Headaches and Migraines


Primary headaches : migraine, tension type, cluster, chronic daily 

Secondary headaches : meningitis, brain tumour, cerebral aneurysm, subdural hematoma 

Tension headaches


  • Bilateral
  • dull aching
  • diffused with sensation of tight band around head


  • massage
  • acupuncture

Chronic Daily headaches

Headaches that occur 15 days or more in a month, can be from med overuse, migraines, post-traumatic 


  • Trigeminal nerve is activated

The initial vasoconstriction followed by vasodilation of blood vessels increases pressure within cranium eliciting pain from the blood vessels and meninges 

Triggers: some food, abnormal levels of stress, change in sleeping patterns 


  • Migraine with aura :
    • symptoms last 4-72 hours
    • unilateral, pulsating,
    • moderate to severe
    • aggravated by activity
  • Migraine without aura 
    • most common 
    • Pain is pulsating, throbbing
    • Unilateral typically
    • Sensitivity to light 
  • Ophthalmoplegic migraine
    • Rare
    • Transient paralysis of cranial nerve 3 – oculomotor 
  • Hemiplegic migraine
    • Rare
    • Sudden hemiparesis accompanied by aphasia and confusion


  • Avoid triggers 
  • Pharmacological – SSRIs
  • Cluster headaches
  • When several attaches occur in a day for a period of days, weeks or months followed by remission 
  • Episodic and chronic 


  • Sudden
  • Severe
  • Unilateral
  • Unrelenting pain in orbital, temporal, supra orbital and infra orbital 
  • Lasts 30 minutes to 2 hours 

Head Injuries


  • MVA
  • Falls
  • sports injury
  • violence


Primary head injuries

Caused directly by injury ; concussion, contusion, laceration


Momentary interuption of brain function with or without loss of non-consciousness


  • post-concussion syndrome
  • irritability
  • insomnia
  • poor concentration

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