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Emergencies associated with headache Are all headaches medical emergencies? When is a headache a medical emergency? What are the emergency causes of headaches? When can a child say he or she has a headache? What are the emergency signs in a baby who cannot say he or she has headache? What should you know about headaches? How is Internet human health care useful in this situation? What measures can be taken to prevent headaches? What is a headache? How are headaches classified? Which is the most common type of headaches? What are primary headaches? What are secondary headaches? What are cranial neuralgias, facial pain, and other headaches? What causes tension headaches? What are the symptoms of tension headaches? How are tension headaches diagnosed? How are tension headaches treated? What causes cluster headaches? What are the symptoms of cluster headaches? How are cluster headaches diagnosed? How are cluster headaches treated? Can cluster headaches be prevented? What diseases cause secondary headaches? How are secondary headaches diagnosed? What are the exams and tests for secondary headaches? When should I seek medical care for a headache? What kinds of treatments have been effective for your headache? Headache emergencies: diagnosis and management. Diagnostic Criteria for Cluster Headache Diagnostic Criteria for Episodic Tension-Type Headache Diagnostic Criteria for Migraine Medical History for Headaches What medical history should you seek relevant to this issue? Pregnancy and Headaches What causes headaches during pregnancy? Headaches Quiz: Test Your Headache Pain IQ |
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Emergencies associated with headache Are all headaches medical emergencies? No. When is a headache a medical emergency? It may be a medical emergency if you have a headache with slurred speech, change in eyesight, problems moving your arms or legs, dizziness, confusion, memory loss, fever, numbness, shortness of breath, stiff neck, persistent vomiting, unexpected symptoms affecting your ears, nose, throat, or eyes, unremitting diarrhea, vision loss, weakness, or paralysis. Other possibilities: Your headache is from a head injury. You have headaches that began after a head injury or other trauma and continue. You take over-the-counter medications for headache relief, and the recommended dosage isn't adequate. You have headaches that interfere with your normal activities. You have a headache that persists, keeps getting worse, and won't stop. You find yourself taking pain relievers more than two days a week. You have a headache that comes on suddenly and is very bad. You have a headache that is your "worst ever." You have a headache that gets worse and worse over 24 hours. You have a very bad headache around one eye, with redness in that eye. You are over age 50 and your headaches have begun recently — especially if you have trouble seeing or have pain while chewing. What are the emergency causes of headaches? Acute stress reaction Dehydration Starvation Meningitis Subarachnoid hemorrhage Other intracranial hemorrhages (epidural, subdural) Acute glaucoma Temporal arteritis (giant-Cell arteritis) Carbon monoxide poisoning Acute stroke Cranial vessel dissection Mass lesions (causing increased intracranial pressure) Brain or parameningeal abscess Pseudotumor cerebri (benign intracranial hypertension) Trauma with injuries to external or internal organs. Evaluation, diagnosis, and management of headache in adults. Evaluation, diagnosis, and management of headache in pregnancy. Evaluation, diagnosis, and management of headache in adolescents. Evaluation, diagnosis, and management of headache in children. When can a child say he or she has a headache? When children, especially young children, under school age, complain of their head hurting, it must be taken seriously. By the age of 7, at least 40 percent of children have had a headache. Headaches are very common in children and adolescents. What causes headaches in children? Head pain can be the result of common ailments such as colds, toothaches, and infections of the sinuses, eyes, ears, or throat. Your child may have a headache simply because he's stressed or tired or a little dehydrated. Or he may have gotten bumped on the head. In extremely rare cases, a child's throbbing head may be a sign of a brain tumor or meningitis, but keep in mind that both of these illnesses will cause other symptoms in addition to a headache. These are the major types of headaches in young children: Tension headaches: This common type of headache is marked by a dull ache (rather than sharp pain) on one or both sides of the head. Sometimes it feels like a band of tightness or pressure around the head. The symptoms are often the result of stress, anxiety, or depression, but may be linked to poor posture as well. Tension headaches usually flare up at school or home under tense conditions and disappear when a child plays or relaxes. Migraines: These headaches tend to run in families, and they usually first appear in children between the ages of 5 and 8, though they can strike at any age. (Roughly 5 percent of 10 year olds have had at least one bout with migraines, though most of them outgrow the problem before they reach puberty.) Migraines are usually one-sided and throbbing, and they often get worse with physical exertion. If your child has a migraine, he may experience mood changes, skin pallor, fatigue, dizziness, blurred vision, food cravings or loss of appetite, nausea and vomiting, diarrhea, or fever. Some kids also see auras (often described as wavy lines, flashing lights, blind spots, or tunnel vision) before the pain hits, and some are sensitive to bright lights and noise. Meningitis: Headache is often the major complaint of a child who has meningitis, which happens when an inflammation of the membranes covering the brain and spinal