We see many patients with headaches. Headache is a condition that everyone has had at some time in their lifetime. The World Health Organization (WHO) have stated that half the adult population will have suffered from one or more headache disorders once in any given year. Headaches are reported most often within general practices and frequently seen in neurological disorders. Headache disorders affect all ages, financial status, races and geographical areas.
At our clinic our headache assessment involves a comprehensive evaluation of the patient's physical condition to design an
individualized rehabilitation plan. What do we provide?
PRIMARY HEADACHES
These headaches are a result of non-medical conditions, no under lying structural cause, are cyclic in nature
and have symptoms caused by stand alone mechanisms. They are the most common type of headache and due to their varying aetiology, are
classified by their clinical presentation, by the affect on patients being either severe or chronic and from one headache disorder to
another. Multifaceted in nature these disorders are due to physiological changes in the central nervous system and autonomous
nervous system occurring simultaneously.
TENSION-TYPE HEADACHES
These are the most common and reported in the general population and are termed “normal” headache associated with everyone in their life. These are self-managed with the female-to-male ratio about 5:4 but higher in chronic (CTTH) affecting more women by 65% of cases with increased episodic levels of TTH in educated patients. TTHs are also known as stress headaches or muscle contraction headaches and are multifactorial in origin. With TTHs myofascial mechanisms have been presented as aggravating factors. While central chronic tension headaches (CCTH) are due to abnormal sensitization of pain pathways along side reduced ability of the body to decrease pain stimuli. Other factors include genetics and reduced levels of cortisol within the central pain processing system coupled with psychological stress and poor posture causing contraction of neck and scalp muscles. In patients with TTH weak neck extensor muscles have shown to be an aggravating factor.
MIGRAINE HEADACHES
One of the most frequently reported primary causing headache worldwide. Recurrent, self-limiting, moderate to
severe in intensity with autonomic symptoms. Contributes to 40% to 50% of all headaches accounting for 1.3% of years of life lost to
worldwide disability. Symptoms include throbbing, unilateral pain, nausea, vomiting, intolerance to lights, sounds, smell and confusion.
Symptoms can last for up to 72 hours. With the most serve attacks causing complete disability losing 15 days per month from normal
living. Migraines have a strong genetic ground but can be environmental affected ranging from a simple lifestyle or routine change can
aggravate a migraine causing severity and frequency. Trigging factors include changes in habits, external stimuli or physical activity
and can cause an attach up to 8 hours later. Common triggers include stress, coffee or other caffeinated drinks, alcohol, lack of sleep,
changes in weather, certain foods (such as cheeses or chocolate), food additives, strong smells and sounds. Stress is particularly
triggering as 70% of patients this being their main driver. With most affected individuals knowing their own triggers and doing what is
necessary to avoid them. The pathophysiology of migraine is still not fully understood. It is thought that deep stimulation of the brain
leads to the releasing of pain producing neurotransmitters which are associated with inflammation of head nerves and blood vessels.
Patients aged over 40 or 50 or in women after menopause generally see a 30% remit.
TRIGEMINAL AUTONOMIC CEPHALALGIAS
This subcategory of primary headaches is disabling and painful and include cluster headaches. These are
characterised by short-term mostly unilateral headache with ptosis (eyelid droop), lacrimation (abnormal tearing) and rhinorrhoea (runny
nose) and other autonomic features. Young male who smokes are 65% more likely to have this headache type. Cluster headaches are episodic
with attacks occurring up to 8 times per day ranging from 15 minutes to 3 hours taking place every day for a few weeks to a few months.
Chronic form TAC can last for a year without remission in that period.
Headaches belonging to this category have an underlying condition that at times can be ominous and life-threatening. They have similar criteria to that of Primary headaches but have causation by another disorder and include the following:
1. Headache attributed to trauma or injury to the head and/or neck
2. Headache attributed to cranial or cervical vascular disorder
3. Headache attributed to non-vascular intracranial disorder
4. Headache attributed to a substance or its withdrawal
5. Headache attributed to infection
6. Headache attributed to disorder of homoeostasis
7. Headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure
8. Headache attributed to psychiatric disorder
Secondary headaches are attributed to a causative disorder such as a vascular, inflammatory, traumatic or neoplastic aetiology. However, medication overuse headache as shown to outnumber other causes, and may can result in large morbidity if left untreated.
Post traumatic headaches related to trauma of head and or neck, whiplash or related cranial trauma are classified as acute if occurring within one week following inciting event or following returning consciousness or ceasing medications which would impair judgement or reporting of headache.
Headache associated with stroke (ischemic and haemorrhagic), arterial bleeding, arteritis, cerebral venous sinus thrombosis (CVST), genetic vasculopathies or post-procedural headaches tend to present acutely with neurological signs and symptoms. All these conditions may occur in patients who have previously been affected by types of primary headaches. The onset of a new headache which reports to be of very strong intensity (worst ever) is a key underlying factor of a vascular condition and should be diagnosed using the following criteria:
1. Headache fulfilling criterion the list above
2. A cranial and/or cervical vascular disorder known to be able to cause headache has been demonstrated
3. Evidence of causation demonstrated by at least two of the following:
headache has developed in temporal relation to the onset of the cranial and/or cervical vascular disorder
▪either or both of the following: –
headache has significantly worsened in parallel with worsening of the cranial and/or cervical vascular disorder –
headache has significantly improved in parallel with improvement of the cranial and/or cervical vascular disorder
▪headache has characteristics typical for the cranial and/or cervical vascular disorder
▪other evidence exists of causation
