### Date : 2024-05-16 16:53 ### Topic : Types of Headache #medicine ---- ### Primary Headaches  Primary headaches are not caused by another medical condition. The main types include: 1. **Migraine**: - **Symptoms**: Throbbing or pulsating pain, usually unilateral; often accompanied by nausea, vomiting, photophobia, and phonophobia. Some patients experience auras, which are sensory disturbances that precede the headache. - **Duration**: 4 to 72 hours. - **Triggers**: Hormonal changes, certain foods, stress, sensory stimuli, changes in sleep patterns, physical exertion. 2. **Tension-Type Headache (TTH)**: - **Symptoms**: Bilateral, pressing or tightening pain (non-pulsating), mild to moderate intensity. Not aggravated by routine physical activity and usually without nausea or vomiting. - **Duration**: 30 minutes to 7 days. - **Triggers**: Stress, poor posture, eye strain. 3. **Cluster Headache**: - **Symptoms**: Severe, unilateral pain typically around the eye or temple, often accompanied by autonomic symptoms like lacrimation, nasal congestion, rhinorrhea, and ptosis. Patients may experience restlessness or agitation. - **Duration**: 15 to 180 minutes. - **Frequency**: Occurs in clusters (bouts), with attacks happening multiple times a day for weeks or months, followed by remission periods. 4. **Trigeminal Autonomic Cephalalgias (TACs)**: - Includes cluster headaches and other types like paroxysmal hemicrania and SUNCT (Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing). - **Symptoms**: Severe, unilateral headaches with autonomic features (similar to cluster headaches but with different patterns and durations). ### Secondary Headaches Secondary headaches are due to an underlying condition. Some common types include: 1. **Medication Overuse Headache (Rebound Headache)**: - **Cause**: Overuse of headache medications (analgesics, triptans, etc.). - **Symptoms**: Frequent or daily headaches, often starting early in the morning. - **Treatment**: Discontinuation or reduction of overused medications under medical supervision. 2. **Sinus Headache**: - **Cause**: Sinusitis or sinus infection. - **Symptoms**: Pain and pressure in the forehead, cheeks, and around the eyes, often accompanied by nasal congestion, discharge, and sometimes fever. - **Diagnosis**: Confirmed by clinical signs of sinusitis or imaging. 3. **Cervicogenic Headache**: - **Cause**: Referred pain from a neck disorder or lesion (e.g., arthritis, disc disease). - **Symptoms**: Unilateral headache starting in the neck, radiating to the fronto-temporal region. Often accompanied by neck pain and stiffness. - **Diagnosis**: Clinical evaluation and imaging if needed. 4. **Headache Due to Trauma (Post-Traumatic Headache)**: - **Cause**: Head injury or concussion. - **Symptoms**: Headache of varying intensity and type, often accompanied by dizziness, cognitive disturbances, and mood changes. - **Duration**: Can be acute (within 7 days of injury) or chronic (persisting beyond 3 months). 5. **Thunderclap Headache**: - **Cause**: Often due to serious underlying conditions like subarachnoid hemorrhage, cerebral venous thrombosis, or reversible cerebral vasoconstriction syndrome (RCVS). - **Symptoms**: Sudden, severe headache reaching maximum intensity within seconds to minutes. - **Diagnosis**: Immediate neuroimaging and medical evaluation to identify the cause. 6. **Hypertension-Related Headache**: - **Cause**: Severe hypertension. - **Symptoms**: Bilateral, pulsatile headache often associated with symptoms of high blood pressure (e.g., visual disturbances, chest pain). - **Treatment**: Blood pressure management. 7. **Temporal Arteritis (Giant Cell Arteritis)**: - **Cause**: Inflammation of the temporal arteries. - **Symptoms**: Unilateral or bilateral throbbing headache, scalp tenderness, jaw claudication, and visual disturbances. - **Diagnosis**: Elevated ESR and CRP, temporal artery biopsy. - **Treatment**: High-dose corticosteroids. ### Approach to Diagnosis and Management **History and Physical Examination**: - Detailed headache history (onset, duration, location, quality, intensity, triggers, associated symptoms). - Physical examination focusing on neurological signs, head, and neck. **Investigations**: - Neuroimaging (CT, MRI) if red flags are present (e.g., sudden onset, neurological deficits, signs of increased intracranial pressure). - Blood tests and other relevant investigations based on suspected secondary causes. **Management**: - **Acute treatment**: Analgesics, NSAIDs, triptans for migraines, oxygen for cluster headaches. - **Preventive treatment**: Beta-blockers, anticonvulsants, antidepressants for chronic headaches. - **Lifestyle modifications**: Stress management, regular sleep, hydration, avoiding known triggers. By distinguishing between these types of headaches and understanding their unique features and management strategies, you can better diagnose and treat your patients.