fluid puts pressure on the brain and decreases the circulation of the spinal fluid. Meningitis can cause high fever, repeated vomiting, loss of appetite, confusion, sleepiness, sensitivity to light, and — sometimes — a rash or an extremely stiff neck. (In a reclining position, your child won't be able to bend his head toward his chest because that will cause nearly unbearable shooting pains in his head or neck.) If your child has these symptoms, call 911 or get medical care immediately. Brain tumor: It's extremely unlikely that your child's headache is caused by a tumor. A tumor is the culprit in only 1 of 40,000 headaches in children. Still, if your child suffers from headaches, especially if they seem to be increasing in severity, if they wake him from his sleep, or if they occur early in the morning, talk with his doctor to rule out the possibility. What are the emergency signs in a baby who cannot say he or she has headache? Crying baby with refusal of feeding. Crying baby even if food is given. Unresponsive baby. What should you know about headaches? All headaches are not medical emergencies. Stress or tension are the most common causes of headaches. Headaches have specific associated signs that raise suspicion of medical emergencies. You should know all the facts of headaches. How is Internet human health care useful in this situation? Internet human health care is the best method to resolve health issues for a patient before reporting to an emergency call center, emergency room, or individualized doctor consultation that needs an appointment. Internet human health care is the best method to educate new medical students. Internet human health care is the best method to educate existing medical students. Internet human health care is the best method for continuing education of existing doctors. What measures can be taken to prevent headaches? Stress should be managed properly at home or home office before it causes headaches. Situations of trauma should be prevented. If symptoms or signs of emergency headaches occur, call for help or report to the nearest medical emergency room. What is a headache? Headache is defined as a pain arising from the head or upper neck of the body. The pain originates from the tissues and structures that surround the brain because the brain itself has no nerves that give rise to the sensation of pain (pain fibers). The periosteum that surrounds bones; muscles that encase the skull, sinuses, eyes, and ears; and meninges that cover the surface of the brain and spinal cord, arteries, veins, and nerves, all can become inflamed or irritated to cause the pain of a headache. This pain may be a dull ache, sharp, throbbing, constant, mild, or intense. Headache facts The head is one of the most common sites of pain in the body. The most common types of headache can be classified as 1) primary, 2) secondary, and 3) cranial neuralgias, facial pain, and other headaches. The most common types of primary headaches are 1) tension, 2) migraine, and 3) cluster. Tension headaches are the most common type of primary headache and usually are treated with over-the-counter (OTC) medications for pain. Secondary headaches are a symptom of an injury or an underlying illness. Patients should seek medical care for new onset headaches, fever, stiff neck, change in behavior, vomiting, weakness, or change in sensation. How are headaches classified? In 2005, the International Headache Society released its latest classification system for headache. Because so many people suffer from headaches and because treatment sometimes is difficult, it was hoped that the new classification system would help health care professionals make a specific diagnosis as to the type of headache and allow better and more effective options for treatment. There are three major categories of headache based upon the source of the pain: 1.primary headaches; 2.secondary headaches; and 3.cranial neuralgias, facial pain, and other headaches. Which is the most common type of headaches? Tension headaches Remember, tension headaches are also commonly referred to as stress headaches. What are primary headaches? Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache. Tension headaches are the most common type of primary headache. Tension headaches occur more commonly among women than men. According to the World Health Organization, 1 in 20 people in the developed world suffer with a daily tension headache. Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience a migraine headache. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. It is estimated that 6% of men and up to 18% of women will experience a migraine headache in their lifetime. Cluster headaches are a rare type of primary headache affecting 0.1% of the population (1 in a 1,000 people). It more commonly affects men in their late 20s though women and children can also suffer this type of headache. Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly while others are debilitated. While these headaches are not life-threatening, they may be associated with symptoms that can mimic strokes. Many patients equate severe headache with migraine, but the amount of pain does not determine the diagnosis of migraine. What are secondary headaches? Secondary headaches are those that are due to an underlying structural problem in the head or neck. This is a very broad group of medical conditions ranging from dental pain from infected teeth to pain from an infected sinus, to life-threatening conditions like bleeding in the brain or infections like encephalitis or meningitis. Traumatic headaches fall into this category including post-concussion headaches. This group of headaches also includes those headaches associated with substance abuse and excess use of medications used to treat headaches (rebound headaches). What are cranial neuralgias, facial pain, and other headaches? Neuralgia means nerve pain (neur= nerve + algia=pain). Cranial neuralgia describes inflammation of one of the 12 nerves that supply the motor and sensation function of the head and neck. Perhaps the most commonly recognized example is trigeminal neuralgia, which affects cranial nerve V (the trigeminal nerve) and can cause intense facial pain. What causes tension headaches? While tension headaches are the most frequently occurring type of headache, their cause is not known. The World Health Organization estimates that in the developed world, 80% of women and 67% of men will experience this type of headache. