Headache

Matthew Robbins, Brian M. Grosberg, Richard Lipton, Matthew Robbins, Brian M. Grosberg, Richard Lipton

• Publisher: Wiley-Blackwell
• Year: 2013
• ISBN:
  9781118678930
• Edition: 1
• Topic: Medicine
• Subtopic: Neurology

Unmask the clinical complexity behind one of the most common neurological symptoms Headache is a common clinical complaint often overlooked by both sufferers and physicians that can be intimidating to approach and manage. Hundreds of different etiologies, both benign and life-threatening, may primarily feature the symptom, and diagnosis can therefore be challenging. Headache is a practical guide to headache medicine designed for both neurologists and general practitioners. Its expert author team introduces the principles of classification and diagnosis, and focuses in detail on the main classes of headache – migraine, tension-type and trigeminal autonomic cephalgias, including cluster headache. They also cover unusual headache disorders such as hemicrania continua and new daily persistent headache, and address the management of headache in women, children and the elderly. With a clinically focused practical approach, Headache draws on the experience of international specialists to help you diagnose and manage your patients more effectively.

Part I

Principles of Headache: Primary and Secondary Headache Disorders

1

The Basics of Headache Classification and Diagnosis

Seymour Solomon^1,2 and Richard B. Lipton^1,2

¹Montefiore Headache Center, Bronx, NY, USA

²Albert Einstein College of Medicine, Bronx, NY, USA

Introduction

The causes of headache range from the short-lived and trivial (e.g., a hangover headache) to the intermittent and quality-of-life threatening (migraine), to the unremitting and life-threatening (subarachnoid hemorrhage headache). This broad range of etiologies is matched by the very high prevalence of headache in the gen­­eral population. In combination, the diversity of causes and high prevalence mandate a systematic approach to classification and diagnosis. Classification refers to a set of categories with diagnostic rules that provide the framework for a clinical approach. Diagnosis is the process of applying the rules to individual patients, defining their place in the classification.

In this chapter, we present an approach to both headache classification and diagnosis. We begin by describing the classification for headache disorders (see Tables 1.1, 1.2, 1.3, and 1.4 in the relevant sections). We recommend a three-step diagnostic process. First, we emphasize the identification or exclusion of secondary headache disorders by history, physical examination, and judicious use of diagnostic tests (see Table 1.5 and Figure 1.1). Second, we consider four groups of primary headache disorders that are defined based on headache frequency and duration (see Table 1.6) and refer to these as primary headache syndromes. Finally, we emphasize the identification of specific disorders within syndromic groups.

Table 1.1. The classification system (modified) (numbers refer to the ICHD-2 code)

A. Primary headache disorders 1. Migraine 1.1. Migraine without aura 1.2. Migraine with aura 1.3. Childhood periodic syndromes that are commonly precursors with migraine 1.4. Retinal migraine 1.5. Complications of migraine 1.6. Probable migraine 2. Tension-type headache 2.1. Infrequent episodic tension-type headache 2.2. Frequent tension-type headache 2.3. Chronic tension-type headache 2.4. Probable tension-type headache 3. Cluster headache and other trigeminal autonomic cephalalgias (TAC) 3.1. Cluster headache 3.1.1. Episodic cluster headache 3.1.2. Chronic cluster headache 3.2. Paroxysmal hemicrania 3.2.1. Episodic paroxysmal hemicrania 3.2.2. Chronic paroxysmal hemicrania 3.3. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) 3.4. Probable TAC 4. Other primary headaches 4.1. Primary stabbing headache 4.2. Primary cough headache 4.3. Primary exertional headache 4.4. Primary headache associated with sexual activity 4.5. Hypnic Headache 4.6. Primary thunderclap headache 4.7. Hemicrania continua 4.8. New daily persistent headache (NDPH)

B. Secondary headache disorders 5. Headache attributed to head and/or trauma 5.1. Acute post-traumatic headache 5.2. Chronic post-traumatic headache 6. Headache attributed to cranial or cervical vascular disorder 6.1. Headache attributed to ischemic stroke or transient ischemic attack 6.2. Headache attributed to non-traumatic intracranial hemorrhage 6.3. Headache attributed to unruptured vascular malformation 6.4. Headache attributed to arteritis 6.5. Carotid or vertebral artery pain 6.6. Headache attributed to cerebral venous thrombosis 6.7. Headache attributed to other intracranial vascular disorder 7. Headache attributed to non-vascular intracranial disorder 7.1. Headache attributed to high cerebrospinal fluid pressure 7.2. Headache attributed to low cerebrospinal fluid pressure 7.3. Headache attributed to non-infectious inflammatory disease 7.4. Headache attributed to intracranial neoplasm 7.5. Headache attributed to intrathecal injection 7.6. Headache attributed to epileptic seizure 7.7. Headache attributed to Chiari malformation type I 7.8. Syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis 7.9. Headache attributed to other non-vascular intracranial disorder 8. Headache attributed to a substance or its withdrawal 8.1. Headache induced by acute substance use or exposure 8.2. Medication-overuse headache (MOH) 8.3. Headache as an adverse event attributed to chronic medication 8.4. Headache attributed to substance withdrawal 9. Headache attributed to infection 9.1. Headache attributed to intracranial infection 9.2. Headache attributed to systemic infection 9.3. Headache attributed to HIV/AIDS 9.4. Chronic post-infection headache 10. Headache attributed to disorder of homeostasis 10.1. Headache attributed to hypoxia and/or hypercapnia 10.2. Dialysis Headache 10.3. Headache attributed to hypertension 10.4. Headache attributed to hypothyroidism 10.5. Headache attributed to fasting 10.6. Cardiac cephalalgia 10.7. Headache attributed to other disorder of homeostasis

