It is a brief presentation on headache disorders. My reference was mainly Medscape. I mentioned treatment in a concise way so you may want to read up more on that.

1. Tasneem Mustafa

2.  Headache ː common disorders of the nervous
system.
 Headache ː painful and disabling ː
 primary headache disorders namely migraine,
tension-type headache, and cluster
headache.
 Headache ː 2nd to other conditions, e.g.
medication overuse headache.

4.  ◍ ~ prevalence among adults 47%. ½ - ¾
adults aged 18–65 years in the world have
had headache in the last year
 >10% are migraine.
 Headache on ≥15d/30d affects 1.7–4% of the
world’s adult population.
 Worldwide problem, all ages, races, income
levels and geographical areas.

6.  Migraine is an episodic disorder/severe headache generally +
nausea, and/or light and sound sensitivity.
 Common, affects 10-12% of the general population. It is
more frequent in women > men, with attacks occurring in up
to 17% ♀ & 6% ♂ each year.
 Migraine is most common in those aged 30-39, an age span
in which prevalence in men and women reaches 7% and 24%.
 Migraine →disorder→recurrent attacks. The attacks unfold
through a cascade of events that occur over the course of
several hours to days. A typical migraine attack progresses
through four phases: the prodrome, the aura, the headache
and the postdrome.

7.  The migraine prodrome occurs in up to 60% of people &
consists of affective or vegetative symptoms that appear 24-
48 hours prior to the onset of headache. Symptoms include
euphoria, depression, irritability, food cravings, constipation,
neck stiffness, & increased yawning
 About 25% of patients experience ≥ focal neurologic
symptoms in the second phase, called the migraine aura.
Auras are most often visual, but can also be sensory, verbal,
or motor disturbances.
 A visual aura classically begins as a small area of visual loss
often just lateral to the point of visual fixation. It may either
appear as a bright spot or as an area of visual loss. Over the
following five minutes to one hour, the visual disturbance
expands to involve a quadrant or hemifield of vision

8.  The sensory aura → visual aura within minutes, although it
may also occur without the visual aura. A sensory aura usually
begins as a tingling in one limb or on one side of the face. As
the tingling sensation migrates across one side of the face or
down the limb, numbness is left in its wake that may last up
to an hour
 Language/dysphasic aura < sensory aura. It causes transient
language problems that range from mild wording difficulties
to frank dysphasia with paraphasic errors.
 Many individuals report photophobia or phonophobia during
attacks, leading such migraine sufferers to seek relief by lying
down in a darkened, quiet room

10.  In a retrospective study of 1750 patients with migraine, ~ 75%
reported at least one trigger of acute migraine attacks. These
included:
 Emotional stress (80 percent)
 Menstruation ♀ (65 percent)
 Fasting (57 percent)
 Weather changes (53 percent)
 Sleep disturbances (50 percent)
 Odors (44 percent)
 Neck pain (38 percent)
 Lights (38 percent)
 Alcohol (38 percent)
 Smoke (36 percent)
 Food (27 percent)
 Exercise (22 percent)

11.  The diagnosis of migraine is based on the history.
According to International Headache Society (IHS),
patients → least 5 headache attacks that lasted
4-72 hours and the headache must have had at
least 2 of the following characteristics:
 Unilateral location
 Pulsating quality
 Moderate or severe pain intensity
 Aggravation by or causing avoidance of routine
physical activity (eg, walking, climbing stairs)

12.  In addition, during the headache the patient
must have had at least 1 of the following:
 Nausea and/or vomiting
 Photophobia and phonophobia
 No organic cause.