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may become inflamed, go into spasm, and cause pain. Common sites include the base of the skull where the trapezius muscles of the neck insert, the temples where muscles that move the jaw are located, and the forehead. There is little research to confirm the exact cause of tension headaches. Tension headaches occur because of physical or emotional stress placed on the body. For example, these stressors can cause the muscles surrounding the skull to clench the teeth and go into spasm. Physical stressors include difficult and prolonged manual labor, or sitting at a desk or computer for long periods of time concentrating. Emotional stress also may cause tension headaches by causing the muscles surrounding the skull to contract. What are the symptoms of tension headaches? Common presentation of tension headaches includes the following: Pain that begins in the back of the head and upper neck and is described as a band-like tightness or pressure. It may spread to encircle the head. The most intense pressure may be felt at the temples or over the eyebrows. The pain can vary in intensity but usually is not disabling, meaning that the sufferer may continue with daily activities. The pain usually is bilateral (affecting both sides of the head). The pain is not associated with an aura (see below), nausea, vomiting, or sensitivity to light and sound. The pain occurs sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people. The pain allows most people to function normally, despite the headache. How are tension headaches diagnosed? The key to making the diagnosis of any headache is the history given by the patient. The health care professional will ask questions about the headache to try to help make the diagnosis. Those questions may include learning about the quality, quantity, and duration of the pain, and asking about any associated symptoms. The person with a tension headache will usually complain of pain that is mild-to-moderate, located on both sides of the head, described as a tightness that is not throbbing, and not made worse with activity. There will be no associated symptoms like nausea, vomiting, or light sensitivity. The physical examination, particularly the neurologic portion of the examination, is important in tension headaches because to make the diagnosis, it should be normal. However, there may be some tenderness of the scalp or neck muscles. If the health care professional finds an abnormality on neurologic exam, then the diagnosis of tension headache should be put on hold while the potential for other causes of headaches has been investigated. How are tension headaches treated? Tension headaches are painful, and patients may be upset that the diagnosis is "only" a tension headache. Even though it is not life-threatening, a tension headache can make daily activities more difficult to accomplish. Most people successfully treat themselves with over-the–counter (OTC) pain medications to control tension headaches. The following work well for most people: aspirin, ibuprofen (Motrin, Advil), acetaminophen (Tylenol), and naproxen (Aleve). If these fail, other supportive treatments are available. Recurrent headaches should be a signal to seek medical help. Massage, biofeedback, and stress management can all be used as adjuncts to help with control of tension headaches. It is important to remember that OTC medications, while safe, are medications and may have side effects and potential interactions with prescription medications. It always is wise to ask a health care professional or pharmacist if one has questions about OTC medications and their use. This is especially important with OTC pain medications, because they are used so frequently. It is important to read the listing of ingredients in OTC pain medications. Often an OTC medication is a combination of ingredients, and the second or third listed ingredient may have the potential for drug interaction or contraindication based upon a patient's other medical issues For example: Some OTC medications include caffeine, which may trigger rapid heartbeats in some patients. In night time preparations, diphenhydramine (Benadryl) may be added. This may cause sedation, and driving or using heavy machinery may not be appropriate when taking a sedative medication. Other examples where caution should be used include the following: Aspirin should not be used in children and teenagers because of the risk of Reye's Syndrome, a life threatening complication that may occur when a viral infection is present and aspirin is taken. Aspirin, ibuprofen, and naproxen are irritating to the stomach and may cause intestinal bleeding. They should be used with caution in patients who have peptic ulcer disease or who take blood thinners like warfarin (Coumadin), dabigatran (Pradaxa), clopidogrel bisulfate (Plavix), and prasugrel (Effient). Overuse of aspirin, ibuprofen, and naproxen also may cause kidney damage. Acetaminophen, if used in large amounts, can cause liver damage or failure. It should be used with caution in patients who drink significant amounts of alcohol or who have liver disease. One cause of chronic tension headaches is overuse of medications for pain. When pain medications are used for a prolonged period of time, headaches can recur as the effects of the medication wear off (This