Diagnosis and Treatment of Common Headache Syndromes: A Guide for the Clinician

Abstract

Citation: Waldman SD, Waldman CW, Waldman RA (2014) Diagnosis and Treatment of Common Headache Syndromes: A Guide for the Clinician. J Yoga Phys Ther 4: 156. Practice Points• The targeted headache history will allow the clinician to correctly diagnose the type of headache the patient is suffering from in the vast majority of cases.• Correct diagnosis is essential if the clinician is going to construct a rational and effective plan of treatment.• Tension-type headache is the most common type of headache encountered in clinical practice.• Migraine headache is associated with significant morbidity.• Aura is a painless neurological dysfunction that precedes the onset of headache pain in patients suffering from migraine with aura.• Cluster headache occurs predominately in males.• Cluster headache follows a unique chronobiological pattern.• Patients suffering from cluster headache frequently exhibit trigeminal autonomic symptoms during acute attacks.• Medication overuse headache is frequently triggered by the overuse of simple analgesics, nonsteroidal anti-inflammatory agents, opioids, caffeine, ergotamines, and triptans. AbstractHeadache is a one of the most common problems encountered in clinical practice. Over 90 per cent of headaches fall into one of four diagnostic categories: (1) Tension-type headache; (2) Migraine headache; (3) Cluster headache; and (4) Medication overuse headache. The mainstay of diagnosis of these common headaches is the taking of a careful targeted headache history. The physical examination in patients suffering from these common headaches is almost always normal and abnormalities identified on physical examination in this patient population should raise concern. Appropriate use of diagnostic imaging including magnetic resonance imaging of the brain and cervical spine is indicated in those patients with a recent onset of headaches and in those patients in whom a previously stable headache pattern has changed. Laboratory testing will also help the clinician rule out co-existent or occult disease that may be contributing to the patient's headache symptomatology. In most cases, treatment plans should be aimed at preventing headache rather than aborting the headache after symptoms have already occurred. Care must be taken to identify overuse or misuse of medications prescribed to treat headache, as many of these medications have the propensity to cause medication overuse headaches.