Headache Types and Symptoms Quiz

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.

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.