is classified as a secondary headache when the pain is due to the withdrawal of a medication [rebound headache].). What causes cluster headaches? Cluster headaches are so named because they tend to occur daily for periods of a week or more with long periods of time, months to years, with no headache symptoms. They occur at the same time of day, often waking the patient in the middle of the night. The cause of cluster headaches is uncertain but may be due to a sudden release of the chemicals histamine and serotonin in the brain. The hypothalamus, an area located at the base of the brain, is responsible for the body's biologic clock and may be the location that is the source for this type of headache. When brain scans are performed on patients who are in the midst of a cluster headache, abnormal activity has been found in the hypothalamus. Cluster headaches also: tend to run in families and this suggests that there may be a role for genetics; may be triggered by changes in sleep patterns; and may be triggered by medications (for example, nitroglycerin, used for heart disease). If an individual is in a susceptible period for cluster headache, cigarette smoking, alcohol, and some foods (for example, chocolate and foods high in nitrites like smoked meats) also can be potential causes for headache. What are the symptoms of cluster headaches? Cluster headaches are headaches that come in groups (clusters) separated by pain-free periods of months or years. A patient may experience a headache on a daily basis for weeks or months and then be pain free for years. This type of headache affects males more frequently and often begins in adolescence but can extend to those in middle age. During the period in which the cluster headaches occur, pain typically occurs once or twice daily, but some patients may experience pain more than twice daily. Each episode of pain lasts from 30 to 90 minutes. Attacks tend to occur at about the same time every day and often awaken the patient at night from a sound sleep. The pain typically is excruciating and located around or behind one eye. Some patients describe the pain as feeling like a hot poker in the eye. The affected eye may become red, inflamed, and watery. The nose on the affected side may become congested and runny. Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall, and patients can be driven to desperate measures including contemplating suicide. How are cluster headaches diagnosed? The diagnosis of cluster headache is made by taking the patient's history. The description of the pain and its clock-like recurrence is usually enough to make the diagnosis. If examined in the midst of an attack, the patient usually is in a painful crisis and may have the eye and nose watering as described previously. If the patient is seen when the pain is not present, the physical examination is normal and the diagnosis will depends upon the history. How are cluster headaches treated? Cluster headaches may be very difficult to treat, and it may take trial and error to find the specific treatment regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled, and the following headaches need to be prevented. Initial treatment options may include one or more of the following: inhalation of high concentrations of oxygen (though this will not work if the headache is well established); injection of triptan medications, like, sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt) which are common migraine medications; injection of lidocaine, a local anesthetic, into the nostril; dihydroergotamine (DHE, Migranal), a medication that causes blood vessels to constrict; and caffeine. Prevention of the next cluster headache may include the following: calcium channel blockers (for example, verapamil [Calan, Verelan, Verelan PM, Isoptin, Covera-HS], diltiazem [Cardizem, Dilacor, Tiazac]); prednisone (Deltasone, Liquid Pred); antidepressant medications; lithium (Eskalith, Lithobid); and antiseizure medications including valproic acid, divalproex (Depakote, Depakote ER, Depakene, Depacon), and topiramate (Topamax). Can cluster headaches be prevented? Since cluster headache episodes may be spaced years apart, and since the first headache of a new cluster episode can't be predicted, daily medication may not be warranted. Lifestyle changes may help minimize the risk of a cluster headache flare. Stopping smoking and minimizing alcohol may prevent future episodes of cluster headache. What diseases cause secondary headaches? Headache is a symptom associated with many illnesses. While head pain itself is the issue with primary headaches, secondary headaches are due to an underlying disease or injury that needs to be diagnosed and treated. Controlling the headache symptom will need to occur at the same time that diagnostic tests are being considered to diagnose the underlying disease. Some of the causes of secondary headache may be potentially life-threatening and deadly. Early diagnosis and treatment is essential if damage is to be limited. The International Headache Society lists eight categories of secondary headache. A few examples in each category are noted (This is not a complete list.). Head and neck trauma Injuries to the head may cause bleeding in the spaces between the layers of tissue that surround the brain (subdural, epidural, and subarachnoid spaces) or within the brain tissue itself (intracerebral hemorrhage: intra=within + cerebral=brain, hemorrhage=bleeding). Edema or swelling within the brain, not associated with bleeding, may cause pain and a change in mental function. Concussions, where head injury occurs without bleeding. Headache is one of the hallmarks of post-concussion syndrome. Whiplash and neck injury also cause head pain. Blood vessel problems in the head and neck Stroke or transient ischemic attack (TIA) Arteriovenous malformations (AVM) may cause headache before they leak. Cerebral aneurysm and subarachnoid