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 infrequent 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 Disorders, 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 every 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. Patients 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 characteristics 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.
you arrive at a diagnosis of migraine headache. These triggers include (Cavallaro Goodman et al., 2018): ● Alcohol. ● Food. ● Hormonal changes. ● Hunger. ● Lack of sleep. ● Perfume. ● Stress. ● Medications. ● Environmental factors such as pollutants, air pressure changes, 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 headaches. Tension-type headaches According to Hainer et al. (2013), tension-type headache is the most common form of headache. Its main symptom is the feeling 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 sensitization 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 trigger 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 described 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 upper 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:
Page 43
Book Code: PTNY1024
EliteLearning.com/ Physical-Therapy
Powered by FlippingBook