Vascular headaches of the migraine type
- Classic migraine
- Common migraine
- Cluster headache
- Hemiplegic migraine and Ophthalmoplegic migraine
- Lowe-half headache
- Recurrent attacks of headache
- Unilateral
- Associated with anorexia, sometimes with nausea and vomiting
- Preceded by, or associated with, conspicuous sensory, motor and mood disturbances
- Often familial
- Pain phase: cranial arterial distention and dilatation, no permanent changes in the involved vessel
Vascular headaches of the migraine type
Sharply defined, transient visual and other sensory or motor prodromes or both
Classic headache
Without striking prodromes
Unilateral
Atypical or sick headache
Summer, Monday, week-end, relaxation, premenstrual and menstrual headache
Common migraine
Unilateral on the same side
Associated with flushing, sweating, rhinorrhea and increased lacrimation
Brief in duration
Occurring in closely packed groups separated by long remissions
Erythroprosopalgia, ciliary or migrainous neuralgia, erythromelalgia of the head or histamine cephalalgia, petrosal neuralgia
Cluster headache
Sensory and motor phenomena persist during and after the headache
Hemiplegic migraine and Ophthalmoplegic migraine
Centered primarily in the lower face
Atypical facial neuralgia, sphenopalatine ganglion neuralgia, vidian neuralgia
Lower half headache
Ache or sensation of tightness, pressure or constriction, widely varied in intensity, frequency and duration, sometimes long-lasting and commonly suboccipital
Associated with sustained contraction of skeletal muscles in the absence of permanent structural change, usually as part of the individual’s reaction during life stress
Tension, psychogenic and nervous headache
Muscle-contraction headache
Headaches and nasal discomfort, recurrent and resulting from congestion and edema of nasal and paranasal mucous membranes
Headache of nasal vasomotor reaction
Associated with generally nonrecurrent dilatation of cranial arteries
Nonmigrainous vascular headache
Headache resulting from traction on intracranial structures, mainly vascular, by masses
Traction headache
Traction headache
- Primary or metastatic tumors of meninges, vessels or brain
- Hematomas
- Abscess
- Postlumbar puncture headache
- Pseudotumor cerebri
Due to readily recognized inflammation of cranial structures
Headache due to overt cranial inflammation
Behind or above one eye with extension to temple or maxilla
Nasal congestion, lacrimation, conjunctival injection; may occur at night
Cluster headache
Hatband, bitemporal, occipital, suboccipital
Chronic anxiety; in some cases may be related to occupational muscle fatigue
Muscle-contraction headache
In and around nose, ethmoid and maxillary areas; may radiate into frontal area
Nasal obstruction and rhinorrhea often occur
Nasal vasomotor reaction
In area of temporal (often bilateral) or other involved branches of extracranial arteries
Ischemic optic neuritis
Temporal arteritis
Pain in area of involved sinus; sphenoid sinusitis may cause retro-orbital, occipital or vertex pain
Fever, malaise, tenderness over involved sinus, nasal discharge and congestion, associated URTI
Acute sinusitis
Infrequently causes chronic head pain; may be confused with vasomotor reaction
Nasal polyposis, chronic suppurative nasal discharge
Chronic sinusitis
In and around ear with radiation into neck and temporal area
Aural fullness; clicking in joint
TMJ dysfunction
Face; any of 3 divisions of the trigeminal nerve
Associated with trigger zones that respond to light contact
Trigeminal neuralgia
Pharynx with radiation into ear
Salivation; trigger zones in tonsillar region
Glossopharyngeal neuralgia
Most excruciating of the vascular headaches
Cluster headache
Unilateral facial and head pain occurs primarily in men
With sudden onset and abrupt cessation
No prodrome
1 to 3 attacks per day of short duration, typically 45 minutes to 1 hour
Periods of remission may last from months to even years, averaging 2 years
Cluster headache
Focus of pain is usually centered behind one eye, with radiation to involve the entire side of the face and neck
Pain is often associated with flushing, sweating, increased lacrimation and rhinorrhea on the involved side
Precipitated by alcohol, histamine and other vasodilators
Cluster headache
Modes of treatment (cluster headache)
- Inhalation of 100% oxygen
- Ergotamine
- Local application of anesthetic nose drops
- Methylsergide
- Psychotherapy
