Cluster, Tension and Migraine Headaches Differentiation

Bebe Babbit is a 27-year-old female patient who experienced frequent headaches lasting for the past several months. Symptoms of a persistent and worsening headache started to occur more frequently and lasted for longer periods. She experienced vomit, nausea; blurred vision, light and sound irritated her, while a problem disappeared only during sleep. Physical examination of the patient showed no damages to the brain; temperature and blood pressure appear to be satisfactory. Bebe’s headaches could be provoked by the stressful environment, related to graduate school and waitressing job as well as family history of headaches. Considering all information gathered during the examination, it is critical to differentiate the condition among a cluster headache, tension headache or a migraine headache.

A cluster headache is a rare headache disorder that can be characterized by short but severe headaches. Its symptoms are easily identifiable: “recurrent attacks of unilateral pain, usually involving the orbital and periorbital region, associated with local autonomic symptoms on the same side” (Voiticovschi-Iosob et al., 2014, p1). Other symptoms include watery eyes and running nose. It often occurs with a seasonal pattern. Since Bebe’s symptoms are described differently, cluster headache is eliminated.

A tension headache is usually characterized by muscle contraction around the neck and head. A patient might feel tightness and pressure in these areas. Tension headaches are less harmful as they do not necessarily interrupt the daily activities, does not affect vision, breathing or blood pressure. It can occur because of stress, hunger, consumption of alcohol or other environmental factors (Kaniecki, 2015). A tension headache is eliminated for the same reasons: main symptoms do not include vomit, nausea, and blurred vision.

A migraine headache is found to be one of the most common neurological disorders accompanied with severe headaches. Primary symptoms include sensitivity to light and sound, nausea and vomiting (Diener, Solbach, Holle, & Gaul, 2015). Often migraine is diagnosed late because people do not pay attention to mild headaches. Therefore, migraine headaches without proper treatment can quickly become chronic. In the case of Bebe, she has experienced stable-character headaches and other apparent symptoms of a migraine. The goal of migraine treatment is to improve the quality of life by reducing the amount of a headache and other symptoms. Treatment for a migraine usually consists of preventive therapy and acute therapy. The latter provides a “rapid and definitive relief” (Antonaci et al., 2016, p.2). Oral intake of non-specific drugs is the primary acute therapy treatment for a migraine.

They include OTC drugs like aspirin, paracetamol. Among other drugs proven to be effective are acetylsalicylic acid, ibuprofen, diclofenac, metamizole and more. However, with often headaches, people tend to overuse these drugs, and the effect becomes less tangible. There are also specific anti-migraine drugs which are more effective and act longer but have greater adverse effects. For instance, various types of triptans are considered to be highly effective (Antonaci et al., 2016). The treatment plan depends on the patient, intensity of headaches, tolerability, and availability. Effective drugs are also used for prevention: Calcitonin Gene-Related Peptide has been proven to be useful in the prevention of a migraine (Lauritsen &Silberstein, 2016; Mitsikostas & Reuter, 2017). However, some researchers also suggest spinal rehabilitative exercise and manual treatment for prevention of migraine attacks (Bronfort et al., 2015).

Thus, Bebe Babbit is diagnosed with migraine headaches. She can be prescribed the triptan drugs depending on her tolerability. Manual treatment and CGRP could be used for preventing migraine.

References

Antonaci, F., Ghiotto, N., Wu, S., Pucci, E., & Costa, A. (2016). Recent advances in migraine therapy. Springerplus, vol. 5, 637. Web.

Brønfort, G., Evans, R. L., Goldsmith, C. H., Haas, M., Leininger, B., Levin, M., … Westrom, K. (2015). Spinal rehabilitative exercise and manual treatment for the prevention of migraine attacks in adults. Cochrane Database of Systematic Reviews, 8. Web.

Diener, H., Solbach, K., Holle, D., & Gaul, C. (2015). Integrated care for chronic migraine patients: Epidemiology, burden, diagnosis and treatment options. Clinical Medicine, 15 (4), 344–350.

Kaniecki, R. (2015). Tension-type headache. In Diamond S. (Ed.), Headache and migraine biology and management (pp. 149- 161). Oxford, UK: Elsevier.

Lauritsen, C. G, & Silberstein, S.D. (2016). Practical Neurology. Web.

Mitsikostas, D., & Reuter, U. (2017). Calcitonin gene-related peptide monoclonal antibodies for migraine prevention: Comparisons across randomized controlled studies. Current Opinion in Neurology, 30(3), 272-280.

Voiticovschi-Iosob, C., Allena, M., De Cillis, I., Nappi, G., Sjaastad, O., & Antonaci, F. (2014). Diagnostic and therapeutic errors in cluster headache: A hospital-based study. The Journal of Headache and Pain, 15 (56).

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