertigo, diplopia, and nystagmus should trigger careful evaluation and treatment.

Headache Examination - General

Vital signs to identify any general condition.
Neurological assessment including:
- Mental status.
- Cranial nerves.
- Ophthalmoscopic evaluation to see if papilledema (swelling of the optic nerve) is present.
- More sensitive cranial nerve tests (CN 2, 3, 4, 6, 9, 10, and 12).
Other neurological evaluations.

Chiropractic Efficacy in Headache Management

Evidence for the efficacy of chiropractic care in treating migraines, cervicogenic headaches, and tension-type headaches.
Limitations: Small studies, inconsistent evidence, requiring strong investigation and ongoing research.

Pain Physiology

Pain stems from the front of the head, face, and anterior skull, innervated by cranial nerve 5, and from regions like the eyes and potentially from the carotid arteries.
Cranial nerves are potentially connected and contribute to pain innervation.
Generally, pain can arise from non-nociceptor-containing structures in the head, including the meninges, distension of blood vessels, and inflammation.

Principles for Diagnosis

Headaches may need separate diagnoses until proven linked, but may occur together without underlying link.
Details of patient history and the symptoms and patterns of the head pain need further investigation.

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Description

Test your knowledge on various types of headaches, including cervicogenic and benign stable headaches. This quiz covers symptom duration, common pathologies, and classifications under ICHD-2. Evaluate your understanding of headache characteristics and triggers.