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Headache. Need to know.

Updated: Jan 31, 2021

When a patient has more than 15 days a month of headache for at least 3 months, they are considered to have chronic headache. It can be chronic daily headache or chronic migraine.


Approximately 23% of hemicrania continua patients had abnormal findings on neurological examination, which were mainly ipsilateral sensory changes such as decreased sensation of the face.


Primary headaches may include chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. These headaches typically last longer than 4 hours a day.

Primary headaches with shorter periods (less than 4 hours) include chronic cluster headache, chronic paroxysmal hemicrania, hypnic headache, and primary stabbing headache.


The most common finding on examination for chronic headache is muscle spasm, particularly a cervical myofascial pain syndrome found in chronic tension-type headache. This may also be seen in patients with chronic migraine.


Another type of headache that may be accompanied by a neurological abnormality on examination would be idiopathic intracranial hypertension. You may find papilledema or swelling of the optic disc seen in the fundi. These patients may also have visible swelling on a cerebral MRI, possibly with an empty sella or partially empty sella. In addition, they may, on an MRV, have a thrombosus in the sagittal sinus.

References:



Another type of headache that may be accompanied by a neurological abnormality on examination would be idiopathic intracranial hypertension. You may find papilledema or swelling of the optic disc seen in the fundi. These patients may also have visible swelling on a cerebral MRI, possibly with an empty sella or partially empty sella. In addition, they may, on an MRV, have a throm


Essential readings:


American Academy of Neurology. 2012. Headache guide. OA

Evers, S, Afra, J, Frese, A, Goadsby, PJ, Linde, M, May, A, Sandor, PS. 2009. ‘European Federation of Neurological Societies: EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force’. European journal of neurology 16 (9): 968–81. DD


IHS. 2013. ‘The international classification of headache disorders (3rd ed., beta version)’. Cephalalgia 33 (9): 629–808. OA


Mokri, B. 2013.‘Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks’. Headache 53: 1034–53. EZ


Molnár, L , Simon, É, et al. 2014. ‘Postcraniotomy headache’. Journal of anesthesia 28 (1): 102–11. EZ


Rashmi, B, Halker, E, et al. 2011. ‘Chronic daily headache: an evidence-based and systematic approach to a challenging problem’. Neurology 76: s37-s43. OA


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