0:00
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>> Now I want to briefly mention tension-type headache
because this is this is arguably the most
common type of headache that's say, not associated
with having the flu or some other similar disorder.
and, and again, many of you can probably relate to this type of headache.
This is taken again from the International Headache Society criteria.
Tension type headaches are defined as headaches that are lasting from
30 minutes to 7 days, they can be episodic or chronic.
They have to have at least 3 of the
follow a bilateral as opposed to unilateral in migraine.
Pressing or tightening non-pulsating quality
compared to pulsating and migraine.
Mild or moderate intensity rather than moderate or severe
intensity migraine and not aggravated by routine physical activity.
So you can see that these
are components that just fall shy of the
kinds of symptoms that we described before in migraine.
Also, no nausea, vomiting, photophobia or
phonophobia and not attributed to another disorder.
Again incredibly common, and the treatment, these are treatments that
actually most people are able to figure out fairly easily.
Stress management, counseling again simple medications, such as
aspirin and non-steroidals.
Bio feedback has sometimes been shown to be effective.
And for the more severe and chronic types of
tension type of headaches, anti-depressant or anxiolytics can be useful.
1:38
So Mister Hackett can you tell me why you came into the hospital.
I'm experiencing headaches, and for like for the
past 3-4,5 days, you know, straight in a row.
>> Mm hm.
>> You know they come at the same time and it's kind of making it worse.
[UNKNOWN].
>> [INAUDIBLE] They come in every day, you know?
>> What, what time do they come on? >> Around
10:30, 10:35 they come around and they stay around for about an hour.
>> Mm-hm.
>> You know? >> Are they pretty severe?
>> Yeah very much so. >> Uh-huh.
Where, where's the pain?
>> The pain starts like up here and, and works you know, right this
way like this, and just shoots up like on this side of my face.
>> Mm-hm.
That's it.
>> Does anything happen to your eye or your face?
>> Yes.
My eye turns red and it, and it feels like it's going to fall out of face,
out of my head, you know. It's awful.
It's, you get this tears and everything else.
>> Mm-hm. Does it occur during the day time at all?
>> No. >> Uh-huh.
So over the last 5 days, you've had these
headaches pop up everyday, the same time, only at night?
>> At night. That's right.
>> Uh-huh.
>> Have you had, have you ever had a headache like this before?
2:47
>> Yes.
I have before. >> Oh.
So are these new headaches or old headaches?
>> These are old headaches.
>> Old headaches.
And, and why, why do you mean? When did
you have them last? >> Well last was was November.
>> Mm-hm.
>> And then it's going all the way back to like 1972.
>> Oh really, what happened in November?
>> November the the [INAUDIBLE] arrived there around 9, it
was about 9:39, 40, something like that, they came on.
They woke me up out of my sleep and then
they just, just just took me up to this peak.
>> Mm-hm.
And how many days did it occur in November?
>> 3 days. >> Uh-huh.
And so when you say these have happened before, did they always seem to
come together in groups of a couple nights and then you're free for awhile?
>> Yeah.
>> And how, how much, how long might it be that you're free from a headache?
>> Maybe a month. Maybe maybe a month, maybe less.
>> Mm-hm.
>> It's maybe a month, maybe I think 2 months.
>> I see, okay.
And have you noticed anything that makes it better?
3:43
>> yeah.
Well, nothing really makes it better, but you know like, I can easily.
I've, I've, I've taken the [INAUDIBLE].
>> Mm-hm. >> And, and it eases, eases the pain.
It doesn't take it away. >> Mm-hm.
>> But.
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>> Well I don't think you'll find a
better description of the experience of having cluster headaches.
This, this gentleman really provided you with all the, the the
classic symptoms that usually occurs in men ages 20 to 50.
It's characterized by unilateral periorbital pain, this kind
of like ice pick behind the orbit pain.
It has this remarkable circadian rhythmicity.
This patient's
headaches were occurring between about 10:30 and 10:35 at night,
every night while the headaches occurred lasting about an hour.
They oftentimes have autonomic symptoms or redness
or tearing of the eyes on one-side.
They can be quite sensitive to alcohol and the reason they're named cluster headaches
is because the attacks cluster over time and this is depicted here in
again our cartoon of the time course of headaches.
A cluster headache fairly abrupt onset usually at the same time of night or day
and the headache usually last only the, only an, an hour or a couple of hours.
And importantly, if you look at it over
the larger time scale, these individual daily circadian
headaches come in clusters of, of 3, 4, 5 or 6 over the course of a number of days
and then there's this delayed period, sometimes many, many weeks
or even months before another cluster appears and so forth.
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The treatment of cluster headache again as in all
these cases, I'm not going to go into any detail.
I just want
to have you appreciate the various approaches that can be used.
The Triptan drugs can be useful.
Prednisone during that short period of time
when the patient knows that they're at
risk of having successive headaches as part of the cluster, can be very useful.
Calcium channel blockers, Ergots, oxygen therapy often times at night
Lidocaine and Lithium have all proven to be quite effective in selected patients.
Daniel Lowenstein, MDProfessor and Vice Chair, Department of Neurology
S. Andrew Josephson, MDAssociate Professor
Wade Smith, MDProfessor
