Headache Simplified

Marcus, Dawn A.

• Publisher: tfm Publishing Ltd
• Year: 2008
• ISBN:
  9781908986276
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This practical book provides a handy reference for the doctor confronted with patients complaining of headache. Headache is one of the most common complaints seen in the outpatient or ambulatory care setting, and may be caused by a wide variety of conditions. This book clearly explains up-to-date headache epidemiology, impact, and pathogenesis, and walks the reader through the steps to evaluating and treating the patient presenting with primary or secondary headache disorders. Also included are reviews of common headache comorbidities, including cardiovascular disease and stroke, epilepsy, fibromyalgia and mood disturbance. Copious use of easy-to-understand figures, tables, and algorithms make this book a useful and practical tool in the clinic. Guidance on selecting diagnostic tests and specific treatment protocols are provided. Treatment recommendations are evidence-based with full referencing and include emerging therapies. Sections on evaluating and treating headaches in children, women during pregnancy, and the elderly complete this comprehensive reference. The likely readership will include the following: neurologists, general physicians, doctors in training, hospital pharmacists, primary care physicians, nurses and nurse practitioners.

Chapter 1

Epidemiology of headache

Introduction

Pain is the number one somatic complaint seen in ambulatory care (Figure 1) ¹. Back pain is the most common complaint (10%), followed by lower extremity pain (9%), and upper extremity pain and headache (each 6%). Similarly, the National Health and Nutrition Examination Survey reported active, problematic localized chronic pain with episodes lasting at least 24 hours in an estimated 11% of adults in the United States, with chronic widespread pain in 4% of adults ². This survey only included reports of major pain, resulting in a substantially lower prevalence of headache pain than reported in the studies cited in the next section, which included any headache complaint. Head pain was the fourth most common individual pain location (Figure 2), with head pain more common among women and variability within genders based on race (Figure 3).

Figure 1 Somatic complaints in primary care office visits. GI includes gastroenteritis and nausea. (Based on Khan 2003.)

Figure 2 Estimated prevalence of major chronic pain with episodes lasting ≥24 hours by body regions. (Based on Hardt 2008.)

Figure 3 Gender and ethnic differences in major head pain population prevalence estimates. (Based on Hardt 2008.)

Headache epidemiology

Headache is endorsed as a current complaint by nearly half of all adults worldwide (Figure 4), with two in every three adults affected at some point during their lives ³. The vast majority of chronic headache patients are managed by primary care physicians (PCPs). According to the National Ambulatory Medical Care Survey, two in every three migraine patients are treated by PCPs, with only 17% treated by neurologists ⁴.

Figure 4 Worldwide headache prevalence. (Based on Stovner 2007.)

Acute or new onset headaches may be caused by systemic illness, such as infection or intracranial pathology (Table 1). Head pain may also occur as a consequence of musculoskeletal dysfunction in the neck or cervical spine. Chronic headache is most commonly caused by primary headache disorders, although some secondary headaches (like post-trauma headache, trigeminal neuralgia, post-herpetic neuralgia, and analgesic overuse headache) may also result in chronic pain syndromes.

Table 1 Common causes of head pain.
Primary headaches
•	Migraine
•	Tension-type
•	Cluster
Secondary headaches
•	Infection
	– Viral illness
	– Respiratory infection
	– Meningitis
•	Inflammatory
	– Giant cell arteritis
	– Systemic lupus erythematosus
•	Intracranial pathology
	– Cerebrovascular disease
	– Subdural hematoma
	– Tumor
	– Vascular malformation or aneurysm
•	Medications
	– Analgesic overuse headache
	– Alcohol-induced headache
	– Caffeine, opioid, or estrogen withdrawal
•	Musculoskeletal
	– Temporomandibular dysfunction
	– Cervical myofascial or joint dysfunction
•	Neuralgias
	– Post-herpetic neuralgia
	– Trigeminal neuralgia
•	Systemic illness
	– Anemia
	– Thyroid disease

Adult headaches

Acute headaches

Patients with new onset acute or a recent change in headache will require a more thorough evaluation to rule out secondary conditions than patients with stable, chronic headaches. Patients reporting new headaches often experience headaches related to an acute viral illness or trauma.

Headaches seen in the emergency department (ED) may be acute heada...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Preface
• Glossary of terms
• About the author
• Acknowledgements
• Chapter 1: Epidemiology of headache
• Chapter 2: Diagnostic testing in the headache patient
• Chapter 3: Distinguishing primary from secondary headaches
• Chapter 4: Pathophysiology of chronic headaches
• Chapter 5: Treating headaches
• Chapter 6: Headache comorbidity
• Chapter 7: Complementary and alternative therapies
• Chapter 8: Managing headaches in children and women
• Chapter 9: Emergency department treatment of headache
• Chapter 10: Uncommon and geriatric headaches