Primary headaches

Primary headaches

1. tension-type headache

   • features
     • symmetrical
     • onset
       • gradual
     • description
       • tightness
       • a band
       • pressure

2. migraine w/o aura

   • accounts for 90%
   • episodes may last 1-72h
   • often bilateral
     • but may be unilat
   • site
     • temporal or frontal area
   • assoc sx
     • unpleasant GI disturbance
       • nausea
       • vomiting
       • abdominal pain
       • photophobia
       • phonophobia
   • exacerbating factors
     • physical activity

3. migraine w/ aura

   • 10% of migraine
   • headache preceded by an aura
     • visual
       • commonest aura
       • -ve phenomena
         • hemianopia
           • loss of half the visual field
         • scotoma
           • small areas of visual loss
       • +ve phenomena
         • e.g. fortification spectra
           • seeing zigzag lines
     • sensory
     • motor
   • features
     • absence of probs btw episodes
     • freq presence of premonitory sx
       • tiredness
       • difficulty concentrating
       • autonomic features
     • duration
       • few hours
         • spent lying down in a quiet, dark place
     • relieving features
       • sleep
   • unilat sensory or motor sx
     • rare

4. sx of tension-type headache or a migraine often overlap

   • probably part of same pathophysiological continuum
     • evidence suggests they both come from primary neuronal dysfuncn
       • incl channelopathies
       • w/ vascular phenomena as secondary events
     • genetic predisposition
       • 1st & 2nd degree relatives often affected
     • triggers
       • disturbance of biorhythms
         • late nights
         • early rises
         • stress
         • winding down after stress at home or school
       • food
         • cheese
         • chocolate
         • caffeine
         • rarely a trigger
       • in girls
         • menstruation
         • oral contraceptive pill

5. uncommon forms of migraine

   • familial
     • linked to Ca2+ channel defect
     • dominantly inherited
   • sporadic hemiplegic migraine
   • basilar-type
     • vomiting w/ nystagmus
       • and/or
         • cerebellar signs
   • periodic syndromes
     • often precursors of migraine
     • cyclical vomiting
       • recurrent stereotyped episodes of vomiting
       • intense nausea
         • assoc w/ pallor or nausea
     • abdominal migraine
       • idiopathic recurrent disorder
       • episodic midline abdo pain
         • bouts lasting 1-72h
         • moderate to severe intensity
         • assoc sx
           • vasomotor sx
           • nausea
           • vomiting
       • child well in btw episodes
     • benign paroxysmal vertigo of childhood
       • heterogeneous disorder
       • brief episodes of vertigo
         • occur w/o warning
         • resolving spontaneously in otherwise healthy kids
       • btw episodes neuro examn, audiometric & vestibular funcn are normal