tients are unable to lie down and characteristically pace the floor. First-degree relatives of individuals with cluster headaches have between a 5 and 15 times greater chance of developing cluster headaches than the general population (Vollesen et al., 2018). Cluster headaches share some of the pathophysiological charac- teristics of migraine headaches, including involvement of both the peripheral and central nervous systems and interactions between the trigeminovascular system, parasympathetic nerve fibers, and the hypothalamus (Vollesen et al., 2018). The diagnostic criteria for cluster headaches are: 1. At least five attacks fulfilling criteria b–d. 2. Severe or very severe unilateral orbital, supraorbital, and/or temporal pain lasting 15–180 minutes (when untreated). 3. Either or both of following: a. At least one of the following symptoms or signs, ipsilateral to the headache: i. Conjunctival injection and/or lacrimation. ii. Nasal congestion and/or rhinorrhea. iii. Eyelid edema. iv. Forehead and facial sweating. v. Miosis and/or ptosis. b. A sense of restlessness or agitation. 4. Occurring with a frequency of between one every other day and eight per day. 5. Not better accounted for by another ICHD-3 diagnosis. Differential diagnosis of cluster headaches Cluster headaches share some common symptoms with other types of headache, but the following characteristics can be used to differentiate a cluster headache from other types: 1. Migraine —more common in women versus men and typically starts younger, in puberty or young adulthood. In addition, migraine often displays nausea and vomiting, phonophobia, and photophobia as distinguishing characteristics. 2. Paroxysmal hemicrania —a unilateral headache last 2 to 30 minutes. It is more common in women, with onset typically at age 34 to 41 years. 3. Tension-type headache —symptoms develop more gradually and are bilateral with a squeezing, bandlike headache. These headaches often start around midday. 4. Trigeminal neuralgia —involves a paroxysmal, electrical, stabbing pain in the trigeminal nerve distribution that last a few seconds. It is often triggered by cold air or light touch in the nerve distribution area. (Weaver-Agostini, 2013). Cervicogenic headaches Cervicogenic headaches are thought to arise from musculoskel- etal impairment(s) in the neck. They are described as a lateralized nonthrobbing headache that result from a nociceptive source in cervical spine (Verma et al., 2021). Cervicogenic headaches are commonly associated with suboccipital neck pain but can also be associated with ipsilateral arm discomfort (Racicki et al., 2020). Onset of these headaches may be due to postural strain or chron- ic tension, acute whiplash injury, intervertebral disc disease, or progressive facet joint arthritis (Carvallo Goodman et al., 2018). Mean age of onset is age 33– 43 years, and the mean duration of symptoms is 7 to 17 years (Hall et al., 2008). The conditions that share symptoms with cervicogenic headaches and which must be differentiated during physical therapy assessment include mi- graine, cervical spondylosis, and tension-type headache. Typical signs and symptoms of cervicogenic headache include: ● Pain starting in the occipital region that spreads anteriorly to- ward the frontal area. ● Typically bilateral location of symptoms. ● Mild to severe pain intensity. ● Often made worse by neck movements or sustained positions. ● Decreased neck range of motion. ● Trigger or tender points in the cervical muscles. ● Cervical muscle dysfunction or weakness, especially the sub- occipital muscles. ● Can have accompanying nausea or light/sound sensitivity. ● History of trauma, disc disease, or arthritis.
ger points in the head and neck muscles, which refer pain that radiates to the head. These active trigger points could cause sensitization of peripheral nociceptors, which could contribute to central sensitization. Suboccipital muscles, especially the rectus capitis posterior minor, are often involved. Signs and symptoms of tension-type headache include: ● Described as dull pressure. ● Sensation of band or vise around the head, sometimes de- scribed as a painful or tight scalp. ● Pain is bilateral or global (affecting the entire head). ● Muscular tenderness or soreness in the soft tissues of the up - per cervical spine. ● May get worse with loud sounds or bright lights. ● Current diagnosis or history of anxiety, depression, or panic disorder. The areas most commonly affected by tension-type headaches include the upper eyes, temporal area, and occipital area with accompanying possible involvement of the upper trapezius and sternocleidomastoid muscles (Turkistani et al., 2021). Sleep disturbances have been shown to be more prevalent in people with tension-type headaches. This includes insomnia, poor sleep quality, excessive daytime sleepiness, insufficient sleep, and shift working (Cho et al., 2019). The International Classification of Headache Disorder divides tension-type headaches into infrequent, frequent, and chronic categories with diagnostic criteria as follow: 1. Infrequent episodic tension-type headaches: a. At least 10 episodes of headache occurring on <1 day/ month on average (<12 days/year) and fulfilling criteria b–d. b. Lasting from 30 minutes to 7 days. c. At least two of the following four characteristics: i. Bilateral location. ii. Pressing or tightening (nonpulsating) quality. iii. Mild or moderate intensity. iv. Not aggravated by routine physical activity such as walking or climbing stairs. d. Both of the following: i. No nausea or vomiting. ii. No more than one of photophobia or phonophobia. e. Not better accounted for by another ICHD-3 category. 2. Frequent episodic tension-type headaches: a. At least 10 episodes of headache occurring on 1–14 days/ month on average for >3 months ≥12 and <180 days/year and fulfilling b–d as listed above for infrequent episodic tension-type headaches. 3. Chronic tension-type headache: a. Headache occurring on ≤15 days/month on average for >3 months, fulfilling criteria b–d as listed above for infre- quent episodic tension-type headaches. Self-Assessment Quiz Question #18 Which of the following findings would lead you to conclude that a patient does NOT have a tension- type headache? a. Headache described as dull pressure on both sides of the head. b. Muscle tightness and tenderness in the upper trapezius and sternocleidomastoid muscles. c. Nausea and vomiting. d. Sensitivity to loud sounds when headache is present. Cluster headaches According to the International Classification of Headache Disor- ders, cluster headaches are attacks of severe, strictly unilateral pain that is orbital, supraorbital, temporal, or in any combination of these sites. They last 15–180 minutes and occur from once ev- ery other day to eight times a day. Age of onset is usually between 20 and 40 years, and men are affected three times more than women. During the worst attacks, the pain is excruciating. Pa-
EliteLearning.com/ Physical-Therapy
Book Code: PTCA2624
Page 107
Powered by FlippingBook