Tension Headaches and TACs Flashcards
Most common
type of
headache
Presents in
two forms
* Episodic - frequency is < 15 days/month
* Chronic- (frequency > 15 days/month for 6 months)
* Most patients who suffer TTHA do not seek specific
medical treatment
* Use OTC medications to combat symptoms
TTHA
Tension type headache
Diagnostic Criteria:
A. At least 10 episodes of headache occurring on
<1 d/mo. (<12 d/yr.) and fulfilling criteria B-D
B. Lasting from 30 min to 7 days
C. 2 of the following 4 characteristics:
1. bilateral location
2. pressing or tightening (non-pulsating) quality
3. mild or moderate intensity
4. not aggravated by routine physical activity
D. Both of the following:
1. no nausea or vomiting
2. no more than one of photophobia or phonophobia
E. Not better accounted for by another ICHD-3
diagnosis
TTHA
Tension type headache
Symptoms begin before the age 20 years in 40% of patients.
No predilection for any particular cranial location-may involve the frontal,
temporal, parietal, or occipital areas alone, or in combination
Associated with pericranial/cervical muscle tenderness-Studies have shown that
patients with chronic TTH have a higher incidence of active Trigger Points in the
upper trapezius, SCM, temporalis, as well as the suboccipitals and other
posterior cervical muscles than in controls.
Occurs in relation to emotional conflict/stress
Tension type headache
Most patients with TTH experience occasional very painful headaches
often accompanied by migrainous symptoms.
Epidemiological characteristics of TTH patients not significantly
different from migraine patients-
Migraine and TTH also share common triggers (stress, mental tension,
fatigue, lack of sleep, and menstruation)
Suggests that these disorders are at two ends of a continuum and many
people will experience both types over a lifetime
Tension headaches
Decrease intake of caffeine and alcohol as well as any medications that have
been chronically used by the patient for the headache
May at first increase the frequency and intensity of headaches
After 1-2 weeks the withdrawal should subside
Decrease Caffeine use by 25% every week so caffeine withdrawal
headache should not occur
NOn pharm ways to decrease headaches
The following drugs are used to
ANALGESICS: aspirin, acetaminophen
NSAIDs: indomethacin, ibuprofen,
naproxen, ketoprofen
COMBINATION: aspirin &/or
acetaminophen with caffeine (i.e. Excedrin
Migraine)
MUSCLE RELAXANTS: diazepam,
methocarbamol (Robaxin), cyclobenzaprine
(Flexeril), carisoprodol, baclofen
Usage is on an as needed basis but
typically limited time use
Pharmacological
Management
Tension-type
Headache
Analgesics should be used for tension headaches for no more than ____ days per week
2 days per week
______ are unilateral headaches accompanied by
autonomic features
3.1 Cluster headache
3.2 Paroxysmal hemicrania
3.3 Short-lasting unilateral neuralgiform headache attacks
3.4 Hemicrania continua
3.5 Probable trigeminal autonomic cephalalgia
RULE OUT SECONDARY CAUSE!
Trigeminal autonomic cephalalgias (TACs)
(TAC)
A. At least 5 attacks fulfilling criteria B-D
B. Severe or very severe unilateral orbital, supraorbital
and/or temporal pain lasting 15-180 min (when
untreated)
C. Either or both of the following:
1. Autonomic Symptoms:1 of the following ipsilateral symptoms or signs:
a) conjunctival injection and/or lacrimation; b) nasal congestion and/or rhinorrhea; c)
eyelid oedema; d) fore-head and facial sweating; e) forehead and facial flushing;
f) sensation of fullness in the ear; g) miosis and/or ptosis
2. a sense of restlessness or agitation
D. Frequency from 1-2x/ d to 8x/d for > half the time when
active
E. Not better accounted for by another ICHD-3 diagnosis
More common in males
Cluster headache
A. Attacks fulfilling criteria for 3.1 Cluster headache and occurring
in bouts (cluster periods)
B. 2 cluster periods lasting 7 days to 1 year (when untreated)
and separated by pain-free remission periods of 1 month.
Episodic cluster headache
A. Attacks fulfilling criteria for 3.1 Cluster headache and criterion
B below
B. Occurring without a remission period, or with remissions lasting
<1 mo, for 1 year
Chronic cluster headache
Brief attacks are:
Provoked by alcohol
Frequently occurs during sleep or napping times.
During an attack, patients will characteristically pace,
cry, scream, or pound their fists.
Primarily affects men (4:1) males: females ratio
Age of onset between 20-40
-Runny nose
Cluster headache
Abortive tx of ______
Abortive Treatment
100% Oxygen at 7-10 l./min. for 15 min. using face mask is
effective within 10-15 minutes in 60-70% of cases
Sumatriptan (6 mg S.C. or nasal spray)
DHE-45 (1.0 mg I.M. or I.V. or Migranol (intranasal)
Intranasal administration of 1 ml of 4% topical Lidocaine
Indomethacin (oral or rectal suppositories)- cluster
headache MAY respond
Cluster Headache
Prophylactic tx of ______
Episodic Cluster:
Calcium channel blockers
i.e. Verapamil
Ergotamine
Lithium carbonate
Methysergide
Valproate
Prednisone
Chronic Cluster:
Verapamil
Lithium carbonate
Methysergide
Gabapentin
Cluster headaches
Common in women
Temporal or frontal pain is most
common
Throbbing, aching, sharp, stabbing
Age: 10-77 y.o. (mean range= 35-49
years)
A daily, continuous, strictly
unilateral primary headache
The intensity of the pain may
fluctuate but the headache never
remits
Treatment: By definition, hemicrania
continua remits with indomethacin
medication.
Hemicrania Continua
