Section 1-Family Medicine
The Essentials 4th Edition
The Essentials 4th Edition
Section 1
Background (Headache)
Epidemiology
- In Saudi Arabia, a comprehensive cross sectional study reported an adjusted one year prevalence of 65.8% for all headache types. Specifically, the prevalence rates were 34.1% for tension type headache, 25% for migraine, and 2% for medication overuse headache.
- Although cluster headache remains an uncommon with a prevalence of <1 % → It typically leads to significant disability and requires medical attention.
ICHD-3 criteria for primary headache types
ICHD-3 criteria for primary headache types
Clinicians can quickly become familiar with the most common primary headache disorders and how to distinguish them (Table 3). The diagnostic criteria for primary headache types by ICHD-3 criteria (Migraine, tension-type headache (TTH) or cluster headaches) are as follows:
Migraine without aura
- At least 5 attacks fulfilling criteria 2 and 3
- Headache attacks lasting 4–72 hours (when left untreated or unsuccessfully treated)
- Headache has ≥ 2/4 of the following: - Unilateral in location - Pulsating in quality - Moderate or severe pain in intensity - Aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)
- During the headache, at least 1 of the following symptoms: - Nausea and/or vomiting - Photophobia and phonophobia
- No other explanation for this pain
Migraine with aura
- At least 2 attacks fulfilling criteria 2 and 3
- One or more of the following fully reversible aura symptoms: -Visual (flickering lights, spots, lines) or loss of vision - Sensory (pins and needles, or numbness) - Speech and/or language (fully reversible dysphasic speech disturbance) - Motor (but not weakness) - Brainstem - Retinal
- At least ≥ 3/6 of the following: -At least one aura symptom that spreads gradually over ≥5 minutes - ≥ 2 aura symptoms occur in succession - Each aura symptom lasts 5–60 minutes - At least one aura symptom is unilateral - At least one aura symptom is positive - The aura is accompanied, or followed by headache within 60 minutes
- No other explanation for this pain
POUND mnemonic for migraine headache:
Pulsatile
One-day duration
Unilateral
Nausea or vomiting
Disabling
Features of migraine in children and adolescents
- Attacks may last 2 to 72 hours
- Headache is more often bilateral than in adults; an adult pattern of unilateral pain usually emerges in late adolescence or early adulthood
- Photophobia and phonophobia may be inferred by behavior in young children
Tension-type headache (TTH)
- At least 10 episodes of headache occurring on < 1 day/month on average (<12 days/year) and fulfilling criteria 2 and 3
- Lasting from 30 minutes to 7 days
- At least ≥ 2/4 of the following: - Bilateral location - Pressing or tightening (non-pulsating) quality - Mild or moderate intensity - Not aggravated by routine physical activity such as walking or climbing stairs
- Both of the following: - No nausea or vomiting - No more than one of photophobia or phonophobia
- No other explanation for this pain
Trigeminal autonomic cephalalgias (Cluster Headache)
- At least 5 attacks fulfilling criteria 2 and 4
- Severe or very severe unilateral orbital, supraorbital, and/or temporal pain lasting 15-180 minutes (when untreated)
- At least one of the following symptoms or signs, ipsilateral to the headache: - Conjunctival injection and/or lacrimation - Nasal congestion and/or rhinorrhea - Eyelid edema - Forehead and facial sweating - Miosis and/or ptosis - A sense of restlessness or agitation
- Occurring with a frequency between one every other day and 8 per day
- No other explanation for this pain
References:
- Al Jumah M, Al Khathaami AM, Kojan S, Hussain M, Thomas H, Steiner TJ. The prevalence of primary headache disorders in Saudi Arabia: a cross-sectional population-based study. The Journal of Headache and Pain. 2020 Feb 7;21(1). DOI: 10.1186/s10194-020-1081-1
- Benamer HT, Deleu D, Grosset D. Epidemiology of headache in Arab countries. J Headache Pain. 2010;11(1):1-3. doi:10.1007/s10194-009-0173-8
- 1. Chawla J. Migraine Headache: Practice Essentials, Background, Pathophysiology [Internet]. Medscape.com. 2019. Available from: https://emedicine.medscape.com/article/1142556-overview
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- Gaul C, Meßlinger K, Holle-Lee D, Neeb L. Pathophysiologie von Kopfschmerzerkrankungen [Pathophysiology of Headaches]. Dtsch Med Wochenschr. 2017;142(6):402-408. doi:10.1055/s-0042-111694
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- Ihsclassification. Classification - ICHD-3 The International Classification of Headache Disorders 3rd edition [Internet]. ICHD-3 The International Classification of Headache Disorders 3rd edition. 2016. Available from: https://ichd-3.org/classification-outline/
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- Ford B, Dore M, Harris E. Outpatient Primary Care Management of Headaches: Guidelines from the VA/DoD. Am Fam Physician. 2021;104(3):316-320.
- https://www.uptodate.com/contents/pathophysiology-clinical-manifestations-and-diagnosis-of-migraine-in-adults
- https://www.uptodate.com/contents/medication-overuse-headache-etiology-clinical-features-and-diagnosis
- https://www.uptodate.com/contents/post-dural-puncture-headache?search=post%20puncture%20headache&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H1010412474
- https://www.uptodate.com/contents/evaluation-of-headache-in-adults#H574564343
- https://www.aafp.org/pubs/afp/issues/1998/1115/p1785.html
- https://www.aafp.org/pubs/afp/issues/2012/0301/p447.html
- https://www.uptodate.com/contents/post-dural-puncture-headache? search=post%20dural%20puncture%20headache&source=search_result&selected Title=1~61&usage_type=default&display_rank=1
- https://www.uptodate.com/contents/headache-during-pregnancy-and-postpartum#H3
- https://www.aafp.org/pubs/afp/issues/2011/0201/p271.html
- https://www.uptodate.com/contents/headache-during-pregnancy-and-postpartum#:~:text=For%20patients%20with%20new%20onset,of%20gestation%20with%20a%20headache.
- https://www.aafp.org/pubs/afp/issues/2023/0700/practice-guidelines-headache-pregnancy-breastfeeding.html