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Headaches

Headaches. Study Group Laura Maidment. Headache classification (According to IHS, 2004). Primary headaches Migraine Tension –type headaches Cluster headaches Other primary headaches Secondary headaches Caused by another disorder Includes cervicogenic headache. Migraine .

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Headaches

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  1. Headaches Study Group Laura Maidment

  2. Headache classification (According to IHS, 2004) • Primary headaches • Migraine • Tension –type headaches • Cluster headaches • Other primary headaches • Secondary headaches Caused by another disorder Includes cervicogenic headache

  3. Migraine • Ranked 19 by the WHO among all diseases worldwide causing disability • Thought to be a neurovascular pain syndrome • Triggers include: red wine, skipping meals, excessive afferent stimuli, stress, hormonal changes, sleep depreviation • Two major sub-types: • Migraine without aura • Migraine with aura

  4. Migraine without aura • Recurrent headache disorder manifesting in attacks lasting 4-72 hours • Unilateral location, • Pulsating quality • Moderate or severe pain intensity • Agg by routine physical activity eg walking • During HA one of the following: • Nausea and or/vomitting • Photophobia and phonophobia

  5. Migraine with aura • Recurrent disorder manifesting in attacks of reversible focal neurological symptoms (develop 5-20mins, <60mins) • Aura consisting of one of the following: 1) Visual symptoms 2) Sensory symptoms 3) Dysphasic speech disturbance • Headache with features of migraine without aura usually follows aura symptoms

  6. Treatment • Elimination of triggers • Stress coping strategies • Mild attacks: NSAID’s or acetaminophen Mild analgesics containing opoids, caffeine are helpful for infrequent attacks (can be overused) • Severe attacks: Triptans (specifically block the release of vasoactiveneuropeptides that trigger migraine pain) • Preventative: Amytriptyline

  7. Tension –type headaches • Very common but little research • Can be episodic or chronic • Mild generalised pain • Does not worsen with activity • No nausea or vomiting • Exact mechanism unknown

  8. Episodic tension-type headache • Episodes of headache lasting minutes to days • Bilateral location (usually occipital/frontal region) • Pressing or tightening in quality • Mild to moderate intensity • May have photophobia or phonophobia • Typically start hours after wakening and worsen as day progresses

  9. Chronic tension-type headache • Headache occuring on >15days per month on average for >3months • Headache lasts hours or may be continuous • Bilateral location (usually occipital or frontal region) • Pressing/tightening quality • Mild or moderate intensity • May have photophobia or phonophobia

  10. Treatment • Analgesics egasprin • Preventative: Amitriptyline • Relaxation and stress management • Manual therapy

  11. Cluster headaches • Usually affects men, typically at age of 20-40 • Vascular headache- causing dilation of blood vessels which creates pressure on trigeminal nerve • Hypothalamus involvement • Severe unilateral orbital, supraorbital or temporal pain • Lasts 15-180 mins • Occurs from one every other day up to 8 times a day • Ipsilateral autonomic symptoms: nasal congestions, rhionrrhea, lacrimation, facial flushing, horners syndrome

  12. Treatment • For attacks: triptans • Long term: Verapamill, lithium • Frequent, severe attacks: Prednisone(used to treat inflammatory diseases),Greater occipital nerve block

  13. Other primary headaches • The pathogenesis of these headaches is still poorly understood • Thunderclap headaches: high intensity headache, <1min • Stabbing headache: ice prick pains, jabs and jolts • Cough headache: precipitated by coughing or straining 1sec-30mins • Exertional headache: Precipitating any form of exercise, 5mins-48 hours

  14. Secondary headaches • Another disorder known to be able to cause headache has been demonstrated • HA greatly reduced after successful treatment or spontaneous remission of the causative disorder

  15. Types of secondary headaches • HA attributed to head or neck trauma • HA attributed to cranial or cervical vascular disorder eg TIA, haemorrage, arteritis • HA attributed to non-vascular intracranial disorders eg intracranial neoplasm, high CSF, epileptic seizure • HA attributed to substance or its withdrawal eg acute substance overuse, medication overuse • HA attributed to infectioneg intracranial, systemic, HIV/Aids

  16. Types of secondary headaches cont. • HA attributed to disorder of homoeostasiseg hypoxia, hypertension, hypothyroidism, fasting • HA attributed to disorder of cranium, neck, eyes, ear, nose, sinus, teeth, jaw, mouth egCervicogenic HA • HA attributed to disorder of cranial bone

  17. Cervicogenic headache • Pain referred from a source in the neck and perceived in one or more regions of the head or face • Precipitation of HA by: • Neck movement or sustained awkward head postures • External pressure over the upper csp or occipital region • Restriction of range of motion in the neck • Unilateral HA’s, originating post and migrating to front

  18. Cervicogenic HA mechanism • Results from a convergence of sensory input from the upper cervical spine into the trigeminal spinal nucleus • Trigeminocervical nucleus- region of upper cervical spinal cord where sensory nerve fibres in the descending tract of the trigeminal nerve interact with sensory fibres from upper cervical roots.

  19. Trigeminocervical nucleus

  20. Input from these areas can have an affect on the trigeminocervical nucleus: • Upper cervical facets • Upper cervical muscles • C2-3 IV disc • Vertebral and internal carotid arteries • Dura mater of the spinal cord • Posterior cranial fossa

  21. Musculoskeletal features of cervicogenic headache 1) Forward head posture: increases stress on upper cervical segments 2) Decreases in active ROM in csp 3) Hypertonicity of SCM, UFT, scalenes, sub-occipitals, pect minor, pect major, levscap 4) Weak deep cervical flexors 5) Poor diaphramatic breathing- causing overuse of accessory muscles of respiration 6) Palpable joint dysfunction

  22. Medication overuse Headache • Regular overuse for >3months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache • Peculiar pattern with characteristics shifting from migraine like to tension-like headache • Analgesics • Ergotamine (migraine) • Triptan (migraine and tension type) • Opioid (opioid dependence; withdrawal syndrome • http://www.bbc.co.uk/news/health-19622016

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