Tension Headaches

Question 1

A type of headache where it is the condition. E.g. Migraine, Tension

Answer 1

Primary Headache

Question 2

A type of headache where it is the result of an underlying pathology. E.g. head trauma, hypertension

Answer 2

Secondary Headache

Question 3

True or False?

There are 14 categories of headaches according to the International Headache Society (IHS)

Answer 3

True

Question 4

• Tension-Type Headaches
• Migraine
• Cluster

Answer 4

Most Common Primary HA’s

Question 5

• Cervicogenic
• Cervical neuralgia
• Sinus, Ear, Nasal
• Hypertension

Answer 5

Most Common Secondary HA’s

Question 6

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

Answer 6

Other Secondary HA’s

Question 7

Most common type: 30 to 80% of prevalence in the general population, least studied despite the highest socio-economic impact.

Answer 7

Tension-Type Headache (TTH)

Question 8

• Stress (musculoskeletal or emotional)
• Muscle origin: Myofascial trigger points that refer pain to the head and neck (see perpetuating factors, triggering stimuli)

Answer 8

Causes of Tension-Type HA

Question 9

Viselike, tight, binding

Answer 9

Quality of Pain for TTH

Question 10

• Less than 15/ month-30 minutes to 7 days, can also be Chronic (CTTH) with fluctuations in pain levels

Answer 10

Frequency of TTH

Question 11

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

Answer 11

Criteria for Assessment/Dx

Question 12

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%

Answer 12

Migraine

Question 13

• Unknown
• Imbalances in serotonin, stress, attention, mood
• Vascular theory: vasospasm causing aura (does not explain non-aura migraines)
• Neurogenic theory-primary disorder of CNS

Answer 13

Causes of Migraine

Question 14

Throbbing, intense pain

Answer 14

Quality of Pain for Migraine

Question 15

Sensitivity to light (photophobia), sensitivity to noise (phonophobia), nausea, vomiting

Results in person withdrawing from activity; suffering pain and disability

Answer 15

Associated Symptoms

Question 16

• 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

Answer 16

Migraine Triggering Factors

Question 17

• 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

Answer 17

Migraine in Children

Question 18

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

Answer 18

Cluster Headaches

Question 19

• 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

Answer 19

Types of Cluster Headaches

Question 20

Piercing, boring deep-rarely throbbing

Answer 20

Quality of pain for Cluster HA’s

Question 21

Ipsilateral sweating, tearing, nasal discharge, eyelid swelling

Answer 21

Associated Symptoms of HA’s

Question 22

Unknown, associated with peptic ulcers, heart disease

Answer 22

Cause of Cluster HA’s

Question 23

Stress, glare, bright lights, allergies, alcohol, tobacco, sex, extreme temperature ∆’s

Acute episode tx-Pure oxygen, abortive analgesics, anesthetic nasal spray

Answer 23

Triggers of Cluster Ha’s

Question 24

• Headache associated with problems in the muscles, ligaments, joints, discs of the cervical spine.
• Affects F > M

Answer 24

Cervicogenic Secondary HA’s

Question 25

• Dull, achy, moderate-intensity

- May trigger migraine or cluster type HA’s

Answer 25

Quality of Pain of Cluster HA’s

Question 26

May be prior history of neck trauma such as acceleration, deceleration injury (could be an acute HA with recent trauma). Nerve Roots C1-C3

Answer 26

Causes of Cluster HA’s

Question 27

Specific neck movements, sustained postures

Answer 27

Triggers of Cluster HA’s

Question 28

• CNS infection: meningitis
• Neoplasm brain tumor
• Hemorrhage: subarachnoid, subdural, epidural
• Stroke
• Blunt trauma
• Brain swelling: high altitudes
• Diabetes: hypoglycemia

Answer 28

Headaches with Potentially Life-threatening Origin

Question 29

• 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

Answer 29

Headache Warning Signs suggesting a possibility of Pathology

Question 30

Temporal Arteritis, Herpes Zoster (shingles), Trigeminal neuralgia, TMJ, Caffeine withdrawal, Paget’s disease, Medication side effects, medication withdrawal, glossopharyngeal neuralgia

Answer 30

Other Causes of Headaches