Primary Headache Syndromes

Approach to Patients
Migraine Headache
Primary Headache Syndromes
Secondary Causes
Cranial and Facial Pain Disorders

Table of Contents

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Tension-Type Headache


Extracranial muscle tension

Questioned relationship

Muscle tension is cause or epiphenomenon

Common pathophysiology with migraines and represent different ends of a clinical spectrum


Clinical Features

Bilateral, nonpulsating, not worsened by exertion, not ass with N/V

In severe cases --> fit the description of mild migraine

Accurate classification requires at least two of the following four characteristics:

  • Pressing/Tightness Quality (Non-Pulsating)
  • Mild to Moderate Intensity
  • Bilateral Location
  • Not Aggravated by Activity

Important associated symptoms include

  • anorexia, and
  • photo/phonophobia.

Typically nausea and vomiting do not occur.


Simple analgesics or NSAID

Same as migraine in severe cases



Cluster Headache


Rare (0.4% prevalence rate)

Very short-lived even without treatment

More common in men

Onset after 20 YO


Dysfunction of the trigeminal nerve

A common mechanism with migraines (respond to 5-HT 1D agonist)


Clinical Features

Very severe, unilateral or bital, supraorbital, or temporal pain

Lasting 15 to 180 min

Pt rarely lie still, most are pacing and restless

Clinical Features

It generally lasts forty-five to sixty minutes.

There is no associated aura.

Associated features include

  • ipsilateral lacrimation
  • conjunctival injection
  • rhinorrhea
  • ptosis and myosis (more than 50%.)

There is often a history of excessive alcohol intake and heavy smoking.

Tend to occur in “cluster”

  • Same side of face for several weeks
  • Remitting for anywhere from weeks to years



Oxygen : Effective up to 70%

DHE and Sumatriptan

NSAIDs : Reducing the frequency and severity of future attacks

Oral agents are unlikely to be effective (short duration of Dz)



Disposition for All Primay Headache Syndromes

Poor response --> suspect secondary cause and prompt emergent Ix

Respond well --> D/C and F/U

Intractable migraine --> admission for more aggressive pain control


Summarized By Thirayost Nimmanon

โดย ธีรยสถ์ นิมมานนท์


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