Tension Headaches Flashcards
A type of headache where it is the condition. E.g. Migraine, Tension
Primary Headache
A type of headache where it is the result of an underlying pathology. E.g. head trauma, hypertension
Secondary Headache
True or False?
There are 14 categories of headaches according to the International Headache Society (IHS)
True
- Tension-Type Headaches
- Migraine
- Cluster
Most Common Primary HA’s
- Cervicogenic
- Cervical neuralgia
- Sinus, Ear, Nasal
- Hypertension
Most Common Secondary HA’s
HA attributed with cervicovascular, infection, Paget’s disease, drug use or withdrawal, alcoholism, caffeine withdrawal, food, environmental sensitivities.
99.5% of headaches are benign, 1/300 headaches are pathological
Other Secondary HA’s
Most common type: 30 to 80% of prevalence in the general population, least studied despite the highest socio-economic impact.
Tension-Type Headache (TTH)
- Stress (musculoskeletal or emotional)
- Muscle origin: Myofascial trigger points that refer pain to the head and neck (see perpetuating factors, triggering stimuli)
Causes of Tension-Type HA
Viselike, tight, binding
Quality of Pain for TTH
- Less than 15/ month-30 minutes to 7 days, can also be Chronic (CTTH) with fluctuations in pain levels
Frequency of TTH
At least 2 of the following: - Bilateral - Pressing/tight NOT throbbing - Mild to moderate ADL modifications i.e. can still f’n - Not aggravated by walking stairs/exertion And BOTH of the following: - NO photo or phonophobia - NO nausea or vomiting
Criteria for Assessment/Dx
2 Types:
- With Aura “Classic” 20%-visual or olfactory distortions, also sensory pins & needles, cold hands and feet, fluid retention gradually over 20 minutes ~ 1 hour prior to onset of headache(could be days)
- Without Aura 80%
Migraine
- Unknown
- Imbalances in serotonin, stress, attention, mood
- Vascular theory: vasospasm causing aura (does not explain non-aura migraines)
- Neurogenic theory-primary disorder of CNS
Causes of Migraine
Throbbing, intense pain
Quality of Pain for Migraine
Sensitivity to light (photophobia), sensitivity to noise (phonophobia), nausea, vomiting
Results in person withdrawing from activity; suffering pain and disability
Associated Symptoms
- Stress or post stressful event (weekend)
- Tension HA’s can progress into migraines
- Cyclical: PMS, menopause, puberty
- Blood sugar changes, dieting
- Seasonal allergies
- Tyramine rich foods-red wine, aged cheese, chocolate, nuts
- Food additives: MSG, aspartame
- Visual stimuli: bright light, computer screens
- Olfactory: perfumes
- Auditory: loud music
Migraine Triggering Factors
- 5% of all children
- In early childhood boys are more affected than girls, in puberty girls are more affected.
- Headache is less predominant; instead abdominal pain, cramping, vertigo
Migraine in Children
Primary or secondary?
- Recurrent brief attacks of sudden, severe unilateral periorbital , temporal or frontal pain.
- Episodes last 4 to 8 weeks affecting m > f
- AKA Cluster histamine HA, Trigeminal Autonomic Cephalalgia
Cluster Headaches
- Episodic: occuring in periods of 7 days to 1 year separated by pain-free intervals lasting ~ 2 weeks
- Chronic: more than 1 year without remission
Types of Cluster Headaches
Piercing, boring deep-rarely throbbing
Quality of pain for Cluster HA’s
Ipsilateral sweating, tearing, nasal discharge, eyelid swelling
Associated Symptoms of HA’s
Unknown, associated with peptic ulcers, heart disease
Cause of Cluster HA’s
Stress, glare, bright lights, allergies, alcohol, tobacco, sex, extreme temperature ∆’s
Acute episode tx-Pure oxygen, abortive analgesics, anesthetic nasal spray
Triggers of Cluster Ha’s
- Headache associated with problems in the muscles, ligaments, joints, discs of the cervical spine.
- Affects F > M
Cervicogenic Secondary HA’s
- Dull, achy, moderate-intensity
- May trigger migraine or cluster type HA’s
Quality of Pain of Cluster HA’s
May be prior history of neck trauma such as acceleration, deceleration injury (could be an acute HA with recent trauma). Nerve Roots C1-C3
Causes of Cluster HA’s
Specific neck movements, sustained postures
Triggers of Cluster HA’s
- CNS infection: meningitis
- Neoplasm brain tumor
- Hemorrhage: subarachnoid, subdural, epidural
- Stroke
- Blunt trauma
- Brain swelling: high altitudes
- Diabetes: hypoglycemia
Headaches with Potentially Life-threatening Origin
- Abrupt, very severe onset, client reports worst HA ever experienced
- Persistent, progressive HA
- New HA in older patient
- Associated neurological symptoms: cognitive ∆’s
- Nuchal rigidity: marked neck stiffness
- Anticoagulant therapy
- Blood Pressure Diastolic > 115 mm Hg
- Persistent, severe HA in a Child
- Suspicion of alcohol or drug dependence
- Signs of papilledema
Headache Warning Signs suggesting a possibility of Pathology
Temporal Arteritis, Herpes Zoster (shingles), Trigeminal neuralgia, TMJ, Caffeine withdrawal, Paget’s disease, Medication side effects, medication withdrawal, glossopharyngeal neuralgia
Other Causes of Headaches
