1

What are the typical pain characteristics of migraine headache?

The migraine headache is unilateral and pulsatile in nature, ranging in severity from moderate to severe and usually worsened by physical activity.

2

What is an aura?

Reversible cerebral dysfunction (abnormal smells, eye floaters, etc.) that develops over 5 (or more) minutes and lasts less than an hour.

3

What is the classic presentation of a migraine headache with an aura?

A migraine headache, usually within 1 hour of an aura.

4

What is the classic presentation of a migraine headache without an aura?

Unilateral, pulsatile headache that can last anywhere from 4 hours to 3 days. There is frequently associated nausea/vomiting and/or light/noise sensitivity.

5

What is the treatment for a mild/moderate migraine headache?

Treatment can be done in a stepwise fashion. For headaches that are mild to moderate (without nausea/vomiting) nonspecific pain medications can be used (e.g., nonsteroidal antiinflammatory drugs [NSAIDs] and/or acetaminophen).

Other nonspecific agents that can be used are dopamine antagonists (e.g., metoclopramide or chlorpromazine). Their greatest effect is in the treatment of nausea/vomiting.

If available, the use of high flow oxygen can be a great adjunct to any treatment decision.

6

What is the treatment for moderate/severe migraine headache?

Migraine-specific medications should be used, such as triptans. These can be given orally, subcutaneously, nasally, or intravenously; they work well alone or in conjunction with nonspecific agents.

7

What are the different types of migraine headaches?

Hemiplegic, basilar, childhood periodic syndromes, retinal migraine, ophthalmologic, vertiginous, nocturnal.

8

What are the main causes of tension headaches?

Any stressor can lead to tension headaches, so it is not surprising that these are the most common type of headache. Other contributing factors are poor posture (especially weak neck extensors), depression, and anxiety.

Any stressor that is not a direct cause of the headache can be a contributing factor by leading to spasm of the neck and scalp muscles.

9

What is the best way to treat tension headaches?

Pharmacologic and stress reduction therapies work well together. In the fast-paced world of urgent care, stress reduction techniques are not a viable option. In the urgent care setting the use of NSAIDs, acetaminophen, and oxygen would be your best options.

10

How can I differentiate a tension headache from other headaches?

If you were to guess a headache was tension type, you would be right most of the time as tension headaches are the most common type of headache.

On physical exam you may also find diffuse scalp or trapezius tenderness.

11

What is the classic presentation of a cluster headache?

Cluster headaches present with unilateral pain (usually around the eye and temporal area) with cranial nerve autonomic dysfunction (tearing, facial pain, etc.).

The cluster headache usually lasts 45 to 90 minutes and is episodic in nature, with these headaches lasting as long as 1 week.

12

What is the best treatment for a cluster headache?

The same medications (triptans, NSAIDs, acetaminophen) for migraines are used to treat cluster headaches, with the best medication being triptans via the subcutaneous route. Unlike migraines, there is more of an emphasis on oxygen for the acute treatment.