hemorrhage. An aneurysm, or a weakened area in a blood vessel wall, can expand and leak a small amount of blood causing what is called a sentinel headache. This may be a warning sign of a future catastrophic bleed into the brain. Carotid artery inflammation Temporal arteritis (inflammation of the temporal artery) Non-blood vessel problems of the brain Brain tumors, either primary, originating in the brain, or metastatic from a cancer that began in another organ Seizures Idiopathic intracranial hypertension, historically called pseudotumor cerebri, where pressure within the spinal canal increases. The cause is unknown and while it can occur in all ages, it often affects young, obese females. Idiopathic intracranial hypertension can cause significant headache and if left untreated may, on occasion, lead to blindness. Medications and drugs (including withdrawal from those drugs) Infection Meningitis Encephalitis Systemic infections (for example, pneumonia or influenza) Changes in the body's environment High blood pressure (hypertension) Dehydration Hypothyroidism Renal dialysis Problems with the eyes, ears, nose throat, teeth, sinuses, and neck Psychiatric disorders How are secondary headaches diagnosed? If there is time, the diagnosis of secondary headache begins with a complete patient history followed by a physical examination and laboratory and radiology tests as appropriate. However, some patients present in crisis with a decreased level of consciousness or unstable vital signs. In these situations, the health care professional may decide to treat a specific cause without waiting for tests to confirm the diagnosis. For example, a patient with headache, fever, stiff neck, and confusion may have symptoms that suggest meningitis. Since meningitis can be rapidly fatal, antibiotic therapy may be started before blood tests and a lumbar puncture are performed to confirm the diagnosis. It may be that the diagnosis is found to be a brain tumor or subarachnoid hemorrhage, but the benefit of early antibiotics outweighs the risk of not giving them promptly. What are the exams and tests for secondary headaches? The patient history and physical examination provide the initial direction for determining the cause of secondary headaches. Therefore, it is extremely important that a patient with new, severe headache seeks medical care and gives their health care professional an opportunity to assess their condition. Tests that may be useful in making the diagnosis of the underlying disease causing the headaches will depend upon the doctor's evaluation and what specific disease, illness, or injury is being considered as the cause of the headaches (the differential diagnosis). Common tests that are considered include the following: blood tests; computerized tomography (CT scan); magnetic resonance imaging (MRI) scans of the head; and lumbar puncture (spinal tap). Specific tests will depend upon what potential issues the health care professional and patient want to address. Blood tests Blood tests provide helpful information in association with the history and physical examination in pursuing a diagnosis. For example, an infection or inflammation in the body may cause a rise in the white blood cell count, the erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP). These two tests are very nonspecific; that is, they may be abnormal with any infection or inflammation, and abnormalities do not point to a specific diagnosis of the cause of the infection or inflammation. The ESR is often used to make the tentative diagnosis of temporal arteritis, a condition that affects an older patient, usually over the age of 65, who presents with a sharp, stabbing temporal headache. Blood tests may be used to assess electrolyte disturbances, and a variety of organ dysfunctions including liver, kidney, and thyroid. Toxicology tests may be helpful if the patient is suspected of abusing alcohol, prescription, or other drugs of abuse. Computerized tomography of the head Computerized tomography (CT scan) is able to detect bleeding, swelling, and some tumors within the skull and brain. It can also show evidence of previous stroke. With intravenous contrast injection, it may also be used to look at the arteries of the brain. Magnetic resonance imaging (MRI) of the head MRI is able to better look at the anatomy of the brain and meninges (the layers that cover the brain and the spinal cord). While it is more precise, the time to perform the scan is significantly longer than for computerized tomography. This type of scan is not available at all hospitals. Moreover, it takes much longer to perform, requires the patient to cooperate by holding still, and requires that the patient have no metal in their body (for example, a heart pacemaker or metal foreign objects in the eye). Lumbar puncture Cerebrospinal fluid, the fluid that surrounds the brain and spinal cord, can be obtained with a needle that is inserted into the spine in the lower back. Examination of the fluid looks for infection (such as meningitis due to bacteria, virus, fungus, or tuberculosis) or blood from hemorrhage. In almost all cases, computerized tomography is done prior to lumbar puncture to make certain there is no bleeding, swelling, or tumor within the brain. Pressure within the space can be measured when the lumbar puncture needle is inserted. Elevated pressures may make the diagnosis of idiopathic intracranial hypertension in combination with the appropriate history and physical examination. When should I seek medical care for a headache? A patient should seek medical care if their headache is: The "worst headache of your life." This is the wording often used in textbooks as a cue for medical practitioners to consider the diagnosis of a subarachnoid hemorrhage due to a ruptured cerebral aneurysm. The amount of pain will often be taken in context with the appearance of the patient and other associated signs and