NURS 5462 HEADACHE QUESTIONS
AND ANSWERS
•6Primary6headache6-6ans--
common6and6is6not6a6symptom6of6another6medical6condition6•6Migraine6•6Tension-
type6•6Cluster
Secondary6Headache6-6ans--specific6etiologies-and6sx6depend6on6these6pathologies
Gender6differences6-6ans--migraine/tension/Giant6Cell6Arteritis-
more6common6in6women.6Cluster6more6common6in6men
Onset6over6506-6ans--
or6worsening6headache6check6for6underlying6neurological6disease,617%6of6older6adults6r
eport6frequent6headche
Headache6Needing6Investigation6-6ans--
•6Sudden6onset6of6new,6severe6headache6•6Progressively6getting6worse6•6After6exertion,6
straining,6coughing,6or6sex-suggests6inc6ICP-needs6CT6•6With6associated6symptoms6-
6"worst6headache6I6have6ever6had"6•6First6headache6occurring6after6the6age6of6506years
Cortical6Spreading6Depression6-6ans--
•6Basis6of6the6migraine6aura6•6Cortical6neuronal6activity6followed6by6a6postictal6depressio
n6of6neuronal6firing6•6CSD6can6trigger6meningeal6pain6mechanisms6via6neurogenic6infla
mmation,6vasodilation6and6plasma6extravasation6•6Blood6barrier6is6activated—
which6may6explain6some6of6the6pain6•6Glutamatergic6synapses6in6the6cortex6are6activate
d
Brain6Stem6Generator6-6ans--
•6Meningeal6pain6mechanisms6are6activated6through6the6trigeminovascular6pathways6•6T
his6causes6release6of6inflammatory6cytokines,6neuroinflammatory6peptides6and6calcitoni
n6gene-related6peptide—
this6hormone6causes6the6vasodilation6•6Peripheral6nociceptors6are6activated—
this6mechanism6is6referred6to6as6peripheral6sensitization6•6When6the6trigeminal6nucleus6
caudalis6and6rostral6brain6structures6are6activated—it6is6known6as6central6sensitization
Clinical6Presentation:6Migraine6-6ans--
•6Migraine6without6aura6•6Common6migraine6•6Most6common6headache6•6One6sided6hea
, dache6•6Pounding/throbbing6•6Moderate6to6severe6intensity6•6Lasts64-
246hours,6May6be6associated6with6nausea,6vomiting,6sensitivity6to6light6or6sound
Clinical6Presentation:6Migraine6(aura)6-6ans--
•6Aura6usually6occurs6before6onset6of6headache6•6Auras6usually6last6seconds,6but6can6la
st6up6to620",6patient6then6gets6headache6•6"Fortification6spectrum"6occurs6in610%6[Jagge
d6lines6similar6to6stone6fortifications6around6a6fort],6•6Visual6auras6can6be6spots,6shimmer
ing6bright6lights6or6visual6loss6[scotomas]6•6Sensory6auras6include6tingling,6numbness6of6
fingers,6motor6disturbances6such6as6hemiparesis6or6monoparesis6and6cognitive6disorder
s
"prodrome"6to6a6migraine6-6ans--
•6Increased6irritability,6decreased6energy,6food6cravings6•6A6signal6that6a6headache6is6co
ming6and6may6allow6patient6to6use6methods6to6abort6the6headache
IHS6Criteria6for6Migraine6without6Aura6-6ans--
A6At6least656attacks6fulfilling6criteria6B6through6D6B6Headache6lasting64-
726hrs.6[treated6or6untreated]6C6Headache6has6at6least626of6the6following:6Unilateral6locat
ion6Pulsating6quality6Moderate6to6severe6intensity6Worse6with6walking6stairs6or6physical6
activity6D6During6headache,6at6least6one6of6the6following:6Nausea,6vomiting6[or6both]6Pho
tophobia6and/or6phonophobia6E6No6evidence6of6related6organic6disease
IHS6Criteria6for6Migraine6with6Aura6-6ans--
A6At6least626attacks6fulfilling6criterion6B:6B6At6least636of6the6following6characteristics:6One6
or6more6fully6reversible6aura6symptoms6At6least616aura6symptom6develops6gradually6ove
r6>4"6or626or6more6symptoms6occur6in6succession6No6single6aura6symptoms6lasts6>60"6H
eadache6follows6aura6with6a6free6interval6of6<60"6C6No6evidence6of6a6secondary6cause
*MgSO46[with6aura]61-26grams6IV
Clinical6Presentation:6Tension-Type6Headache6-6ans--
•6Feeling6like6a6tight6band6is6around6head6•6Nausea/
vomiting6are6not6present6•6Mild6to6moderate6intensity6•6Can6last6minutes6to6hours6•6Not6in
creased6with6physical6activity,6present6most6of6the6day6and6may6start6after6patient6wakes
6up6[Does6not6wake6patient6at6night],6stress6is6common6trigger,6most6common6in6older6ad
ult6and6Gen6pop-78%6incidence
•6Chronic6tension-type6headache6-6ans--similar,6but6occurs6more6than6156days6a6month
IHS6Criteria6for6Tension-Type6Headache6-6ans--
Criteria6A6At6least6106previous6headaches6fulfilling6criteria6B6through6D6B6Headache6last
s630"6to676days6C6At6least626of6the6following:6Pressing/
tightening6[nonpulsating]6quality6Mild6to6moderate6intensity6Bilateral6No6aggravation6by6w
alking6stairs6or6other6physical6activity6D6Both6of6the6following:6Absence6of6nausea6and6vo
miting6Absence6of6photophobia6and6phonophobia
