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