Headache Migraine and Tension-Type

Migraine is a common, recurrent, primary headache of moderate to severe intensity that interferes with normal functioning and is associated with GI, neurologic, and autonomic symptoms. In migraine with aura, a complex of focal neurologic symptoms precedes or accompanies the attack. 

Twin studies suggest 50% heritabUity of migraine, with a multifactorial polygenic basis. Migraine triggers may be modulators of the genetic set point that predisposes to migraine headache. 

In selected circumstances and secondary headache presentation, serum chemistries, urine toxicology profiles, thyroid function tests, lyme studies, and other blood tests, such as a complete blood count, antinuclear antibody titer, erythrocyte sedimentation rate, and antiphosphoUpid antibody titer may be considered. 

Acute therapy should provide consistent, rapid headache relief with minimal adverse effects and symptom recurrence, minimal disability and emotional distress, thereby enabling the patient to resume normal daily activities. Ideally, patients should be able to manage their headaches effectively without emergency department or physician office visits. 

Monosodium glutamate (e.g., in Chinese food, seasoned salt, and instant foods) Nitrate-containing foods (e.g., processed meats) 

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Headache Migraine and Tension-Type CHAPTER 53 LABORATORY TESTS ... 

Aspirin and other salicylates are used in the treatment of mild to moderate pain. Aspirin is commonly used to treat headache (including migraine and tension type) and to decrease elevated body temperature. Salicylic acid, as a 10% to 20% solution in alcohol or propylene glycol, is used for the treatment of corns. 

Kaniecki RG. Migraine and tension-type headache An assessment of challenges in diagnosis. Neurology 2002 58(suppl 6) S 15-20. 

Edmeads J, et al. Impact of migraine and tension-type headache on life-style, consulting behavior, and medication use a Canadian population survey. Can J Neurol Sci 1993 20 131-137. 

Characteristics of migraine, cluster and tension-type headaches. 

Tekle Haimanot R, Seraw B, Forsgren L, Ekbom K, Ekstedt J. Migraine, chronic tension-type headache, and cluster headache in an Ethiopian rural community. Cephalagia 1995 15 482-8. 

ADP-ribosylation reactions such as DNA repair, calcium mobilization and deacetylation (Kirkland 2009). In addition, at pharmacological concentrations, niacin is an effective agent for the treatment of dislipidemias and atherosclerosis (Prousky et al. 2011). Furthermore, evidence exists that niacin ameliorates acute migraine, chronic tension-type headaches, depression and schizophrenia (Prousky et al. 2011). This chapter focuses on chemical and biochemical aspects of the vitamin. 

Prevalence rates for a variety of different types of pain have been described. The annual incidence of moderate-intensity back pain is 10% to 15% in the adult population with a point prevalence of 15% to 30%.3 Migraine affects more than 25 million Americans, and 90% of Americans report some other types of headaches (e.g., tension or sinus) each year.4 Pain resulting from fibromyalgia affects 4 million Americans.5 Cancer is commonly associated with both acute and chronic pain, and about 70% of those diagnosed with cancer will experience significant pain.6... 

Primary headaches are classified as migraine, tension-type, or cluster and other trigeminal autonomic cephalalgias. 

Tension-type headache (TTH) is the most common primary headache disorder. It is often underrepresented in clinical practice, as many patients do not present for care.6 The term tension-type headache is used to describe all headache syndromes in which muscle contraction is the most significant factor in the pathogenesis of pain. The 1-year prevalence of TTH in the population ranges from 30% to 90%.6 It is more common in adult females. Environmental factors, as opposed to genetic predisposition, play a more central role in their development. Tension-type headaches can be further divided into episodic or chronic the mean frequency of attacks is 3 days per month in episodic disorders, and chronic TTH is defined as 15 or more attacks in a 1-month period.7 The estimated prevalence of chronic TTH is less than 5%.6 Some researchers believe that chronic TTHs represent a continuum of headache severity with migraine headache.8 When severe headaches are difficult to differentiate clinically, treatment should initially target TTH. 

The International Headache Society classifies headaches into one of 13 categories, ranging from migraine, tension-type, and cluster headaches, to headaches that are not classifiable. Effective headache treatment is thus guided by an accurate diagnosis of the headache type. 

This section covers oral non-prescription medicines for most types of pain, including tension headache, migraine, sinusitis, dental pain and musculoskeletal pain. Treatment for dysmenorrhoea pain is covered in Chapter 31. 

Premonitory symptoms and aura are absent with tension-type headache. The pain usually is mild to moderate in intensity and often is described as a duU, nonpulsatile tightness or pressure. Bilateral pain is most common, but the location can vary (frontal and temporal pain are most common occipital and parietal regions also may be affected). The pain is classically described as having a hatband pattern. Associated symptoms generally are absent, but mild photophobia or phonophobia may be reported. The disability associated with tension-type headache typically is minor in comparison with migraine headache, and routine physical activity does not affect headache severity. Palpation of the pericranial or cervical muscles may reveal tender spots or localized nodules in some patients. Tension-type headache is classified as either episodic (infrequent or frequent) or chronic based on the frequency and dmation of the attacks. ... 

Besides lymphocytes, other blood cells express an ECS that plays an important role in human pathologies. For instance, in platelets isolated from humans with headache, Cupini et al. (2006) found an increase in the activity of FAAH in two groups of headache subjects migraine without aura (MoA) or episodic tension-type headache (FTTH) patients. In particular, this FAAH dysfunction was found in female but not male migraineurs. Furthermore, in a recent paper it has been reported a decrease of AEA and 2-AG levels in other two types of headache disorders (Rossi et ah, 2007). 

Currently, there is no specific abortive treatment for a tension-type headache (TTH). Self-medication constitutes the most common treatment. Among headache sufferers, 91% of TTH and 90% of migraine patients use non-opioid, over-the-counter analgesics, which are often taken without any other form of treatment and without consulting a physician. A community-based... 

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