● Chronic migraine. Chronic migraine is defined as greater than or equal to 15 headache days per month with fulfillment of International Classification of Headache Disorders criteria for headaches more than 7 days per month (Eigenbrodt et al., 2021). Family history of migraine/age of onset There is a strong genetic component for migraine. First-degree relatives of people with migraine have a higher prevalence of migraine than the general population (Eigenbrodt et al., 2021). Onset of migraine headaches is typically at or around puberty (Ei- Medical history is critical to migraine diagnosis. Medical history should include the following important elements: Age at onset of headache; duration of headache episodes; frequency of head- aches; pain characteristics, including location, quality, severity, ag- gravating factors and relieving factors; accompanying symptoms such as photophobia, phonophobia, nausea and vomiting; and medication use. Diagnostic criteria genbrodt et al., 2021). Diagnosis of migraine Diagnosis of migraine headache is established via the diagnosis criteria established by application of the International Classifica- tion of Headache Disorders criteria. These criteria prioritize speci- ficity over sensitivity (Eigenbrodt et al., 2021): 1. ICHD-3 criteria migraine without aura: a. At least five attacks that fulfil criteria b–e. b. Headache attacks that last at least 4–72 hours when un- treated or unsuccessfully treated. c. Headache with at least two of the following four charac- teristics: i. Unilateral location. ii. Pulsating quality. iii. Moderate or severe pain intensity. iv. Aggravation by, or causing avoidance of, routine physi- cal activity (e.g., walking or climbing stairs). d. At least one of the following during the headache: i. Nausea and/or vomiting. ii. Photophobia and phonophobia. e. Not better accounted for by another ICHD-3 diagnosis. 2. Migraine with aura: a. At least two attacks that fulfil criteria b and c. b. One or more of the following fully reversible aura symp- toms: i. Visual. ii. Sensory. iii. Speech and/or language. iv. Motor. v. Brainstem. vi. Retinal. c. At least three of the following six characteristics: i. At least one aura symptom spreads gradually over ≥5 minutes. ii. Two or more aura symptoms occur in succession. iii. Each individual aura symptom lasts 5–60 minutes. iv. At least one aura symptom is unilateral. v. At least one aura symptom is positive. vi. The aura is accompanied with or followed by a head- ache within 60 minutes. d. Not better accounted for by another ICHD-3 diagnosis. 3. Chronic migraine: a. Headache (migraine-like or tension-type-like) on ≥15 days/ month for >3 months that fulfil criteria b and c. b. Attacks occur in an individual who has had at least five at- tacks that fulfill the criteria for migraine without aura and/ or migraine with aura. c. On ≥8 days/month for >3 months, any of the following criteria are met: i. Criteria c and d for migraine without aura. ii. Criteria b and c for migraine with aura. iii. Believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative.
d. Not better accounted for by another ICHD-3 diagnosis.
Self-Assessment Quiz Question #16 All of the following are common symptoms associated with mi- graine headaches except: a. Muscle tenderness in the upper cervical spine. b. Nausea and vomiting.
c. Photophobia. d. Phonophobia. Differential diagnosis and migraine headaches
Differential diagnosis from other primary headaches is important. Tension- type headaches lack the symptoms that accompany mi- graine, are typically bilateral, are mild to moderate in intensity, and have a pressing or tightening quality that is not aggravated by routine physical activity (Eigenbrodt et al., 2021). Cluster head- aches are much less prevalent and are characterized by recurrent but short-lasting attacks; strictly unilateral pain; severe or very severe intensity; and accompanying ipsilateral cranial autonomic symptoms such as conjunctival injection, lacrimation, and nasal congestion (Eigenbrodt et al., 2021). Medication overuse head- aches commonly develop from overuse of acute medication to treat migraine attacks (Eigenbrodt et al., 2021). Migraine triggers Migraine headaches are often brought on by specific triggers. When interviewing the patient about their pain pattern, the onset of a headache associated with these triggers may help you arrive at a diagnosis of migraine headache. These triggers include (Ca- vallaro Goodman et al., 2018): ● Alcohol. ● Food. ● Hormonal changes. ● Hunger. ● Lack of sleep. ● Perfume. ● Stress. ● Medications. ● Environmental factors such as pollutants, air pressure chang- es, and temperature changes. Self-Assessment Quiz Question #17 The onset of migraine headaches most commonly occurs: a. In puberty. b. In middle age. c. In older adulthood. d. There is no age correlation with onset of migraine head- aches. Tension-type headaches According to Hainer et al. (2013), tension-type headache is the most common form of headache. Its main symptom is the feel - ing of pressure in the head bilaterally. The cause of this type of headache has not been defined, but muscular factors, especially from pericranial muscles; stress; and central sensitization all seem to play a role (Kroll et al., 2021). Women are affected more than men (Hainer et al., 2013). Evidence-based practice: Tension-type headaches are characterized by a bilateral feeling of pressure in the head. Although the cause of these headaches has not be completely defined, according to Kroll et al. (2021), muscular factors, stress, and central sensitiza- tion all seem to play a role.
According to Jiang et al. (2019) several pathogenic factors are involved in the development of tension-type headaches. Their development is related to the presence of active myofascial trig-
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