AND ANSWERS
•6Primary6headache6-6ans--
common6and6is6not6a6symptom6of6another6medical6condition6•6Migraine6•6Tension-
type6•6Cluster
Secondary6Headache6-6ans--specific6etiologies-and6sx6depend6on6these6pathologies
Gender6differences6-6ans--migraine/tension/Giant6Cell6Arteritis-
more6common6in6women.6Cluster6more6common6in6men
Onset6over6506-6ans--
or6worsening6headache6check6for6underlying6neurological6disease,617%6of6older6adults6r
eport6frequent6headche
Headache6Needing6Investigation6-6ans--
•6Sudden6onset6of6new,6severe6headache6•6Progressively6getting6worse6•6After6exertion,6
straining,6coughing,6or6sex-suggests6inc6ICP-needs6CT6•6With6associated6symptoms6-
6"worst6headache6I6have6ever6had"6•6First6headache6occurring6after6the6age6of6506years
Cortical6Spreading6Depression6-6ans--
•6Basis6of6the6migraine6aura6•6Cortical6neuronal6activity6followed6by6a6postictal6depressio
n6of6neuronal6firing6•6CSD6can6trigger6meningeal6pain6mechanisms6via6neurogenic6infla
mmation,6vasodilation6and6plasma6extravasation6•6Blood6barrier6is6activated—
which6may6explain6some6of6the6pain6•6Glutamatergic6synapses6in6the6cortex6are6activate
d
Brain6Stem6Generator6-6ans--
•6Meningeal6pain6mechanisms6are6activated6through6the6trigeminovascular6pathways6•6T
his6causes6release6of6inflammatory6cytokines,6neuroinflammatory6peptides6and6calcitoni
n6gene-related6peptide—
this6hormone6causes6the6vasodilation6•6Peripheral6nociceptors6are6activated—
this6mechanism6is6referred6to6as6peripheral6sensitization6•6When6the6trigeminal6nucleus6
caudalis6and6rostral6brain6structures6are6activated—it6is6known6as6central6sensitization
Clinical6Presentation:6Migraine6-6ans--
•6Migraine6without6aura6•6Common6migraine6•6Most6common6headache6•6One6sided6hea
, dache6•6Pounding/throbbing6•6Moderate6to6severe6intensity6•6Lasts64-
246hours,6May6be6associated6with6nausea,6vomiting,6sensitivity6to6light6or6sound
Clinical6Presentation:6Migraine6(aura)6-6ans--
•6Aura6usually6occurs6before6onset6of6headache6•6Auras6usually6last6seconds,6but6can6la
st6up6to620",6patient6then6gets6headache6•6"Fortification6spectrum"6occurs6in610%6[Jagge
d6lines6similar6to6stone6fortifications6around6a6fort],6•6Visual6auras6can6be6spots,6shimmer
ing6bright6lights6or6visual6loss6[scotomas]6•6Sensory6auras6include6tingling,6numbness6of6
fingers,6motor6disturbances6such6as6hemiparesis6or6monoparesis6and6cognitive6disorder
s
"prodrome"6to6a6migraine6-6ans--
•6Increased6irritability,6decreased6energy,6food6cravings6•6A6signal6that6a6headache6is6co
ming6and6may6allow6patient6to6use6methods6to6abort6the6headache
IHS6Criteria6for6Migraine6without6Aura6-6ans--
A6At6least656attacks6fulfilling6criteria6B6through6D6B6Headache6lasting64-
726hrs.6[treated6or6untreated]6C6Headache6has6at6least626of6the6following:6Unilateral6locat
ion6Pulsating6quality6Moderate6to6severe6intensity6Worse6with6walking6stairs6or6physical6
activity6D6During6headache,6at6least6one6of6the6following:6Nausea,6vomiting6[or6both]6Pho
tophobia6and/or6phonophobia6E6No6evidence6of6related6organic6disease
IHS6Criteria6for6Migraine6with6Aura6-6ans--
A6At6least626attacks6fulfilling6criterion6B:6B6At6least636of6the6following6characteristics:6One6
or6more6fully6reversible6aura6symptoms6At6least616aura6symptom6develops6gradually6ove
r6>4"6or626or6more6symptoms6occur6in6succession6No6single6aura6symptoms6lasts6>60"6H
eadache6follows6aura6with6a6free6interval6of6<60"6C6No6evidence6of6a6secondary6cause
*MgSO46[with6aura]61-26grams6IV
Clinical6Presentation:6Tension-Type6Headache6-6ans--
•6Feeling6like6a6tight6band6is6around6head6•6Nausea/
vomiting6are6not6present6•6Mild6to6moderate6intensity6•6Can6last6minutes6to6hours6•6Not6in
creased6with6physical6activity,6present6most6of6the6day6and6may6start6after6patient6wakes
6up6[Does6not6wake6patient6at6night],6stress6is6common6trigger,6most6common6in6older6ad
ult6and6Gen6pop-78%6incidence
•6Chronic6tension-type6headache6-6ans--similar,6but6occurs6more6than6156days6a6month
IHS6Criteria6for6Tension-Type6Headache6-6ans--
Criteria6A6At6least6106previous6headaches6fulfilling6criteria6B6through6D6B6Headache6last
s630"6to676days6C6At6least626of6the6following:6Pressing/
tightening6[nonpulsating]6quality6Mild6to6moderate6intensity6Bilateral6No6aggravation6by6w
alking6stairs6or6other6physical6activity6D6Both6of6the6following:6Absence6of6nausea6and6vo
miting6Absence6of6photophobia6and6phonophobia
