Diagnosis of Headache: Migraine, Tension, Cluster, Stroke and TIA

Migraine headache is severe intense throbbing pain with pulsating character mostly localized on one side of head. Patient may suffer with nausea and vomiting during the episode of headache. Patients are sensitive to light and sound. Pain may last for hours or days. Migraine headache may precede or accompany aura. Auras are sensory symptoms such as light flashing, blind spot or feeling of tingling and numbness.^[1] Aura may precede migraine and considered as warning symptoms. Physical activities increase intensity of headache.

Tension headache may be acute in nature or rarely become chronic with daily pain lasting more than 3 to 6 months. Tension headache may be once or few times a week or continuous for a several days. If tension headache last for 15 days or more in one month it is considered chronic tension headache.^[2] Headache is mild to moderate in intensity compared to migraine or cluster headache. Tension headache is not preceded or accompanied by aura like symptoms. Physical activities do not increase intensity of headache. Headache is either unilateral or bilateral.

Cluster headaches are one of the most painful cyclical headaches. Pain is often around the eyes and patient may wake up often in the middle of the night. Headache is unilateral like migraine headache. Cluster period of attack may last from weeks to months. In between attacks patient may pass through remission period of months to year. It is one of the rare types of headache.^[3]

Migraine patients with a history of frequent auras or cluster headaches may exhibit history of aura in 14% cases.

TIA is transient lack of blood supply to brain for very short period of time and may not induced brain damage or serious ischemia. But, if sustained for longer time may cause brain injury or stroke because of lack of blood supply (ischemia) to brain tissue. Persistent and frequent TIA may result in brain injury or stroke. TIA symptoms are brief and similar to those of stroke.^[4] TIA is often a warning sign indicating a person is at risk for severe stroke. Headaches with auras may also increase the risk for eye retinal damage (retinopathy). Aura-related headaches may affect the small blood vessels in the brain and the eyes, thereby increasing the risks for stroke and retinopathy.^[5] Cluster headaches are rare, affecting less than 1% of the population.

Pathophysiology causing these events and how they relate to cluster headaches are still unclear.

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Also Read:

• What is Headache or Cephalalgia
• Pathophysiology of Headache
• Signs and Symptoms of Headache
• Tests to Diagnose Headache
• Treatment for Headache