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withdrawn, irritable and pessimistic, avoiding company and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 |