What Type of Headache do I have ?. David M. Biondi, DO Director, Headache Management Programs Spaulding Rehabilitation Hospital Consultant, Massachusetts General Hospital Instructor in Neurology, Harvard Medical School Boston, MA. Headache in the Population.
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David M. Biondi, DO
Director, Headache Management Programs
Spaulding Rehabilitation Hospital
Consultant, Massachusetts General Hospital
Instructor in Neurology, Harvard Medical School
Migraine is 6.3x more common than TTH
TTH is 1.5x more common than migraine
TTH is 3.3x more common than migraine
* People who want to talk to the doctor about their headaches or who
have headaches that interfere with daily activities.
Lipton RB et al. Neurology. 2003;61:375-385.
© 2002 Primary Care Network
Resting head on pillow
Pulling hair back (wearing a ponytail)
Wearing eyeglasses or contact lenses
Wearing hat or head band
Other painful events
Water hitting head or face while showering
Breathing through nose especially cold air
Cooking over a hot stove
Rubbing the neck or shoulders
Hanging head down or bending over“Even My Hair Hurts”(allodynia)
82% had previously been given a diagnosis of tension-type headache
Kaniecki R. Neurology. 2002;58(Suppl 6):S15-S20.
9% Function Normally
>75% Report Severe to Extremely Severe Pain
Severe Impairment or Bed Rest Required
Lipton RB et al. Headache. 2001;41:638-645.
1. Data on File. GlaxoSmithKline.
2. Cady RK, et al. Poster presented at:10th IHC; June 29-July 2, 2001; New York NY.
3. Kaniecki RG, et al. Poster presented at:10th IHC; June 29-July 2, 2001; New York NY.
Headaches that are triggered by weather or are associated with sinus symptoms are not migraines.
– Nasal congestion
1. Raskin NH. Headache. 2nd ed. New York: Churchill Livingstone; 1998.
2. Barbanti P et al. Cephalalgia. 2001;21:295.
Purulence in nasal cavity on exam
Nasal obstruction/blockage/ discharge
Fever (in acute only)
Ear pain/pressure/fullnessHeadache: A Minor Criteria in AAO-HNS Sinusitis
Headache is a minor factor in the diagnosis of rhinosinusitis, according to AAO-HNS*
* Facial pain/pressure alone does not constitute a suggestive history for rhinosinusitis in the absence of another major nasal symptom or sign.
* American Academy of Otolaryngology-Head and Neck Surgery Lanza et al. Otolaryngol Head Neck Surg 1997.117(pt 2): S1-S7.
Worsened by Activity
IHS Migraine Symptoms
“Sinus Symptoms”Are Common in the Presentation of Migraine
N = 2424
Schreiber C. Poster presented at: American Headache Society Meeting; June 21-23, 2002;Seattle, WA.
Migraine w/o or with Aura
IHS 1.1, 1.2
Source: SUMMIT Study