Pain is often a chronic nature and is located in the frontal, temporal, occipital and suboccipital regions
Tension is a common cause
Muscle-contraction headache
Patient complains of the sensation of a tight band (hat band) around the head, but it is not severe enough to be painful
Sensation is produced by a mild, involuntary increase in temporal muscle tension
Muscle-contraction headache
Treatment consist of sympathetic listening (heat and massage)
Muscle-contraction headache
Secondary to structural abnormalities in the neck
Muscle-contraction headache
Headache pain tends to be dull and is moderately by massage and/or heat
Other therapies: NSAID’s, PT, anti-depressants, muscle relaxants
Cervical spondylosis
Irritation of one or more of the cervical roots may lead to headaches, often present upon waking
Cervical radiculopathy
Simple muscle pain that has been linked with physical allergy and autonomic instability
Myalgia
Localized inflammatory condition involving muscle and overlying and adjacent fasciae with resultant fibrosis
Myofascitis
Acute frontal headaches that wad frequently present upon arising
Tenderness in the area of the floor of the frontal sinus on the involved side
“Vacuum” type pain
Causes constant, moderately severe head pain that tends to be bilateral
Associated with tenderness in the area of the involved arteries
May mimic migraine, muscle-contraction, or cluster headache
Not influenced by cough or head movements
Temporal arteritis
Occurs in older individuals
Accompanied by generalized weakness and anemia
ESR is often markedly increased
Treatment: high-dose, prolonged prednisone
Temporal arteritis
Diagnosis of temporal arteritis
Biopsy
Sinusitis (pain locations)
- Maxillary: anterior facial (cheek) with radiation into teeth, orbital and malar regions
- Ethmoids: interocular with spread into frontal location
- Frontal: forehead, interocular and temporal areas
- Sphenoid: retro-orbital, radiation toward vertex and occasionally the mastoid areas
Is a common cause of secondary otalgia
Frequently complaining of ear infection
Deep, boring pain in the ear mimicking acute otitis media
Accompanied by muscle spasm
TMJ dysfunction
Involved muscle in TMJ dysfunction
- Temporalis
- Masseter
- Medial and lateral pterygoid muscles
Trapezius
Suboccipital
Frontal
Occipital
Patient exhibits malocclusion and, on occasion, malposition of the maxilla and/or mandible
TMJ dysfunction
May cause joint dysfunction or muscle spasm
Manifested as morning headache and unconscious stress-induced daytime grinding producing evening headache
Bruxism (grinding of the teeth)
Translation
Evidence of opening or closing click, crepitus or restricted anterior motion on opening
Complete otolaryngologic exam (TMJ dysfunction)
Dentition
Function of masticatory muscles
Maximal mouth opening (between the edges of the upper and lower incisors)
Average adult: 40 mm
Indicate decrease in joint function and translation
Measurement of less than 40 mm
Initial symptomatic treatment (TMJ dysfunction)
- Soft to liquid diet
- Heat applied over the affected muscles
- Anti-inflammatory drugs
Disocclude the teeth and allow the mandible to assume the normal position–> allowing the muscles of mastication to relax and assume a more normal function
Oral splints
Pain is of sudden onset, sharp and lancinating and initiated at trigger zones about the face which react to physical contact or drafts of air
Trigeminal neuralgia
Least affected in trigeminal neuralgia
Ophthalmic division
The pain as a rule is of a chronic nature, with longer episodes and less severe attacks
Trigger zones are uncommon
Secondary type of trigeminal neuralgia
Drug treatment (trigeminal neuralgia)
- Phenytoin
- Baclofen
- Clonazepam
- Valproic acid
- Carbamazepine
Unresponsive to the medical treatment (trigeminal neuralgia)
- Alcohol injection
- Rhizotomy (percutaneous radiofrequency rhizotomy)
Other: surgical ablation of the gasserian ganglion or nerve decompression
A tic douloureaux of this nerve is relatively rare
Paroxysms of stabbing pain in the ear, with trigger zones in the tonsillar area, accompanied by salivation
Glossopharyngeal neuralgia
A secondary form of glossopharyngeal neuralgia
Seen briefly after tonsillectomy
Unresponsive to drug therapy (glossopharyngeal neuralgia)
- Suboccipital craniectomy
2. Rhizotomy
Pain upon palpation of the common carotid arteries
Acute: lasting 1 to 2 weeks, with no recurrence
Chronic: possibly related to migraines
Treatment: corticosteroid
Carotidynia