3 Headache Diagnosis

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From the course by University of Minnesota

Preventing Chronic Pain: A Human Systems Approach

93 ratings

University of Minnesota

Preventing Chronic Pain: A Human Systems Approach

93 ratings

Chronic pain is at epidemic levels and has become the highest-cost condition in health care. This course uses evidence-based science with creative and experiential learning to better understand chronic pain conditions and how they can be prevented through self-management in our cognitive, behavioral, physical, emotional, spiritual, social, and environmental realms. The goal of this course is to blend creative, experiential, and evidence-based teaching strategies to help participants understand chronic pain conditions and how a human systems approach can be applied to self-management strategies to reduce risk factors, enhance protective factors, and prevent chronic pain. There are four major objectives to the course; 1. Describe the prevalence, personal impact, and health care dilemma associated with chronic pain. 2. Recognize the clinical characteristics and underlying etiology of several common pain conditions and the peripheral, central, and genetic mechanisms of chronic pain 3. Based on the literature associated with risk and protective factors in the seven realms of our lives, learn specific strategies in each realm that can be employed daily to prevent chronic pain and enhance wellness. 4. Appreciate the value of a human systems approach to health care and how it can provide a basis for integrative, interdisciplinary, and individualized care to preventing pain and enhancing wellness. CONTINUING EDUCATION CREDIT OPTION Accreditation Statement: University of Minnesota, Interprofessional Continuing Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. American Medical Association (AMA) The University of Minnesota, Interprofessional Continuing Education designates this enduring material for a maximum of 24.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. American Nurses Credentialing Center (ANCC) This activity is awarded up to 24.0 ANCC contact hours. Other Health Care Professionals Other health care professionals who participate in this CE activity may submit this certificate statement of participation to their appropriate accrediting organizations or state boards for consideration of credit. The participant is responsible for determining whether this activity meets the requirements for acceptable continuing education. Registration and disclosure information is available here at http://z.umn.edu/chronicpain and pay the additional fee. Then, email your Coursera certificate statement of completion to cme@umn.edu.

From the lesson

Common Pain Conditions and their Mechanisms (Week 4)

1 What You Can Do to Prevent Headaches: An introduction 2:25

2 Understanding Your Headache 8:41

3 Headache Diagnosis 6:43

4 Headache Triggers and Contributing Factors 5:45

5 What About Muscle Dysfunction? 7:26

6 Transformation of Episodic to Chronic Heachache 18:44

7 Managing Headaches: An individualized treatment plan 8:23

8 Treatment Planning: Simple to complex 6:55

Last Scroll: The Vacation v25:22

Meet the Instructors

Dr. James Fricton, DDS, MS
Professor and Pain Specialist
University of Minnesota, HealthPartners Institute, and Minnesota Head and Neck Pain Clinic

Now that we've covered a little about the

epidemiology and classification of headache, I'd like to

start talking about the characteristics of individual headaches

and how do you make a headache diagnosis.

The first headache I'd like to talk about is, tension type headache.

This is by far the most common type of headache.

Occurs in 90% of adults.

It's not typically aggravated by activity.

It's usually described as a steady dull ache.

Sometimes pressure.

It's non-throbbing.

And as you can see by this headache sufferer, some people describe

it as a tight band, or even a cap-like sensation on the head.

People often have this sense of tension or fatigue and the headache pattern

tends to wax and wane throughout the day or from day to day.

Migraine is just a little bit different.

Migraine is almost like an event as opposed to

a tension type headache that kind of waxes and wanes.

A migraine almost seems like it's an event and

it often is unilateral but it can be bilateral.

It can be preceded by.

What's known as an aura which lasts up to typically around 20 minutes.

Headache pain usually peaks over minutes sometimes it takes a

couple of hours and headaches tend to last a couple hours to even a couple of days.

There are a number of associated

symptoms with migraine headaches including sensitivity

to light, sound and some GI symptoms such as nausea and occasionally vomiting.

What's unique about migraine is that it is somewhat aggravated by activity and people

like to sleep and recover which could be helpful sometimes in the diagnosis.

Just to cover the aura a little bit.

This is a image right here you can see of the, of one of the visual components of.

This one has a visual aura.

And this is either we call fortification spectrum.

A bright light, holes in the vision that occur.

These gradually come on over five to 20 minutes.

Sometimes the, the spot will start small and gradually become bigger and bigger.

And it may or may not be associated with a headache.

Some people actually have the aura and never.

Actually experience the headache.

And in terms of auras visual, are

much more common than sensory or motor symptoms.

And occasionally people have much more complex auras that involve language, and

even brain stem problems, such as dizziness, or imbalance.

Or even a coma as part of that whole picture.

I think it's important to understand a little bit at the overlap of headaches.

This is when we look at people that are

undiagnosed having migraine what are they giving as your diagnosis.

And you can see here a tension type headache.

And sinus headache are two of the most common other

diagnosis that people are given that really have migraine headaches.

And you say well why is that and when we look at sinus,

Symptoms, they usually project to the exact same

areas of the head that migraines project to

50% of people with migraine describe association with weather changes.

And 45% of them have associated sinus symptoms such as

congestion, runny nose, postnasal drip as part of the migraine headache.

And it's just part of the autonomic outflow that's associated with a migraine.

And how about with tension headaches?

You can see that most migraineurs describe tension and tightness in their neck.

And it's.

Probably the most common associated symptom

is that stiff neck associated with migraine.

Stress and anxiety are big triggers for both tension type headaches and migraine.

And migraine is bilateral.

In about 40% of people.

And so, it almost seems like it could be a tension type headache.

But what's important, and when you look at the spectrum

of migraine, there are people that have migraine without aura.

There are people that have migraine with aura.

There are people that have a headache that kind of sounds like a tension

type headache, and there are people that

have headaches that sound like sinus headache.

And there are even people that have what we call, migrainous

types of headaches, that really don't fit any of those categories,

but they all respond to Tryptins, which are the, a medication

that treats the physiology or the mechanism of a migraine headache.

And so, when we talk about migraine, sinus

headache, or tension headache, they are all triptan responsive.

What happens if you're a person that has what sounds like an, an episodic tension

type headache, but it, never ever, ever

had a headache that sounds like a migraine?

Well if you give a, a Tryptin to a

person with just an episodic tension headache, it doesn't work.

You really need to have the physiology.

The brain chemistry of a migraine to have

kind of, where your episodic headache becomes Tryptin responsive.

So, just as a review on a few of important

diagnostic considerations, there's no single

criterion necessary, sufficient for the diagnosis.

15% of patients do have a neurological aura with migraine.

You don't have to have GI.

Symptoms to be diagnosed with migraine.

Vomiting occurs in less than 1 3rd of people.

About 40% of people have bilateral pain in migraine,

and 50% of the time the pain is non-throbbing.

A good, important clue is that recurring moderate to severe headache

is migraine until proven otherwise, especially if it seems to occur in events.

And is improved by sleep.

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