Nature of Patient
1. Females - Tension, vascular (migraine), temporal arteritis, pseudo tumor
cerebri, and subaracnoid hemoorhage
6. Classic Migraine (migraine with aura) prodrome are prominent, and the
headaches are throbbing and UNILATERAL. Often sleep and wakes with
relief.
10. Patients over 50: few conditions that cause chronic headaches: temporal
arteririts, cluster headaches, mass lesions, post traumatic headaches,
cervical arthritis, Parkinson's disease, medications, and depression.
Nature of Pain
1. Tension headaches - DULL, not throbbing, steady, and of moderate but
persistent intensity. IF WAKEN UPON with headache, it will worsen
throughout the day and improve by evening. Presist all day.
Headache Patterns
1. Migraine headaches recur at irregular internals and have no specific
pattern. recur once or twice weakly or once a year. OFTEN occur around the
MENSTRUAL PERIOD.
Classic migraine - prodrome occurs 15 to 30 minutes before the headache.
Abrupt in onset, lasts for 10 to 15 minutes and is often contralateral to the
headache.
Visual aura: scotomata, transietn blindness, blurred vision, and
hemianopsia
nonvisual aura: weakness, aphasia, mood disturbances, and
photophobia
Common migraine- often has no specific aura
2. Tension headaches: occur daily but may also occur several times a week.
Chronic tension headaches may awaken in the morning with a headache but
rarely at night. Bruxism is a specific type of tension headache.
5. Sinus headache- often begin in the morning and progressively worsen but
tend to improve toward evening.
Associated Symptoms
1. Classic Migraine: anorexia, nasua, vomiting, sonophobia, photophobia,
and irritability. Less common: dizziness, fluid retention, abdominal pain, and
sleepiness.
2. Common Migraines: above as well as fatigue, chills, diarrhea, and
urticaria. CYCLIC ABDOMINAL PAIN or vomiting in children and motion
sickness in adults are typically seen in patiens with migraine headaches.
Amerliorating Factors
1. Ergot-containing drugs - vascular nature headaches
2. Aspirin or indomethacin- trigeminal autonomic cephalgia.
3. Nasal decongestants and antibotics - sinus cause
4. Headache that is severe; associated with nausea, vomiting, scotomata, or
aura with relief with sleep - probable migraine.
5. medication-overuse headaches are relieved with cessation of medications
Physical Findings
1. Tension or Migraine - seldom contribute to the differential diagnosis
2. Trigeminal neuralgia - have a trigger point.
3. True nuchal rigidity, neck stiffness throughout the arc as the examiner
flexes it but not in extension or lateral rotation.
4. TMJ dysfunction
Diagnostic Studies
1. CT may confirm acute sinusitis
2. ESR greatly elevated with temporal arteritis
3. SAH - lumber puncture/CT scan
4. MRI - for intracranial disease
5. Arteriograms may show vascular abnormalites and mass lesions.
Treatment of Headaches