Headaches & Migraine
Classification of headache :
- Vascular(migraine/cluster/aneurism)
- Tension(muscle contraction)
- Pressure/Inflammatory(brain tumor,infection, cva)
- Cranial neuralgias(trigrminal neuralgia,dysfunction of TMJ/assoc muscles)
- psychotic (usually delusional ie. feels worms inside their head)
Headache Case History Taking Sieve
- where is the pain?
- What type of pain?
- How severe is the pain?
- What is the duration?
- What is the onset?
- What is the frequency?
- Is it acute or chronic and re-occurring?
- If chronichas it changed its characteristics or become progressively severe?
- Does the pain occur at the same time every day
- Does coughing and sneezing or changing the position of the head affect the headache?
Painful structures in the head
- INTRACRANIAL
- Venous sinuses
- Cortical veins
- Basal arteries
- Dura of anterior,middle and posterior fossa
- EXTRA CRANIAL
- Scalp vessels
- Scalp muscles
- Orbital contents
- Mucus membranes-para/nasal
- External and middle ear
- Teeth and gums
- Examination
- Active/ passive movements of the cervical spine/temporomandibular joint
- Compression
- Blood pressure
- Eye/vision examination
- Neurological examination including cranial nerve testing
- Tap over frontal and maxillary sinuses(if u suspect sinusitis)
- Kernig’s sign
- Vertebro basilar insufficiency
- Migraine There are a number of trigger factors causing a migraine headache and these can range from the following
- Chemical toxins
- Various E numbers
- Red wine
- Cheese
- Chocolate
- Bright light