C. Headache or facial pain attributed to disorder of cranial structures, psychiatric disorders, cranial neuralgias 11. Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures 11.1. Headache attributed to disorder of cranial bone 11.2. Headache attributed to disorder of neck 11.3. Headache attributed to disorder of eyes 11.4. Headache attributed to disorder of ears 11.5. Headache attributed to rhinosinusitis 11.6. Headache attributed to disorder of teeth, jaws or related structures 11.7. Headache or facial pain attributed to temporomandibular joint disorder 11.8. Headache attributed to other disorder of cranium, neck, eyes, ears, nose sinuses, teeth, mouth or other facial or cervical structures 12. Headache attributed to psychiatric disorder 12.1. Headache attributed to somatisation disorder 12.2. Headache attributed to psychotic disorder 13. Cranial neuralgias and central causes of facial pain 13.1. Trigeminal neuralgia 13.2. Glossopharyngeal neuralgia 13.3. Nervus intermedius neuralgia 13.4. Superior laryngeal neuralgia 13.5. Nasociliary neuralgia 13.6. Supraorbital neuralgia 13.7. Other terminal branch neuralgias 13.8. Occipital neuralgia 13.9. Neck-tongue syndrome 13.10. External compression headache 13.11. Cold-stimulus headache 13.12. Constant pain caused by compression, irritation or distortion of cranial nerves or upper cervical roots by structural lesions 13.13. Optic neuritis 13.14. Ocular diabetic neuropathy 13.15. Head or facial pain attributed to herpes zoster 13.16. Tolosa-Hunt syndrome 13.17. Ophthalmoplegic “migraine” 13.18. Central causes of facial pain 13.19. Other cranial neuralgia or other centrally mediated facial pain 14. Other headache, cranial neuralgia, central or primary facial pain 14.1. Headache not elsewhere classified 14.2. Headache unspecified

Table 1.2. Diagnostic criteria for migraine without and with aura

ICHD-2 diagnostic criteria for 1.1 migraine without aura A. At least 5 attacks fulfilling criteria B–D B. Headache attacks last 4–72 hours (untreated or unsuccessfully treated) C. Headache has at least 2 of the following characteristics: 1. Unilateral location 2. Pulsating quality 3. Moderate or severe pain intensity 4. Aggravation by, or causing avoidance of, routine physical activity (e.g., walking or climbing stairs) D. During the headache attack, at least 1 of the following: 1. Nausea and/or vomiting 2. Photophobia and phonophobia E. Symptoms not attributed to another disorder

ICHD-2 diagnostic criteria for 1.2 migraine with aura (modified) A. At least 2 attacks fulfilling criteria B–D B. Aura consists of at least 1 of the following: 1. Fully reversible visual symptoms 2. Fully reversible sensory symptoms 3. Fully reversible dysphasic speech disturbance (not motor weakness) C. At least 2 of the following: 1. Homonymous visual symptoms and/or unilateral sensory symptoms 2. At least one aura symptom develops gradually over more than 5 minutes and/or different aura symptoms occur in succession over 25 minutes D. Headache fulfills criteria B–D for 1.1 migraine without aura E. Symptoms not attributed to another disorder

Table 1.3. ICHD-2 Diagnostic criteria for 2.0 tension-type headache (TTH) (modified)

A. Episodes occuring in frequencies below (see 2.1, 2.2 and 2.3A) B. Headache lasting from 30 minutes to 7 days C. Headache has at least 2 of the following characteristics: 1. Bilateral location 2. Pressing/tightening (non-pulsating) quality 3. Mild or moderate intensity 4. Not aggravated by routine physical activity, such as walking or climbing upstairs D. Both of the following: 1. No nausea or vomiting (anorexia may occur) 2. No more than one of the following: photophobia or phonophobia E. Symptoms not attributed to another disorder 2.1 Infrequent episodic TTH At least 10 episodes occurring on <1 day per month on average (<12 days per year) and fulfilling criteria B–D 2.2 Frequent episodic TTH At least 10 episodes occurring on ≥1 but <15 days per month for at least 3 months (≥12 and <180 days per year) and fulfilling criteria B–D 2.3 Chronic TTH A. Headache occurring on >15 days per month on average for >3 months (>180 days per year) and fulfilling criteria C–E (above) B. Headache lasts hours or may be continuous

Table 1.4. ICHD-2 diagnostic criteria for cluster headache

3.0 Cluster headache (modified) A. At least 5 attacks fulfilling criteria B–D B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15–180 minutes if untreated C. Headache is accompanied by at least 1 of the following: 1. Ipsilateral conjunctival injection and/or lacrimation 2. Ipsila...