symptoms. Too often, patients are prompted to use this expression by a health care professional and do not routinely volunteer the phrase. Different than their usual headaches Starts suddenly or is aggravated by exertion, coughing, bending over, or sexual activity Associated with persistent nausea and vomiting Associated with fever or stiff neck. A stiff neck may be due to meningitis or blood from a ruptured aneurysm. However, most patients who complain of a stiff neck have muscle spasm and inflammation as the cause. Associated with seizures Associated with recent head trauma or a fall Associated with changes in vision, speech, or behavior Associated with weakness or change in sensation on one side of their body that may be a sign of stroke. Not responding to treatment and is getting worse Requires more than the recommended dose of over-the-counter medications for pain Disabling and interfering with work and quality of life Headache emergencies: diagnosis and management. You have a headache that comes on suddenly and is very bad. You have a headache that is your "worst ever". You have a headache with slurred speech, change in eyesight, problems moving your arms or legs, dizziness, confusion, or memory loss. You have a headache that gets worse and worse over 24 hours. You have a headache along with a fever, stiff neck, nausea, and throwing up. Your headache is from a head injury. You have a very bad headache around one eye, with redness in that eye. You are over age 50 and your headaches have begun recently -- especially if you have trouble seeing or have pain while chewing. Diagnostic Criteria for Cluster Headache Diagnostic Criteria for Episodic Tension-Type Headache Diagnostic Criteria for Migraine Diagnostic Criteria for Cluster Headache A. At least five attacks fulfilling criteria B through D B. Severe unilateral orbital, supraorbital and/or temporal pain lasting 15 to 180 minutes (untreated) C. Headache associated with at least one of the following signs on the pain side: 1. Conjunctival injection 2. Lacrimation 3. Nasal congestion 4. Rhinorrhea 5. Forehead and facial sweating 6. Miosis 7. Ptosis 8. Eyelid edema D. Frequency of attacks: one attack every other day to eight attacks per day Diagnostic Criteria for Episodic Tension-Type Headache A. At least 10 previous headache episodes fulfilling criteria B through D; number of days with such headaches: less than 180 days per year B. Headache lasting from 30 minutes to 7 days C. At least two of the following pain characteristics: 1. Pressing or tightening (nonpulsating) quality 2. Mild or moderate intensity 3. Bilateral location 4. No aggravation by walking stairs or similar routine physical activity D. Both of the following: 1. No nausea or vomiting (anorexia may occur) 2. Photophobia and phonophobia are absent, or one but not the other is present. Diagnostic Criteria for Migraine Migraine without aura A. At least five attacks fulfilling criteria B through D B. Headache lasting 4 to 72 hours (untreated or unsuccessfully treated) C. At least two of the following pain characteristics: 1. Unilateral location 2. Pulsating quality 3. Moderate or severe intensity 4. Aggravation by walking stairs or similar physical activity D. During headache, at least one of the following: 1. Nausea and/or vomiting 2. Photophobia and phonophobia Migraine with aura A. At least two attacks fulfilling criterion B B. At least three of the following characteristics: 1. One or more fully reversible aura symptoms indicating focal cerebral cortical and/or brain-stem dysfunction 2. At least one aura symptom develops gradually over more than 4 minutes, or two or more symptoms occur in succession. 3. No aura symptom lasts more than 60 minutes; if more than one aura symptom is present, accepted duration is proportionally increased. 4. Headache follows aura, with a free interval of less than 60 minutes (headache may also begin before or simultaneously with aura). Medical History for Headaches A medical history is the most important tool a doctor has to evaluate your headaches. If your child or teen has headaches, the doctor will want to talk to you and your child. The doctor may also want to talk with your teen in private to discuss any emotional issues. Questions during the medical history often focus on your description of your headaches, their pattern, and whether people in your family have a history of headache problems. Headache description Questions to Ask in Obtaining a Headache History Is this your first or worst headache? How bad is your pain on a scale of 1 to 10 (1 means not too bad, and 10 means very bad) Do you have headaches on a regular basis? Is this headache like the ones you usually have? What symptoms do you have before the headache starts? What symptoms do you have during the headache? What symptoms do you have right now? When did this headache begin? How did it start (gradually, suddenly, other)? Where is your pain? Does the pain seem to spread to any other area? If so, where? What kind of pain do you have (throbbing, stabbing, dull, other)? Do you have other medical problems? If so, what? What are your headache location, duration, severity (worst ever headache?), and character (dull, sharp, throbbing, etc.)