HEADACHE
Headaches may present in a variety of forms, including primary or secondary headache disorders. Primary headaches are not associated with an underlying medical condition or disease while secondary are due to an underlying cause. Primary headache disorders include tension-type headache, migraine, trigeminal autonomic cephalalgias (i.e. cluster headaches), and other headache disorders. 90% of headaches are primary headaches, the most common of which, are tension-type headache and migraine. Although tension-type headache and migraine represent two different types of headaches, they often have overlapping features, and thus many individuals will have a headache that exhibits qualities of both tension-type and migraine headaches.
Tension-Type Headache
What is tension-type headache?
Tension-type headaches are bilateral and present with an non-pulsating band-like pain. They may be accompanied by nausea or vomiting but not both, and they may range from a moderate dull pain to aching pain. They usually last from 30 minutes to several hours. The pain associated with tension-type headaches is often across the forehead, in the temples, the back of the head and the facial muscles.
These headaches are often described as:
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non-pulsating band like pain
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aching
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squeezing
Tension-type headaches are often associated with temporomandibular joint disorders (TMD). Thus, it is not uncommon for patients with TMD to present with tension-type headaches as their dominant symptom.
Tension-type headache is often divided into episodic versus chronic depending on the chronicity of the disease with episodic tension-type headache being divided further into infrequent and frequent. Chronic tension type headache signifies it occurs greater than 15 days a month for at least 3 months.
How common is tension-type headache?
Tension-type headache is extremely common with a prevalence ranging from 30-70%.
How is tension-type headache treated?
Tension-type headache may sometimes occur along with migraine and TMD. Thus treatment for tension-type headache is geared toward treating these comorbidities as well. Various treatment options exist for tension-type headache including:
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Medications
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Behavioral modifications including biofeedback
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Lifestyle modifications
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Physical therapy
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Therapeutic injections such as trigger point injections
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Treating underlying TMD (when applicable)
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Sleep
Section Title
Migraine
What is migraine?
Migraine is a debilitating neurological condition. It may occur on one side of the head or bilaterally (though more commonly migraine is unilateral). Migraine is often characterized as being moderately to severely painful and can be episodic (occurring less than 15 days a month for three months) or chronic (occuring more than 15 days a month for three months)
Migraine is often described as:
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throbbing
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pulsating
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pressure
Migraine is often accompanied by:
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nausea
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vomiting
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photophobia (sensitivity to light)
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phonophobia (sensitivity to sound)
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osmophobia (sensitivity to smell)
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dizziness
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brain fog
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fatigue
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pain around the eyes and cheeks
Migraine can also be present with:
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ear fullness
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sinus pressure
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nasal congestion
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neck pain
Migraine typically lasts longer than tension-type headaches with a duration anywhere from several hours to three days. Migraine may be both chronic and acute, with chronic migraine lasting greater than 15 days a week for more than 3 months in the year.
Aura
Migraine can also be accompanied by an aura. Aura is a reversible visual, sensory or other neurological symptoms that may precede a migraine. They usually last 5-60 minutes.
Sinus Headaches
"Sinus headaches" are used to describe headaches that are thought to be caused by inflammation or congestion in the sinuses; however, this term is actually a misnomer. Did you know that most headaches that are thought to be sinus headaches are actually migraine? Research has shown that up to 90% of people who self-diagnose with sinus headaches actually have migraine. This is because the symptoms of sinus headaches, such as facial pain and pressure, are also common symptoms of migraine. Headaches that are attributed to sinus disease are called rhinogenic headaches. These headaches are caused by inflammation or irritation of the nasal passages or sinuses, and they can be accompanied by symptoms such as nasal congestion, post-nasal drip, and sinus pressure. Nasal congestion, post-nasal drip, and sinus pressure can all also occur with migraine. The presence or absence of purulent nasal discharge and/or other features diagnostic of rhinosinusitis help to differentiate these conditions.
How is migraine diagnosed?
Migraine is diagnosed by a detailed history and physical examination. Sometimes imaging and labs may be ordered to rule out other causes.
Migraine Treatment
Migraine treatment is multidisciplinary, and treatment often is determined based on chronicity of the disease, meaning, episodic and chronic migraine are treated differently. There are multiple treatment options for migraine including:
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Abortive and preventative medications
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Nutraceuticals
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Neuromodulation
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Botox injections
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Behavioral modification including biofeedback, dietary changes and lifestyle changes
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Physical Therapy
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Sleep hygiene modification
Migraine and TMD
Migraine and TMD are closely related and may have a bidirectional relationship. It is not uncommon for individuals who present with migraine to have concurrent temporomandibular joint pain and for individuals with TMD to also have migraine. Thus assessing for TMD in patients with migraine is important just as screening for migraine in patients with TMD is essential.