The producers of this video are: Dr. Mary Charles Haigler Dr. Patricia BoettnerHeadaches are a common disorder; they lead to absence of work. It can be primary or secondary in nature and we’ll talk about this a little bit more in just one second. I did want to let you know that Cephalgia, in 2018, published the International Classification of Headache Disease The Third Edition which can give more information about the variety of headache disorders.
Now, first of all, with primary headaches these are the headaches that are not caused by another disease. The headache itself is the problem. This includes things like migraines or tension type headaches.
Secondary headaches can be caused by other conditions such as meningitis which is an infection or stroke which is vascular in nature.
Now a primary headache, there are several types of primary headaches but I’m going to talk about two that you’ve probably heard more about such as migraines and tension type headaches. The migraines that we’re going to discuss are the ones without aura. To be diagnosed as a migraine, the patient must have had at least five of these attacks before. The headaches themselves last anywhere from four to 72 hours if an untreated or if unsuccessfully treated. They tend to be on one side pulsating in quality moderate to severe intensity that can be aggravated with exertion like physical activity such as walking or climbing stairs. They need to have two of those those symptoms to be considered a migraine. During the headache greater than one of the following must occur. They must either have or they must have nausea and or vomiting. And or they can have photophobia and phonophobia. So, in order to use the criteria of light or sound sensitivity it has to be both light and sound sensitivity. But you can also have nausea and or vomiting. It’s not better accounted for by another international classification of headache disease diagnosis.
Now when we talk about tension type headaches if we talk about infrequent episodic tension type headaches then these are the ones that can last anywhere from 30 minutes to seven days. The patients often have a bilateral location or meaning both sides of the head have pain. It can be pressing or tightening often described as a “hat band” feel. Mild to moderate in intensity and it’s not aggravated by routine physical activity.
At least two of those criteria must be in place and then both of the following there can be no nausea vomiting and it can either have sound sensitivity or light sensitivity but not both.
Now if we move on to secondary headaches these are the ones that are also considered red flag headaches. These are headaches that indicate there’s something else going on systemically.
So, the acronym SNOOPPPP is very helpful in helping us to find those red flags. There could be systemic signs or symptoms such as fever or malaise, neurologic signs or symptoms. So changes in sensation or motor weakness or paralysis.
Onset can be the indicator. Did the headache come on very quickly? Peak in intensity quickly and it’s the worst headache ever? Is the patient over 50 years old and this is the first time they’ve had this type of headache? That would be a red flag. It can also be progression of a current headache, or it’s persistent. It doesn’t seem to go away, and the medications aren’t helping. Or can be precipitated by exertion. So, this headache started after exercise or after a Valsalva maneuver. It could also be initiated by positional change or worsened by positional change such as bending over, standing up, or laying down.
They can be from a vascular disorder such as an aneurysm or a stroke, non-vascular intracranial disorder such as a mass. It can be due to substance use or withdrawal. It could also be attributed to an infection such as meningitis or a disorder of homeostasis like increased hypertension. Headaches can also be caused by other types of diseases or disorders.
The main point of this talk that I would like to get across to you is that if you’re unsure of the nature of the headache and if any of the red flags are present that patient needs to be evaluated further before beginning treatment as if it was a routine primary headache. I hope this is helpful. Have a nice day.