California
Medical Clinic
for Headache
Common
Migraine (Migraine without Aura)
This is the most common of the migraine headache. 80% of people with migraine experience this type of migraine headache attack. It is characterized by an attack frequency of typically 1-3 times per month but may be more frequent and certainly may be less. It is a moderate to severe headache which may be debilitating precluding the patient from being able to function and work and may confine them to bed until the headache pain and symptoms are lessened. The headache may last from 4-72 hours in duration, shorter sometimes in children and sometimes longer in a few patients. 60% of migraine pain is experienced on one side of the head and 40% of patients have them on both sides or throughout the head. The pain of migraine headache is usually described as throbbing and worsened with movement. Most migraine sufferers prefer to lie quietly and still, not moving and certainly not exerting themselves. Most migraine sufferers experience nausea, some experience vomiting and most will describe sensitivity to light and sound, movement and sometimes odors. A minority of migraine sufferers might experience some numbness or tingling somewhere on their body during the attack. Most migraine sufferers want to be in a quiet, dark place, without commotion or activity around them. They want to sleep if possible. Migraine can awaken the patient in the middle of the night, early in the morning or start at any time. They frequently occur following a stressful event, in response to a trigger such as a food, emotional stimulus either good or bad, weather changes, alcohol, medications and many other factors depending upon the individual.
Classical
Migraine (Migraine with Aura)
The Classical migraine attack begins with a visual disturbance referred to as an aura. It is a very dramatic, sometimes colorful display of shimmering lights often compared to the Aurora Borealis (Northern Lights). It usually begins either in the periphery or in the central visual field and migraines slowly outward. It lasts usually 20 to 45 minutes and then dissipates, followed by the headache described above (Common Migraine). Sometimes, patients will experience the Aura without a headache following. This is referred to as Ophthalmic migraine.
Ophthalmic
Migraine ( Migraine Aura without Headache)
This is a very dramatic, sometimes colorful display of shimmering lights often compared to the Aurora Borealis (Northern Lights). It usually begins either in the periphery or in the central visual field and migrates slowly outward. It lasts usually 20 to 45 minutes and then dissipates. It can produce a complete obscuration of vision in which the patient must stop doing what they are doing and wait for the visual disturbance to pass because then truly cannot see. Sometimes they may experience an almost complete blindness except for a “rim” of vision around the aura. Some will also describe a sensation of tunnel vision.
This is a migraine headache associated with neurological symptoms similar to stroke. The patient might experience numbness, sensory loss, weakness or paralysis of the face, trunk, arm or leg typically on one side of the body. They might also have speech and language disturbances. The neurological symptoms may come and go throughout the attack or they may last for the duration of the attack. A migraine sufferer who has never experienced this type of migraine and then has one must contact their doctor or go to the nearest emergency room. The most important feature of this condition that establishes the diagnosis of hemiplegic migraine is recurrence of attacks that are stereotypical; that is they occur with the same symptoms followed by resolution each and every time. Otherwise it is important to rule out a stroke or other neurological condition when this occurs for the first time.
This is a migraine attack characterized by dysfunction of the nerves that innervate the eye so symptoms include double vision, closure of the eye lid and of course headache. It may last days or weeks even. This is a very rare condition.
This is a migraine attack characterized by headache associated with symptoms of dysfunction of the brainstem. This might include, behavioral changes, double vision, dizziness, vertigo, loss of vision, alteration in consciousness, inability to balance or walk. It is a rather uncommon form of migraine but one that is important to recognize. A person who is experiencing these type of symptoms for the first time must consult their doctor or go to an emergency room for evaluation.
This is the “garden variety” headache that nearly everyone has experienced at one time or other in their life. It might occur infrequently or frequently. It is a dull to moderate headache that usually involves both sides of the head or is felt throughout the head. It is pressure like, gripping or squeezing in character and not usually associated with nausea or vomiting, light or sound sensitivity. It is uaully responsive to over the counter pain relievers. It might occur in response to hunger, stress, to much or too little sleep, boredom or any number of other factors. Patients with this type of headache usually do not consult a doctor as they occur so infrequently at times or are easily explained by some factor the patient experienced. However, some patients note the increasing frequency and intensity of this type of headache and the frequent nature of this headache might bring them to the doctor for evaluation. When this type of headache occurs more often than 14 days per month it is called Chronic Daily Headache. Evaluation and treatment of this headache disorder is important. Using too much over the counter medications can lead to stomach ulcers, liver damage, kidney damage or bleeding and bruising.
This condition is characterized by a frequency of headache which can be mild, moderate or severe, occurring on more than 14 days per month and usually is daily or almost daily. Most patients evolve into this condition sometimes over week, months and most often years. In most cases it is treatable and controllable.
There are 2 types of Cluster Headache (CH). Episodic (80%) and Chronic (20%). The headaches are the same in each type. The headache is severe and incapacitating. It is always located on only one side of the head, most often behind the same eye and into the temporal region and sometimes in the back of the head on the same side. The pain is described as constant and boring rather than throbbing. It is frequently unrelenting and lasts usually 30-90 minutes in duration. Although these patients do not usually experience nausea or vomiting, light or sound sensitivity with the headache, they do experience tearing and either nasal stuffiness or watering from the nose also on the side of the headache. During a severe cluster attack the patient is unable sit still or lie down. Rather they tend to feel irritable and either pace around the room, sit in a chair and rock or writhe in pain. The pain of CH is one of the worst described pains in medicine. Episodic CH is characterized by periods of headache during which patients will have 1-3 attacks per day, daily (sometimes more) for 2 weeks to 3 months followed by a remission period of weeks, months or years. Those with chronic CH do not experience the remission periods.
The medical literature is replete with headache diagnoses, most of which are variants of those headaches described above. For example there is Post-Traumatic headache which occurs following trauma either to the head or neck and may persist for days, weeks or months and in some cases for years. Paroxysmal Hemicrania is a condition similar to cluster headache but the attack durations are typically shorter and more numerous in a 24 hour period. Hemicrania continua is a constant one sided headache which may be associated with cluster headache like features as well. Trigeminal Neuralgia although not typically a headache disorder is head or facial pain condition characterized by jabs of pain, burning pain, electrical pain shocks and aching pain in a particular distribution on the head and face.