? What brings them on (for example, certain foods, stress, bright light, fasting, or sleep disturbances)? What aggravates them (exertion, coughing, bending, or sexual activity)? What relieves them? How long have you had these headaches? Have you had these headaches since childhood? How frequently do you get headaches? Do they occur on weekdays? Weekends? Do other family members have similar headaches? Are headaches often preceded by warning symptoms such as fatigue, yawning, sleepiness, or euphoria? Are your headaches associated with visual disturbances, nausea, vomiting, pallor, cold hands and feet, seizures, weakness or unusual sensations of the arm or leg, unsteady gait, slurred speech, or fever? Has there been a recent head trauma or a fall? Where does your head usually hurt during a headache-all over, on one side, or just in one spot? Do you have different kinds of headaches? How often do you get a headache? How long do the headaches usually last? What time of day do the headaches start? Describe the headache pain. Is it stabbing, dull, pulsating, aching, or sharp? Is the pain constant, or does it come and go? How severe is the pain? Do any warning signs occur right before a headache begins? These might include visual changes (seeing jagged or zigzag lines, stars, flashing lights or colors, illusions with distorted size or shape), numbness in your arms or legs, or a sudden feeling of energy, fatigue, hunger, restlessness, or quick temper. Do any other symptoms occur with the headaches? Other symptoms may include fever or chills, lethargy, confusion, nausea and vomiting, stiff neck, weakness, numbness, vision problems, problems with walking, or loss of bladder control. Have you noticed anything that seems to trigger the headache, such as drinking alcohol, eating a particular food, or the start of your menstrual period? Do the headaches occur after physical exertion, such as exercise, sex, coughing, or bending? What seems to make the headaches worse? What helps the headaches go away? Headache pattern and family history Have you had a recent head injury? Have you had a recent illness, such as flu, sore throat, or cold? Do you have any allergies? Have you had headaches in the past? Are your headaches always the same, or do you have different kinds of headaches? Do your headaches follow a usual pattern (beginning suddenly, occurring at certain times of the day or month)? Has the pattern of your headaches changed? Are you having headaches more often? Has the pain recently gotten worse or better? Are you taking any prescription or nonprescription medicines for your headaches? Which ones are you taking, and how often do you take them? Do they work? Are you taking medicines for any other medical condition? Have your headaches affected your performance at work or school? (School report cards may be a clue for the parents of children with headaches.) Have you had any changes in your sleep pattern? Are you experiencing physical or emotional stress? Is there a history of headaches in your family? Is the headache located in your forehead, around your eyes, in the back of your head, near your temples, behind your eyeball, or all over? Is the headache on one side only? Is this a new type of headache for you? Would you describe the headache as throbbing? Is there a pressure or band-like sensation? When does the headache occur? How long have you had headaches? How long does each headache last? Does the headache wake you up from sleep? Are the headaches worse during the day and better at night? Did other symptoms begin shortly after the headaches began? Do you have repeat headaches? Does the headache reach maximum intensity over 1 - 2 hours? Are the headaches worse when you are lying down? Standing up? Are the headaches worse when you cough or strain? Do they occur at a specific time related to your menstrual period? What home treatment have you tried? How well did it work? Family history (genetics) is a very strong risk factor for migraine headaches. If a child or teen has headaches, the doctor may also ask questions about the mother's pregnancy, labor, and delivery; the child's growth and development, behavior, and school performance; family conflicts; and any previous injuries or problems with the head. The doctor will also ask whether the child looks sick when he or she has a headache. Since how long have you been having headaches? Where in the head does it pain and how does it radiate? How often does the head pain? How long does each attack last? Is it short-lasting or long-lasting? How severe is the pain? What type of pain is it? What is the Nature of the pain? What factors can precipitate or worsen the headache. Are there any triggering or relieving factors? Are there any accompaniments to the head pain? Is there anything that you wish to tell me which you think I have not asked you? Why the consultation now? What is your expectation from this consultation? 10 Important Questions to Ask Your Doctor 1.What do you think is causing my headaches? 2.Is there more than one condition (disease) that could be causing my headaches? 3.What tests will you do to diagnose my headaches? 4.How accurate are the tests? 5.How safe are the tests? 6.What is the likely course of my condition? What is the long-term prognosis? 7.What are my treatment options? How effective is each treatment option? What are the benefits versus the risks of each treatment option? 8.If my symptoms worsen, what should I do on my own? When should I contact you? 9.Are you aware of each of the medications that I am taking? Can they adversely interact with the medications you are prescribing for me? 10.Should we monitor for side effects of the medications that you are prescribing or for their interactions with other medications I am taking? Pregnancy and Headaches What causes headaches during pregnancy? An increase in headaches during the first trimester is believed to be caused by the surge of hormones along with an increase in the blood volume circulating throughout your body. These headaches may be further aggravated by stress, poor posture or changes in your vision. Other causes of headaches during pregnancy may involve one or more of the following: •Lack of sleep •Low blood sugar •Dehydration •Caffeine withdrawal •Stress (too many changes) Women who have regular migraine headaches may discover that they experience fewer migraines during pregnancy; however, some women may encounter the same number or even more migraine headaches. If you are pregnant, it is important to talk to your health care provider about any medications that you may be taking for headaches. Headaches