Professional Documents
Culture Documents
have?
David M. Biondi, DO
Director, Headache Management Programs
Spaulding Rehabilitation Hospital
Consultant, Massachusetts General Hospital
Instructor in Neurology, Harvard Medical School
Boston, MA
Migraine
Tension
Sinus
Treatment
Headache History
Headache attacks
How it begins
Precipitating event, illness, injury
Location
Time to peak intensity
Duration
Quality and intensity
Warning symptoms and aura
Associated symptoms and level of disability
Triggers and aggravating or relieving factors
TTH is 1.5x
more common
than migraine
TTH is 3.3x
more common
than migraine
75
60
Population
50
Percent 40
(%)
30
40
Waiting Room
44
29
20
10
0
12
Tension-Type Headache
Significant
Headaches*
12
Migraine
* People who want to talk to the doctor about their headaches or who
have headaches that interfere with daily activities.
Lipton RB et al. Neurology. 2003;61:375-385.
Unilateral location
Pulsating quality
Moderate or severe intensity
Aggravation by routine physical activity
Aura
Vomiting
Aggravated
by Activity
Throbbing
Pressure
Tension-Type
Migraine
2002 Primary Care Network
Migraine Aura
Positive Neurological Symptoms
Reversible brain/neurological symptoms
Visual flashes, spots, or zig-zag lines
Traveling tingling sensations
Cutaneous allodynia
Hair hurts
Painful when:
Shaving
Combing hair
Touching scalp
Resting head on pillow
Pulling hair back (wearing
a ponytail)
Wearing eyeglasses or
contact lenses
Wearing hat or head band
Descriptions
69% - tightness
17% - stiffness
5% - throbbing
5% - other
92%
100%
80%
61%
60%
41%
40%
20%
0%
Prodrome
Postdrome
Migraine
Phase
53%
Severe
Impairment
or Bed Rest
Required
39%
Patients
30
Some
Impairment
(%)
20
10
0
Mild
Moderately
Severe
Severe
Extremely
Severe
Myth
Headaches that are triggered by weather or
are associated with sinus symptoms are not
migraines.
Fact
Up to 50% of migraine patients report their
headaches are influenced by weather 1
45% of migraine patients report sinus
symptoms including2
Lacrimation
Nasal congestion
Rhinorrhea
1. Raskin NH. Headache. 2nd ed. New York: Churchill Livingstone; 1998.
2. Barbanti P et al. Cephalalgia. 2001;21:295.
Headache:
A Minor Criteria in AAO-HNS Sinusitis
Headache is a minor factor in the diagnosis of
rhinosinusitis, according to AAO-HNS*
Major factors
Purulence in nasal cavity on
exam
Facial pain/pressure/congestion*
Nasal obstruction/blockage/
discharge
Fever (in acute only)
Hyposmia/anosmia
Minor factors
Fever (chronic)
Halitosis
Headache
Fatigue
Dental pain
Cough
Ear pain/pressure/fullness
97%
89%
85%
Moderate/Severe Pain
Pulsatile
Worsened by Activity
84%
82%
79%
Sinus Pressure
Sinus Pain
Photophobia
67%
63%
Phonophobia
Nasal Congestion
40%
38%
Runny Nose
Watery Eyes
29%
27%
Aura
Itchy Nose
Sinus Symptoms
25%
Vomiting
N = 2424
0%
20%
40%
60%
80%
Schreiber C. Poster presented at: American Headache Society Meeting; June 21-23, 2002;Seattle, WA.
100%
82%
8%
Migrainous
IHS 1.7
n=2520
10%
Other
0%
20%
40%
60%
Percentage of Subjects
Source: SUMMIT Study
80%
100%
Summary
Tension-type headaches are very common in the
general population
Migraine headaches are also common but are more
common than tension-type headaches in medical
clinics because of greater severity and disability
True sinus headaches are uncommon
Sinus symptoms and neck pain are very common
symptoms of migraine
Most cases of recurrent sinus headaches are
migraine especially if there is a family history of
recurrent or chronic headaches