Tension headache can be divided into two types: Episodic - usually associated with some stressful event, is of moderate intensity, self-limited, and usually responds to nonprescription preparations; and Chronic - often recurring daily, bilateral location, usually occipito-frontal and associated with contracted muscles of the neck and scalp.
A cluster headache is characterized by attacks of severe, unilateral headache around the eye and temple with ipsilateral lacrimation, rhinorrhea, ptosis, miosis and nasal stuffiness. Attacks last approximately 30-120 minutes and occur 1-3 times per day (often waking the patient) at the same time of day for up to 12 weeks typically followed by 1-24 months without an attack.
Tension headaches can be caused by: poor posture; stress and/or anxiety; depression (found in 70% of those with daily headache); low platelet serotonin; cervical osteoarthritis; or intramuscular vasoconstriction. Risk factors for tension headaches include: obstructive sleep apnea; medications; and excess caffeine.
The exact cause of cluster headaches is unknown. Several mechanisms have been proposed, including: disorder of arterial tone in cerebral arteries; disturbance of circadian rhythm based in hypothalamus; disorder of serotonin metabolism or transmission in CNS; and disorder of histamine concentrations or receptors. Risk factors include: male sex; age > 30 years; and previous head injury or surgery. Attacks may be triggered by nitroglycerine or alcohol.
Ovarian hormones have a significant effect on the central nervous system of female migraineurs. Reproductive milestones such as menarche, pregnancy, and menopause are associated with changes in the clinical course of migraine headache. Migraine attacks are commonly triggered during declines in serum estrogen levels that occur before and during the time of menstruation. Therefore, substantial clinical evidence suggests that changes in ovarian hormones affect migraine headache.
Standard labs include a CBC, SMAC-20, and Thyroid studies. An ESR is ordered for those over 50 years of age. Imaging studies include an X-ray of cervical spine.
A CT or MRI of the head is necessary only when headache pattern has recently changed or there is a positive finding on neurological exam.
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