21/03/2020
Headaches are very common experienced by 90-95 % of population
What type of Headache
Affects you tension, cluster or migraines If you have any of the following seek immediate medical assistance
Sudden onset, especially if no previous history
Severe and debilitating pain
Progressive
Fever
Vomiting
Disturbed consciousness / confusion, drowsiness
Personality change
Worse with bending, coughing or sneezing
Maximum in the morning
Wakes patient at night
Neurological and visual symptoms/signs
Seizure
Young obese female:? On medication
“New” in elderly, especially >50 yr
Post head injury
Tension Headaches image 1
Muscle Contraction Headaches
Most common type of primary headache
75% of patients are females
Often associated with cervical (neck) dysfunction, musculoskeletal neck problems, stress or mental tension.
Cervicogenic Headaches image 2 & 3
Headache can be caused by abnormalities in any structure innervated by the upper two cervical cutaneous nerves C2, C3 (C1/2, C2/3 facet joints)
Bony structures and soft tissues of the neck can refer pain in the head and face
Sinus Headaches (Frontal) Image 4 & 5
Viral inoculation via direct contact with the conjunctiva or nasal mucosa.
Symptoms usually develop in the first day after inoculation.
Nose blowing may propel contaminated fluid from the nasal cavity into the paranasal sinuses.
Inflammation follows, resulting in sinonasal hypersecretion and increased vascular permeability leading to transudation of fluid into the nasal cavity and sinuses. Viruses also can exert a direct toxic effect on nasal cilia, impairing mucociliary clearance. A combination of mucosal oedema, copious thickened secretions, and ciliary dyskinesia results in sinus obstruction and perpetuates the disease process.
Features
Site - Frontal or retro orbital, maxillary tooth discomfort, facial pain or pressure that is worse or localized to the sinuses when bending forward.
Quality – Facial pain, pressure or fullness
Frequency – Diurnal variation, developing in the morning, being most intense in the middle of the day, then subsiding early evening.
Duration - < 4 weeks of purulent discharge
Aggravating factors – Bending forward.
Migraine Headache
Greek - “ Pain involving half the head”.
10-15% of adults.
More common in females (hormonal link)
Peaks between 20-50 yrs
Various types – classic migraine (headache, vomiting & aura), common migraine (without aura).
Aura
Focal neurological symptoms that initiate or accompany an attack that can last between 5-60 minutes.
Include
Visual disturbances – bright spots in the visual fields
Somatosensory sensations including tingling of the lips, face or hands, paresis of an arm or leg, mild aphasia and confusion.
Features
Site - temporofrontal region (unilateral), can be bilateral
Radiation – retro-orbital and occipital
Quality – intense and throbbing
Frequency – 1 or 2 per month
Duration – 4 - 72 hours (average 6-8 hours)
Onset – paroxysmal, often wakes with it
Offset – spontaneous, often after sleep
Aggravating factors – tension, activity
Relieving factors – sleep, vomiting
Associated features – nausea, vomiting (90%), irritability, aura (visual, sensory)
At Serendipity we have experience treating all aspects of headache. Coupled with sensible self management protocols and maintenance, you may be rid or manage your headaches to a bare minimum.