Approach To The Patient With Chronic And Recurrent Headache

Primary Headache Disorders

Migraine , tension-type headache, cluster headache, and chronic daily headache represent
the overwhelming majority of headache seen in primary care. Chronic daily headache is more
common in referral-based practices specializing in headache.
Table. Characteristic of benign recurrent headache disorders
characteristic Migraine Tension-type
headache
Cluster Chronic-daily
headache
Age at onset 10-30 y Any age Middle age 3
rd
-4
th
decade
Sex F > M F > M M > F F > M
Duration 4-7 h 30 min-7 day 15-80 min Constant or
nearly constant
Frequency Variable Occasional to
daily
At least daily for
week to month
Daily or constant
Time of day Any time Later in day Nocturnal constant
Quality Pulsatile Dull, aching,
band like
Severe, boring Variable
location Retro orbital,
temporal, hemi
cranial or
holochepalic
Bilateral,
temporal or
occipitonuchal
Unilateral, retro
orbital
Variable
Associated
symptoms
Nausea,
vomiting, photo
phobia, phono
phobia, with or
without
neurologic
accompaniment
Other symptom
rare, associated
with stress in
episodic form
Ipsilateral
autonomic
symptoms
Migraine history,
analgesic abuse
and
psychopathologic
condition
common

1. Migraine
Migraine is now accepted to be a neurogenic disorders due to disturbed function of the
trigemino vascular system rather than a primary abnormality of blood vassels. Therefore
recent IHS classifications no longer refer to migraine as migraine headache of the
vascular type.