This document provides information on different types of headaches, including their causes, symptoms, and characteristics. It discusses primary headaches like tension headaches, which most commonly affect women, and migraines, which often affect younger females. It also covers secondary headaches that can result from issues like infections, head injuries, or vascular disorders. Specific headache types like clusters headaches that predominantly impact adolescent males are also outlined. The document details factors like headache location, duration, frequency, and associated symptoms that can provide clues to determining the underlying headache type and cause.

1. HEADACHE (cephalalgia)

2. Headache
• Headache is defined as diffuse pain in various
parts of the head, with the pain not confined
to the area of distribution of a nerve.

3. • 30 years female
• Episodic throbbing headache
• One half of the face
• Associated with nausea vomiting parasthesia
of right upper and lower limb
• No aura
• Similar headaches in her mother

4. • 40 years old male
• Limited to right side head
• Daily headache
• 2 attack/day for 3 weeks
• Awakens the patient from sleep
• Associated with lacrimation, nasal stuffiness

5. • 65 years old female
• Right sided headache and blindness * 2 years
• Thick cord like structure on the lateral side of
the head
• ESR 80mm/hr in the first hour

6. • 45 yrs hypertensive male
• Sudden onset severe headache
• Associated with vomiting and neck stiffness
• No focal neurological deficit

7. Headache
Primary:
•Tension Type(69%)
•Migraine (16%)
•Idiopathic stabbing
•Exertional
•Cluster
Secondary Headache:
•Systemic infection
•Head injury
•Vascular Disorder
•SAH
•Brain tumour

9. Migraine
• Fronto-temporal
• Uni or bilateral
• Young female
• Throbbing (pulsatile)
• Upon awakening
• Bright light, noise, tension, alcohol,
• Nausea, vomiting, +- aura

12. Cluster Headache
• Orbito-temporal
• Adolescent male(90%)
• Intense, non throbbing
• Behind the eyes
• 1-2 hrs after falling asleep
• Alcohol(rare)
• Lacrimation, stuffed nostril, rhinorrhoea,
conunctival congestion, ptosis

15. Tension Headache
• Generalized
• More in women
• Feeling of tight band around head
• Start in the daytime and progressive
throughout the day maximum in the evening.
• fatigue, nervous strain
• Depression, anxiety

17. • Brain tumours / raised ICP: headaches that disturb sleep/ early
morning headaches
• Early morning headache on waking up and again at the end of day is
due to Maxillary sinusitis (diurnal variation)
• Office headache: due to Frontal sinusitis [patient wakes up mostly
without pain due to overnight drainage, develops pain after a few
hours that lasts throughout the day]
• Vacuum headache: the headache on waking up that may occur in
Frontal sinusitis due to over night drainage.

19. 1.Age, Sex, Occupation:
Migraine headache – more frequent in teenagers & young adults,
higher occurrence in female.
Cluster headache – almost exclusively in males.
Cranial arteritis – more frequently in late middle age & in elderly.
2. Duration
Tension headache -often has long duration.
Headache due to expanding of intracranial disease – usually short
duration.
Headache due to meningeal cause – acute in onset.
Migraine headache – recur over a long period of time, with
symptoms free interval between attacks
3. Location
As a general rule localized headache is of greater significance than
diffuse headache.
Tension headache – typically generalized, band like or bi-occipital.
Migraine with aura – often unilateral & frequently more
prominent interiorly.
Migraine without aura – frequently bilateral.
Cluster headache – invariably limited to the same side of the
head in any given attacks & usually periorbital

20. 4. Prodromal symptoms
Migraine headache – often precede by neurological
symptoms as scintillating scotoma, transient hemianopias,
hemimotor or hemisensory disturbance & dysphasia.
5. Associated symptoms
Tension headache – often associated with other psycho-
physiologic disturbances.
Cluster headache – typically associated with ipsilateral
lacrimation, Conjunctival injection, Rhinorrhoea, & Facial
Flushing.
6. Quality of pain
Tension headache – Pressing, Squeezing, Tight or Heavy.
Migraine headache – Throbbing or Pounding.
Headache due to intracranial lesion – Relatively Mild.
Acute SAH- Pain tends to be explosive & intense.

21. 8. Frequency, duration & diurnal variation
Tension headache – often persist & may worsen as the day progress.
Migraine headache – the frequency is variable & unpredictable.
Although usual variation is from 4 - 72 hrs, they may persist for days.
Cluster headache – occur repetitively over a period of weeks or
months. Often there are 1 or 2 attacks daily. The headache typically
nocturnal & of brief duration (30 min to a few hours).
9. Family History
Migraine headache – strong family history.
Cluster headache – are not familial.
10. Intracranial Mass Lesion –
Associated symptoms are more prominent than headache. Some intra-
cerebral lesion may exhibit seizure or vomiting.
11. Cranial arteritis
Systemic symptoms as fever, anorexia & rheumatic symptoms.
12.Tension headache & Vascular Headache
Induced or aggravated by emotional factors.
Intraventricular & posterior fossa tumour – may be accentuated by
change in the head position, coughing & Valsalva maneuver

22. 1. General physical examination:
Flushed face, lacrimation, and unilateral rhinorrhoea – cluster
headache.
Systemic sign (fever, weight loss, anaemia) – infectious disease,
specific infection of CNS, metastatic disease of brain &/or
meninges.
2. Neurological examination:
No neurological abnormality – tension headache.
Evidence of cerebral ischaemia – small percentage of
migraine (permanent residual damage).
Horner’s syndrome – sometimes during migraine headache
(rarely permanent).
Localizing sign – expanding ICSOL.
Papilloedema -- ICP due to ICSOL.
Bruits over the eyes/cranium – vascular malformation.
Sign of meningeal irritation – lesion affecting the meninges.

23. Thank you