during the third trimester tend to be related more to poor posture and tension from carrying extra weight. Headaches during the third trimester may also be caused by a condition called preeclampsia, which is high blood pressure during pregnancy. What can you do to treat headaches during pregnancy? The best way to deal with headaches is to avoid them altogether. Avoiding tension headaches is easiest when you follow these tips: •Practice good posture (especially during the third trimester) •Get plenty of rest and relaxation •Exercise •Eat well-balanced meals •Apply cold or heat packs to your head If you are not able to prevent headaches, there are still things that you can do to help them go away. During pregnancy, you want to try and relieve your headache by natural means if possible. Pain relief medications such as aspirin and ibuprofen are not recommended in most pregnancies; however, acetaminophen may be reccommended by your health care provider. You may want to try to relieve your headache with one or more of the following natural remedies: •If you have a sinus headache, apply a warm compress around your eyes and nose •If you have a tension headache, apply a cold compress or ice pack at the base of your neck •Maintain your blood sugar by eating smaller, more frequent meals. This may also help prevent future headaches •Get a massage. Massaging your shoulders and neck is an effective way to relieve pain •Rest in a dark room and practice deep breathing •Take a warm shower or bath Applying heat or cold to the sides of the head, the eyes, or along the back of the neck is one of the best ways to reduce or relieve the pain associated with a headache. Heating pads and cold packs come in a variety of shapes and sizes, but most require using a microwave or the freezer first. Another draw back with some of these is that the heat or cold subsides as time goes on. You may also reduce the likelihood of migraine headaches by avoiding common triggers of migraine headaches. Potential triggers include: •Chocolate •Alcohol •Yogurt •Aged cheese •Peanuts •Breads with fresh yeast •Preserved meats •Sour cream When should you contact your health care provider? Unfortunately, headaches are a normal part of pregnancy; however you should be able to experience some relief. Contact your health care provider: •Before taking any medications •If you do not experience any relief from the remedies above •Your headaches get worse or more persistent •You experience headaches that are different than normal •Your headaches are accompanied by: blurry vision, sudden weight gain, pain in the upper right abdomen, and swelling in the hands and face Headaches Quiz: Test Your Headache Pain IQ 16 / 16 Who suffers more frequently from migraine headaches? Men over the age of 50 Women Correct:Women Which is the most common type of headaches? A Tension headaches B Migraine headaches C Cluster headaches D B & C only Correct:Tension headaches The trigeminal nerve is most closely associated with which type of headaches? Tension or stress headaches Cluster headaches Correct:Cluster headaches Which is not a symptom of migraine headaches? A Aura B Fever C Sensitivity to light D Nausea and vomiting Correct:Fever Fever is not a symptom of migraine headaches. Migraines are painful headaches often accompanied by other symptoms including nausea, vomiting, and sensitivity to light. Sinus headaches are usually caused by: Inflammation of the sinuses Drainage of the sinuses Correct:Inflammation of the sinuses Tension headaches usually are so severe that they keep a person from performing daily tasks. • True • False Correct:Tension headaches usually don't keep a person from performing daily tasks. An episodic tension headache may be described as a mild to moderate constant band-like pain, tightness, or pressure around the forehead or back of the head and neck. Remember, tension headaches are also commonly referred to as stress headaches. Common migraine triggers include everything listed below, EXCEPT:ATobacco smoke, alcohol, and nitrites (food additives) BSalt, allergies, milk, and aging CMSG (monosodium glutamate), aspartame, and caffeine DChocolate, odors, and bright or flickering lights The correct answer is: B Salt, allergies, milk, and aging Migraine, sinus, tension, and cluster headaches are considered to belong to which category of headaches: Primary Secondary Correct:Primary :______________ headaches generally strike at night. Cluster Migraine Correct:Cluster What is the trigeminal nerve? A The fifth of 12 cranial nerves (nerves of the head) B The main nerve of the face C A nerve responsible for facial or cranial sensations such as pain D All of the above Correct:All of the above A migraine sufferer is also likely to suffer from: Tension or stress headaches Cluster headaches Correct: Cluster headaches The "worst headache of your life" may be a symptom of a life-threatening infection known as: A MRSA (methicillin resistant staphylococcus aureus) B Anaphylactic shock C Migraine headache D Meningitis Correct: The correct answer is: D Meningitis Facial swelling is commonly associated with which type of headache: A Migraine headache B Cluster headache C Tension headache D Sinus Headache Correct: The correct answer is: D Sinus Headache Of all headache types, which type of headache is recognized as the least common and most severe? A Migraine headache B Cluster headache C Tension headache D Sinus Headache The correct answer is: B Cluster headache Common migraine headaches have been found to have a genetic basis. • True • False The correct answer is: • True With regard to headaches, the term "bilateral" best describes which type of pain:APain that occurs with at least one additional symptom BPain that affects the top and the bottom of the head CPain that occurs on either side of the head DPain that affects both sides of the head The correct answer is: D Pain that affects both sides of the head |