Different Types of Headache. Migraine, Tension, Cluster, Chronic, TMJ, Trigminal Neuralgia and Sinister Headache Types |
Headache comes in many different guises, not just migraine. Below lists some of the major headache types. A proper diagnosis can only be made by your doctor or health professional. Muscle Contraction Headache/Acute Tension Type Headache Sinister Headache: Meningitis/Subarachnoid Haemorrhage/Cranial Arteritis Migraine is a severe headache type and can have a considerable impact on the daily life of sufferers and affects between 17 per cent of women and 6 per cent of men, although estimates vary. Accurate diagnosis of the different presentations of migraine is the foundation of effective prescribing and management. Diagnostic pointers for migraine. 1. Attacks last from 4 to 72 hours2. Patients are usually symptom-free between attacks 3. Headache is at least two of the following a. Unilateral (on one side) b. Pulsating c. Moderate to severe d. Aggravated by routine activities 4. Accompanying symptoms may include a. Photophobia (more sensitive to light) b. Phonophobia (more sensitive to noise) c. Nausea and Vomiting In any medical condition it is of paramount importance for the diagnosis to be accurate and can only be made by your health professional or physician (MD) who knows your private medical history in detail. Only after this has been achieved it is unlikely that a good management plan will be established. In the late 1980s, the International Headache Society (IHS) formulated a classification for migraine, which has helped us to determine the correct patient groupings for migraine clinical trials. If five headache attacks meet the criteria, the patient is given the diagnostic label of "migraineur". It is important to realise that not all four main symptoms have to be present. It is quite possible for the patient to have a mild headache which is bilateral, but still have migraine. Recently clinicians have realised that it is helpful to ask questions of patients with acute or intermittent headaches. Information about their quality of life and ability, or otherwise, to perform normal activities is very important. High impact, acute headache would, therefore, tend to have a default diagnosis of migraine and the IHS classification is used to confirm this. The main part of the classification is concerned with the headache phase of the attack. However, approximately 10 per cent of patients will have reversible sensory symptoms in the hour preceding the headache. These symptoms are known as aura and will often include visual changes, such as zigzag lines or scotoma (holes in the vision), but a variety of other symptoms may also occur. Other symptoms include, dizziness, numbness and "word salading" (words being mixed up). About 40 per cent of patients describe more vague symptoms of aura that can last substantially longer. In the day or two before an attack, prodromal symptoms, such as cravings and lethargy, can be observed. From within these two groups of symptoms, useful warnings can be identified and patients taking simple treatments during such a warning may have success in heading off a migraine before it has started. Often ignored is the postdrome phase of migraine. Once the headache has subsided the postdrome usually involves the patient feeling quite washed out or hung-over. A few patients may feel entirely the opposite, almost as if they are super-human. Relatively little can be done to alleviate these prodromal symptoms, the cost in terms of disruption to work, relationships, and social activities, which can result from this phase of the attack can be considerable. Trigger Factors For Migraine: Environmental factors: Build up of tiredness over the
working week, emotion and stress (eg, anger), missed meals (hypoglycaemia),
smoke, strong odours (eg, perfume, paint), too much/little sleep,
weather changes, bright/flashing lights. Muscle
Contraction Headache Type/Acute Tension Headache Type Muscle Contraction Headache or Acute Tension Headache Type occurs in about 50% of the population on a monthly basis but is usually low impact which is why it is not seen a lot in primary care. Typically this headache type is mild to moderate only, non-pulsating and bilateral. Sensory sensitivity to noise or light is more likely to be associated with migraine. Difficulties arise when patients who are suffering from migraine are misdiagnosed as having a tension headache type. They then do not receive appropriate management. Patients often describe the pain as a "feeling of tightness or squeezing'. The causes of tension headache type are not known. It is possible but rare to get a tension headache type without exacerbations - causing daily or near daily background symptoms. This is part of the Chronic Daily Headache Syndrome and needs managing as such. Chronic Daily Headache is defined as a headache type which is present on most days ie > 15 days a month, typically occurring over a six-month period or longer and it can be daily and unremitting. In some patients, an episode of chronic headache resolves in a much shorter time. It can occur in children and in the very old. Twice as many men have it compared to women. The symptoms can last for decades and typically patients may have suffered for up to five years before presenting to a specialist centre. About 50% of patients attending a doctor with a headache will have Chronic Daily Headache. Many different classifications have been used to describe Chronic Daily Headache including medication misuse headache, hemicrania continua and transformed migraine. Chronic Daily Headache Type is characterised by a combination of background, low-grade muscle contraction-type symptoms, often with stiffness in the neck, and superimposed migrainous symptoms. Patients might have had migraine in the past and experienced a difficult patch of high frequency headache, prompting them to increase their analgesic intake. These analgesics can then lead to a worsening of the chronic headache pattern resulting in analgesic dependence. In the United Kingdom, the most commonly implicated drugs are those containing codeine but all simple analgesics and ergotamine compounds have been implicated. In recent times, the triptan class of drugs has also been reported to cause chronic headache, although it is our opinion that this situation is uncommon. However, the medication probably does not actually cause the condition. It is more likely that patients achieve transient relief from this class of drug, leading them to repeat dosing. Risk factors appear to include not only a past history of migraine and high analgesic intake, but also injuries to the head and neck, such as a whiplash injury. The aim of management in Chronic Daily Headache Type is to return patients to their original acute headache pattern, which requires a combination of treatments including:
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