Symptoms of Migraine Headaches
Pain Intensity Evaluation:
- Mild - Barely noticeable.
- Moderate - Does not interfere with work or activities.
- Severe - Distracts from work or activities.
- Very Severe - Difficult to maintain normal activities.
- Incapacitating - Unable to concentrate, needs to go to emergency room or see physician immediately.
Headache Symptom Frequencies and Durations
- Low frequency headaches last less than 15 days in a month.
- High frequency headaches last more than 15 days.
- Short duration headache last less than 4 hours.
- Long duration last more than 4 hours.
Diagnosis Based On Frequency And Duration
1. Low frequency and long-duration headaches:
2. High frequency and long-duration headaches:
- Chronic migraine.
- Chronic tension-type headache.
- New daily persistent headache.
- Hemicrania continua.
3. Low frequency and short duration headache:
- Episodic cluster headache (not trigger by cough, exercises)
- Valsalva or headache trigger by cough, exercises or Valsalva
4. High frequency and short duration headache:
- Chronic cluster headache.
- Chronic paroxysmal hemicrania.
- Hypnic headache.
- SUNCT syndrome.
- Valsalva or headache trigger by cough, exercises or Valsalva.
Type of Headache Based on Age and Gender
- Young adults of age around 40 - More often cluster headache.
- Male - More common cluster headache, 2 - 3 times more often than women.
- Women aged 60 or more - Migraine headaches is influence by fluctuations in estrogen and other female hormones in females.
Type of Headache Based on Lifestyle and Personal History
- Nicotine Dependent (smoker) - Cluster headache.
- Alcohol Abuse - Cluster headache.
- Professional stress - Tension headache and cluster headache.
- Red Wine- Cluster headache.
- Discontinuation of smoking or drinking alcohol does not eliminate attacks of headache once it is established.
Type of Headache Based on Medical History
- Eyes Swollen and lacrimation - Cluster headache.
- Running nose and lacrimation - Cluster headache.
- Aura - Migraine.
- Headache after Physical Activities - Migraine.
- Bilateral Headache - Tension headache.
Type of Headache Based on Family History and Genetic Factors
Cluster and migraine headaches tend to run in families, suggesting a genetic component may be involved in some cases. About half of people with migraine headache have a personal or family history of migraine. Studies have reported that about 15% of patients have both kinds of headache.
Type of Headache Based on Head Injury
- Primary Headache - Cluster headache.
- Secondary Headache - Bleeding: epidural, subdural or cerebral bleeding, fracture skull.
Type of Headache Based on Sleeping Disorders
Cluster headaches have been observed during specific sleep stages. Sleep disorders such as sleep apnea and narcolepsy tend to follow by cluster headache or migraine headache. Patient unable to sleep (insomnia) commonly tend to suffer with cluster or migraine headache. Sleep hypoxia secondary to sleep apnea may be triggering physiological events causing cluster headache during sleep. Sleep hypoxia triggered cluster headache may continue its symptom behavior during daytime mostly during late afternoon. Most of the patient with history of sleep apnea causing cluster headache had responded well for treatment such CPAP (continuous positive airway pressure ventilation). Sleep study is extremely important investigation in-patient with history of cluster headache that is not responding for medication treatment.