13. Includes the following:
 Childhood periodic syndromes
 Late-life migrainous accompaniments
 Basilar-type migraine
 Hemiplegic migraine
 Status migrainosus
 Ophthalmoplegic migraine
 Retinal migraine

14.  The prevalence of cluster headache is <1 percent and
mostly affects men. In a meta-analysis of 16
population-based epidemiologic studies, the following
observations were reported:
 The lifetime prevalence of cluster headache for adults of
all ages was 124 per 100,000 (95% CI 101-154), or
approximately 0.1 percent
 The one year prevalence of cluster headache was 53 per
100,000 (95% CI 26-95)
 The overall male to female ratio was 4.3:1

15.  Cluster headache is characterized by attacks of severe orbital,
supraorbital, or temporal pain, accompanied by autonomic phenomena.
The stereotypical attacks may strike up to eight times a day and are
relatively short-lived.
 Cluster headache is strictly unilateral, and the symptoms remain on the
same side of the head during a single cluster attack.
 The symptoms can switch to the other side during a different cluster
attack (so-called side shift) in approximately 15 percent of cases
 The unilateral autonomic symptoms, such as ptosis, miosis, lacrimation,
conjunctival injection, rhinorrhea, and nasal congestion, occur only
during the pain attack and are ipsilateral to the pain
 Another clinical landmark of the cluster headache syndrome is the
circadian rhythmicity of the relatively short-lived (15 to 180 minutes)
painful attacks. In the episodic form, attacks occur daily for some weeks
followed by a period of remission. In the chronic form, attacks occur
without significant periods of remission. On average, a cluster period
lasts 6 to 12 weeks while remissions can last up to 12 months or longer

17.  Most prevalent type of primary headache in the general
population
 Prevalence in 1 year among 12- 41year-old subjects was
86%.
 ♀ > ♂, life time prevalence in men (69%) and women (88%).
 The typical presentation of an attack is that of a mild to
moderate intensity, bilateral, nonthrobbing headache without
other associated features. Descriptions of TTH pain are
characteristically nondescript: "dull," "pressure," "head
fullness", "head feels large," or, more descriptively, "like a
tight cap", "band-like," or a "heavy weight on my head or
shoulders

18.  The pain in TTH may infrequently be unilateral or
pulsating
 Muscle tenderness in the head, neck, or shoulders
(ie, pericranial tenderness) is associated with both
the intensity and the frequency of TTH attacks and
is typically exacerbated during the headache
experience

20. List of 5 commonly performed tests/procedures →
not always necessary in the tx of migraine and
headache by AHS:
 Don't perform neuroimaging studies in patients
with stable headaches that meet criteria for
migraine.
 Don't perform (CT) imaging for headache when
(MRI) is available, except in emergency settings.
 Don't recommend surgical deactivation of
migraine trigger points outside of a clinical trial.
 Don't prescribe opioid or butalbital-containing
medications as first-line treatment for recurrent
headache disorders.
 Don't recommend prolonged or frequent use of
over-the-counter (OTC) pain medications for
headache.

21.  Migraine treatment involves acute (abortive)
and preventive (prophylactic) therapy.
Patients with frequent attacks usually require
both. Measures directed toward reducing
migraine triggers are also generally advisable.

22.  Selective serotonin receptor (5-HT1) agonists
(triptans)
 Ergot alkaloids
 Analgesics
 Nonsteroidal anti-inflammatory drugs
(NSAIDs)
 Combination products
 Antiemetics

23.  Antiepileptic drugs
 Beta blockers
 Tricyclic antidepressants
 Calcium channel blockers
 Selective serotonin reuptake inhibitors (SSRIs)
 NSAIDs
 Serotonin antagonists
 Botulinum toxin

24.  Various modalities are used in the treatment
of tension headaches. These include hot or
cold packs, ultrasound, electrical stimulation,
improvement of posture, trigger point
injections, occipital nerve blocks, stretching,
and relaxation techniques.
 Regular exercise, stretching, balanced meals,
and adequate sleep may be part of a
headache treatment program.

25.  There are a variety of medications available to
treat the pain of a headache, including pain
relievers and combination medications.
Patients should be advised to avoid repeated
use of OTC pain relievers as these can cause
medication overuse headaches.
 Barbiturates may be used when all other
treatment options have failed.

27.  Pharmacologic management of cluster
headache (CH) may be classified into 2
general approaches as follows:
 Abortive/symptomatic (eg, oxygen, triptans,
ergot alkaloids, and anesthetics)
 Preventive/prophylactic (eg, calcium channel
blockers, mood stabilizers, and
anticonvulsants)
 Nerve Blocks, Ablative Procedures, and Brain
Stimulation

28.  Medscape