OROFACIAL PAIN

What are different types of headaches?

Give their clinical features, differences and management in tabulated form.

Answer:
- A headache is any continuous pain in the head. There are many different types of headaches,
but the three main types are migraine, cluster headache and tension-type headache:

Clinical
Migraine Cluster headache Tension-type headache
features/differences
Unilateral, centered over
Unilateral, temporal, occipital orbital region with Bilateral, may affect frontal
Site or frontal muscles extensions to occipital or temporal muscles
maxilla/temporal area
Slightly more common in Men are more affected
Gender females (9:1 ratio)
Women are more affected

May occur in children and

Age 2nd – 3rd decades Less than 20 years of age adolescents but peak
prevalence at > 35 years of age

Severe throbbing or pulsating Mild-moderate pain, feeling of

Nature of pain pain
Severe episodic pain
tightness/constriction
30-180 minutes, severe
Can last from 30 minutes up to
Duration of pain Hours-days (4-72 hours) enough to wake patient
7 days
from sleep

Alcohol and vasodilators Overwork, fatigue,

Stress, certain foodstuffs,
Precipitating factors family history
but may also occur menstruation, emotional crises,
spontaneously alcohol

‘Aura’ phase, consisting of

Prodromal phase visual disturbances, speech No such aura phase No such aura phase
problems, numbness

Sensitivity to light, smells and Autonomic symptoms:

Other associated
noise; nausea and vomiting lacrimation, nasal No such symptoms
symptoms often occur congestion

Migraine Cluster headache Tension-type headache

Management
- Avoid precipitating factors
- First line drug for acute
attack: paracetamol,
aspirin or other NSAID
- Anti-emetic if patient is
nauseated/vomiting
- 5 HT1 agonists i.e.
sumatriptan
- Prophylaxis using beta
blockers e.g. propranolol
and 5 HT1 agonists e.g.
pizotifen
- Bed rest in quiet, dark
room
- Use of nocturnal acrylic
occlusal splint is advocated
by some who experience
migraine upon waking up
or shortly after waking up
- Avoid precipitating - Avoid trigger factors
factors - Improve sleep pattern
- Therapy of choice is - Increase exercise
subcutaneous - Use relaxation techniques
injection of or other stress-coping
sumatriptan strategies
- Often responds well - Attacks can be alleviated
to anti-migraine using analgesics such as
drugs paracetamol, aspirin or
- Bed rest NSAIDs
- Tri-cyclic antidepressants
may be helpful in
conjunction with cognitive
and behavioral approaches
- Avoid caffeine-containing
drugs