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Headache

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Headache is defined as the symptom of pain in the cranial region. It may be an isolated benign occurrence or manifestation of a wide variety of headache disorders.[1]

Contents

Classification

Primary headaches

Primary headaches are defined as "conditions in which the primary symptom is headache and the headache cannot be attributed to any known causes."[1]

Migraine headache

For more information, see: Migraine headache

Tension headache

Cluster headache

Criteria

Diagnostic criteria developed by the International Headache Society are:[2]
A. At least 5 attacks fulfilling criteria B-D
B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes if untreated1
C. Headache is accompanied by at least one of the following:

  1. ipsilateral conjunctival injection and/or lacrimation
  2. ipsilateral nasal congestion and/or rhinorrhoea
  3. ipsilateral eyelid oedema
  4. ipsilateral forehead and facial sweating
  5. ipsilateral miosis and/or ptosis
  6. a sense of restlessness or agitation

D. Attacks have a frequency from one every other day to 8 per day
E. Not attributed to another disorder

Secondary headache

Secondary headaches are defined as "conditions with headache symptom that can be attributed to a variety of causes including brain vascular disorders; wounds and injuries; infection; drug use or its withdrawal."[1]

The role of overuse of medications for treating migraine (triptans, analgesics, ergots) and their withdrawal as a cause of headache is controversial.[3]

Diagnosis

X-ray computed tomography (CT Scan) should be considered if one of the following is present:[4]

  • cluster-type headache
  • abnormal findings on neurologic examination
  • undefined headache (ie, not cluster, migraine, or tension-type)
  • headache with aura
  • headache aggravated by exertion or a valsalva-like maneuver
  • headache with vomiting

CT scan should also be considered in the following settings:

  • Acute thunderclap headache. Prevalence of significant pathology is 40%[4]
  • New-onset or change in chronic headaches. Prevalence of significant pathology is 32%.[4] This compares to a prevalence of significant pathology of 1% for patients with chronic headaches referred to a neurologist.[5] Presumably the prevalence would be lower in primary care.
  • Patients with human immunodeficiency virus. This is based on a clinical practice guideline.[6]

References

  1. ↑ 1.0 1.1 1.2 National Library of Medicine. Headache. Retrieved on 2007-12-11.
  2. ↑ Cluster headache
  3. ↑ Bøe MG, Mygland A, Salvesen R (2007). "Prednisolone does not reduce withdrawal headache: a randomized, double-blind study". Neurology 69 (1): 26–31. DOI:10.1212/01.wnl.0000263652.46222.e8. PMID 17475943.
  4. ↑ 4.0 4.1 4.2 Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM (2006). "Does this patient with headache have a migraine or need neuroimaging?". JAMA 296 (10): 1274–83. DOI:10.1001/jama.296.10.1274. PMID 16968852.
  5. ↑ Sempere AP, Porta-Etessam J, Medrano V, et al (2005). "Neuroimaging in the evaluation of patients with non-acute headache". Cephalalgia 25 (1): 30–5. DOI:10.1111/j.1468-2982.2004.00798.x. PMID 15606567.
  6. ↑ (2002) "Clinical policy: critical issues in the evaluation and management of patients presenting to the emergency department with acute headache". Ann Emerg Med 39 (1): 108–22. PMID 11782746.
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