This document discusses different types of headaches including primary and secondary headaches. It describes the temporal patterns of headaches as acute, recurrent-episodic, chronic-progressive, and chronic-nonprogressive. The most common primary headaches are tension-type headaches and migraine headaches. Tension-type headaches are mild and lack severe symptoms while migraine headaches involve moderate to severe pain with associated symptoms like nausea and sensitivity to light and sound. Diagnostic testing is generally not needed but may include neuroimaging or lumbar puncture in some cases.

1. Headache and migraine
Dr Rezaei, 2022

2. Introduction: Headache is a common problem
• Primary:
• Migraine,
• Tension type
• Secondary:
• Minor illness> sinusitis, viral infections
• Serious illness> Meningitis, Brain tumor

3. Temporal pattern of the headache
• Acute
• recurrent-episodic,
• chronic-progressive,
• chronic-nonprogressive

4. Acute:
• Single episode of pain without a history of such episodes.
• The “first and worst” headache
• Adult: Aneurysmal subarachnoid hemorrhage
• Children: febrile illness
• hemorrhage
• meningitis
• tumor

5. Acute recurrent:
• Primary headache syndromes
• migraine
• tension-type headache
• Other DDX:
• specific epilepsy syndromes (benign occipital epilepsy),
• substance abuse
• recurrent trauma

6. Chronic progressive:
• Increasing ICP.
•pseudotumor cerebri,
•Brain tumor,
•hydrocephalus,
•chronic meningitis,
•brain abscess, and
•subdural collections.

7. Chronic nonprogressive or chronic daily
• Defined as >3-mo history of >15 headaches/mo, with headaches
lasting >4 hr.
• Affected patients have normal neurological examinations;
• psychological factors and anxiety about possible underlying organic
causes are common.

8. Tension-type headaches
• the most common type
• mild and lack associated symptoms
• are not typically disruptive to patients’ lifestyle or activities.
• The pain is global and squeezing or pressing in character and can last
for hours or days.
• There is no associated nausea, vomiting, phonophobia, or
photophobia.
• Headaches can be related to environmental stresses or symptomatic
of underlying psychiatric illnesses, such as anxiety or depression.

9. Migraine headaches
• another common type
• Headaches are stereotyped attacks of frontal, bitemporal or unilateral,
• moderate to severe, pounding or throbbing pain that are aggravated by
• activity
• last 1-72 hours.
• Associated symptoms include nausea, vomiting, pallor, photophobia,
phonophobia, and an intense desire to seek a quiet, dark room for rest.
• episodes of irritability, sleepiness, pallor, and vomiting in toddlers
An aura

10. Aura
• An aura can precede or coincide with the headache and typically
persists for 15-30 minutes.
• Visual auras are very common and consist of spots, flashes, or lines of
light that flicker in one or both visual fields.
• Complex, atypical auras (hemiparesis, monocular blindness,
ophthalmoplegia, vertigo, confusion),
• neuroimaging,
• electroencephalogram,
• appropriate metabolic studies.

11. DIAGNOSTIC STUDIES
• Full history
• physical examination
• provide an accurate diagnosis and obviate the need for further
• testing.

12. Neuroimaging
• usually is not necessary.
• abnormal neurological examination,
• symptoms of increased ICP,
• atypical aura
• progressively worsening. In these cases, brain

13. CT, MRI, or LP
• MRI with and without gadolinium contrast > choice,
• When the headache has a sudden, severe onset, emergent computed
tomography (CT) for intracranial bleeding.
• If the CT is negative, a lumbar puncture should be performed to
measure opening pressure and evaluate for pleocytosis, elevated red
blood cells, and xanthochromia.