Tuesday, June 14, 2016

Types of Headache: Tension, Cluster, and Migraine

PQRST Pain characteristics of Types of Headache: Tension, Cluster, and Migraine

by: Arlene Gentallan

Tension Headache is the most common type

Provocation: 

  • Stress
  • Fatigue
  • Cold temperature
  • Eye strain
  • Awkward sleeping position
  • Helding the head in one position for too long
  • Alcohol intake
  • Excessive caffeine intake
  • Skipping meals
  • Taking pain medication for more than 3 days causing rebound headache

Quality:

  • Dull aching, tight squeezing pressure like putting a tight band around the head.

Region:

  • Temple, sides of the head, back of the head / neck. Pain usually starts at the back of the head spreading towards both sides of the head into the temple.

Severity: 

  • Mild to moderate pain

Timing: 

  • Usually aggravates during the end of the day. May start at the morning when the person wakes up from an awkward sleeping position.
  • Episodic tension headache occurs less than 15 days a month.
  • Chronic tension headache occurs 15 or more days in a month for several months.

Other signs and symptoms:

  • Tension headache is not commonly associated with nausea, vomiting, and visual changes. 

Other causes:

  • Women are more likely to experience tension headache than men. This may be due to hormonal changes.
  • It is possibly caused by neurotransmitter changes in the brain and muscle tension of scalp, jaw, neck, and shoulder.




Cluster Headache (CH)

Provocation: 

  • Not commonly associated with triggers like food and stress.
  • When pain starts, it is aggravated when lying still and alcohol intake, so person under migraine attack tend to be restless.

Quality: 

  • Sharp, burning pain like pushing the eye out of it's socket.

Region:

  • One-sided (unilateral) pain around the eye. May radiate to the head, face, neck, and shoulder.

Severity: 

  • Severe pain

Timing: 

  • Headache usually appears suddenly without warning signs. Most cases occurs at night and will awaken the person from sleep.
  • Pain usually lasts from 15 minutes to 3 hours.
  • Person usually experience pain at precisely the same time of the day, or at the same season of the year. Attacks may occur once to 8 times a day. 
  • Marked by periods of exacerbation and remission.
  • Episodic cluster headache occurs for 1 week to 1 year, followed by 12 months remission period before another attack. 
  • Chronic cluster headache occurs for more than 1 year, followed by a remission period of less than 12 months before another attack.


Other signs and symptoms:

  • The person experiencing cluster headache may be restless and have an abnormally high sensitivity to light and sounds.
  • It is usually associated with teary eye, eye redness, drooping eyelid, runny nose, facial swelling, at the side of the face experiencing pain.
  • Not commonly associated with nausea.

Other causes:

  • Not commonly associated with triggers like food and stress.
  • May be associated with hypothalamic dysfunction which is responsible for the circadian rhythm "biological clock". According to studies, there is an increase activity in the hypothalamus during a cluster headache attack. There may be a genetic predisposition.
  • Men are more likely to experience cluster headache than women.



Migraine

Provocation:

  • Aspartame consumption
  • Monosodium glutamate consumption
  • Tyramine containing foods such as cheddar and aged cheese
  • Chocolate
  • Nuts
  • Soy
  • Balsamic vinegar
  • Alcohol intake
  • Red wine
  • Excessive caffeine intake
  • Stress
  • Fatigue
  • Sleep deprivation
  • Oral contraceptives
  • Hormonal replacements
  • Excessive visual, auditory or olfactory stimuli
  • Changes in the weather
  • Menstrual period (attack may occur before or after menstrual period (drop in estrogen level)
  • Aggravated by light and noise.

Quality:

  • Throbbing, pulsating pounding headache.

Region: 

  • Usually one-sided (unilateral) pain of the head, but may also be bilateral. Usually occurs at the frontal side of the head.

Severity:

  • Severe pain

Timing:

  • Migraine attack may last for 4 to 72 hours.

Other signs and symptoms:

  • There may be warning signs before a migraine attack occurs such as visual aura (visual changes like seeing flashes of light), blind spots, tingling sensation on the arms and legs.
  • Usually associated with nausea, vomiting, and abnormally high sensitivity to light and sound.

Other causes:

  • Migraine is possibly caused by neurotransmitter changes (eg. serotonin.) 
  • Women are more likely to have migraine headache than men.
  • Genetic predisposition