Headache is defined as pain or discomfort in the head, scalp, or neck. There are many different kind of headaches with specific characteristics, including migraine, cluster, and tension headache. It is important to differentiate these headaches as it assists with treatment.
Most patients who present with recurrent severe or disabling headache accompanied with nausea or light sensitivity have migraine. Migraines last more than four hours, with bilateral, throbbing/pulsating pain. The onset of migraine is usually gradual with movement or activity making the symptoms worse. The location is usually frontal, occipital, ocular, temporal and neck pain.
Although some cluster headache symptoms may mimic migraine, a number of peculiar features set CH apart, including seasonal attacks. Most CH patients have daily or near-daily attacks with cycles lasting weeks to months, and they always begin around the same month of each year. Prolonged CH-free periods last months to years. For acute pain, subcutaneous Sumatriptan is the only FDA approved medication for CH and is effective in most patients. Sumatriptan and zolmitriptan nasal sprays are fairly effective. Additionally, oxygen inhalation is effective in about 70% of CH attacks.
Cluster headaches last 3 hours or less with stabbing pain, usually ocular. Onset is usually rapid and movement and activity may improve symptoms.
Tension headaches are considered a type of primary headache, which means that they are not caused by another medical condition or disorder, often caused by severe muscle contractions triggered by stress or exertion.
Tension headaches usually respond very well to such over-the-counter medications as ibuprofen, or acetaminophen. More severe tension headaches may require combination medications, including a mild sedative such as butalbital; these should be used sparingly, though. Chronic tension headaches may respond to low-dose amitriptyline taken at night.
