cephalea

Diagnosing

headache

Elizabeth Vargas Rodríguez

OBJECTIVE

• Identify the different types and subtypes of

headache, comparing the characteristics

of them.

• Establish a diagnosis based in the range of

the International Classification of

Headache Disorders .

Primary headache

• The diagnosis of a primary headache

requires that all other identifiable and

probable conditions that can secondarily

cause headache be excluded.

• For this crucial diagnostic step to take

place, the clinician must be familiar with

the typical features of each headache

type, carried out a competent physical

examination, and selected the

appropriate special investigations (CT).

Secondary Headache

• This type have an important

consideration, not only because of the

potential danger inherent in some, even

also because of their prevalence.

According to lifetime prevalence studies of

headache:

-Primary and secondary tension type headache

are the most common (69%)

-Headache from systemic infection is second in

frequency (63%)

- Migraine is next (16%)

- Headache after head injury (4%)

- Exertional headache (1%)

- Vascular disorders (1%)

- Sub-arachnoid hemorrhage (<1%)

- Brain tumors (0.1%).

Diagnosis of primary headache

syndromes

• Frequency: low to moderate

frecuency, episodic headache and high

frecuency.

• Attack duration: more than 4 hours and

those that last less than 4 hours.

Clinical features

Migraine is a unilateral, moderate to severe

throbbing headache – often frontal in

location. It is aggravated by positional

change and exercise.

Tension type headache is not so severe

usually bilateral, described as ‘tight,

pressing or aching’. It is not generally

aggravated by positional change.

Cluster headache is acute, unilateral,

located behind one eye, boring in

character and not affected adversely by

exercise or position.

Patient behavior and

appearance during attack

• In typical migraine attacks, the patient

chooses silence, tries to sleep (often finding

that sleep relieves the headache), and does

not want to be disturbed.

• But in cluster headache the opposite occurs.

• Unfortunately, this signs are similar in patients

with meningitis, encephalitis or subarachoid

hemorrhage.

Duration

• Untreated or unsuccessfully treated

migraines last 4–72 hours.

• Cluster headaches are shorter, having

a duration range of 15–180 minutes.

• Episodic tension type headache has a

duration of 30 minutes to 7 days.

Conclusion

• Is very important for the

clinician be able to classify

the different types of

cephaleas, based in their

etiology, signs-symptoms

and therefore create a

treatment plan for the

patient.

Bibliography

• Joubert, D. J. (August, 2005). Diagnosis of

headache. Headache • THEME, 621-

625.Recovered in July 27; from:

http://www.racgp.org.au/Content/Naviga

tionMenu/Publications/AustralianFamilyPh

ys/2005Issues/AugustHeadache/200508jou

bert.pdf