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. [SOUND] [BLANK_AUDIO]
