14a. Headache (Table provided by Mari Groves)

feature

migrane w/o aura (common)

migrane w/aura (classic)

tension-type HA (episodic)

cluster HA (episodic)

prevalence

common

uncommon

common

rare

gender

F>M

F>M

F>M

M >> F

family history

frequent

frequent

frequent

rare

age at onset (yr)

10-30 (BEFORE 30--if after that, then not migrane)

10-30

20-40

20-40

site of pain

hemicranial, bilateral, unilateral that alternates sides (most often in the temple)

hemicranial, bilateral

bilateral, occipital, frontal

unilateral, fronto-temporal, periorbital (right behind eye)

character of pain

pulsatile

pulsatile

aching, tight, squeezing

boring

severity of pain

moderate to severe

moderate to severe

mild to moderate

severe

onset to peak pain

min to hrs

min to hrs

hours

SHORT.  minutes (rapid)

duration of pain

usually 4-24hrs (rare to be less than 30min or last for weeks).  Usually wake up with pain

usualy 4-24hrs

hours to days (<15d/month)

30-90 min

frequency of attack

variable, several per month.  Characterized by HA-free periods between prostrating attacks

variable, several per month

variable, several per month (can last for days, weeks, or years)

daily during cluster period (occur in short bursts 30-90min repeating 2-6X/day)

periodicity of attacks

no (exception, menstrual migrane).  Can occur on weekends, beginning of holidays, and immediately following vacations

no (exception, menstrual migrane)

no

yes, "like clockwork"

accompaniments

N/V, photophobia, phonophobia, osmophobia, anorexia, constipation, farting, distension

N/V, photophobia, phonophobia, osmophobia,

nausea on occasion, flatulence, distension

ipsilateral nasal, congestion, rhinorrhea, conjunctival injection, ptosis, lacrimation

symptoms

vertigo

homonymous visual disturbance, unilateral paresthesias or numbness, unilateral weakness, aphasia or unclassifiable speech difficulty

 

 

change in mood

depression, withdrawn, irritable and pessimistic, avoiding company and responsibility--want to be left alone

 

willing to accept attention and care

 

behavior during HA

still, quiet

still quiet

no change

pace, walking, sitting, rocking

nocturnal attacks of pain

can occur

can occur

no disruption of sleep

extremely frequent.  Usually occur after pt goes to sleep during REM

triggering factors

multiple: periods of conflict, tension, or stress.  Heat or humidity (if found uncomfortable). Teachers = fall.  Merchants = holiday rush seasons.  Can be triggered by alcohol, newly prescribed drug, bright lights, fatigue, sleep loss, hypoglycemia, and food additives

multiple

stress, exhaustion

alcohol, sleep, emotional upset