% of migraines w/o aura?
80%
typical average duration of migraine?
7-12 hours
which headache is band-like?
tension
typical trigger of cluster headache?
often alcohol
diagnostic criteria for tension headache?
must present with 2 of the following:
- pressing or tightening (non pulsating)
- B/L - mild/moderate intensity
- not aggravated by physical activity
diagnostic criteria for cluster headache?
- excruciating, stabbing, lancinating pain
- U/L: periorbital, retro-orbital, temporal (can radiate to cheek, jaw, occiput, nuchal regions); pain along trigeminal nerve
- sudden onset, peaks at 10-15 mins
- lasts 5 mins to 3 hours
- 1-8x / day for as long as 4 months
- often nocturnal
- sx free intervals: 2 mos to 20 yrs
labs to run when red flags present?
CBC - systemic or intracranial infection
ESR - suspected temporal arteritis
CT or MRI - r/o intracranial pathology
CSF - suspected hemorrhage, infection, tumour or other concerns related to CSF
headache red flags?
- first or worst headache ever
- neurological symptoms
- valsalva
- neck stiffness
- change in personality, LOC, mental status
- middle age or later onset
- sudden onset
- rapid and severe
- systemic symptoms
- worsening symptoms
- changing features
specific questions to ask with regard to headache?
- accompanying muscle tension
- how long does it last without tx?
- why come in for this particular headache?
- new medications?
- triggers?
- menses?
- sleep quality and duration
- depression & anxiety
what is the Cerena Transcranial Magnetic Stimulator?
- 1st FDA-approved device for migraine with aura
- adults >18yoa
- do not exceed 1 tx/24hrs
- delivers pulse of magnetic energy
- stimulates occipital cortex
- 39% of patients pain-free for 2 hrs after use
CI: metal in head, neck or upper body; active implanted medical device; suspected/diagnosed epilepsy or seizures
effect of caffeine additives on pain relievers
- caffeine additives seem to make pain relievers 40% more effective
- seems to help absorb headache drugs more quickly
“main” homeo headache remedy?
nat mur
R sided homeo Headache remedies (5)
belladonna sanguinaria agaricus iris lycopodium
L sided homeo headache remedies (3)
bryonia
lachesis
sepia
