Chiropractic OnLine Today Presents: Headaches An Analysis
Chiropractic OnLine Today Presents: Headaches. We have all experienced a throbbing, pounding sensation in our heads at some point. But what exactly brings about this uncomfortable sensation? Are they indicators for our bodies? This month, Chiropractic OnLine Today begins an ongoing investigation into the types, causes and treatments of headaches.
According to the CIBA Clinical Symposia on Headaches (volume 22, number 2, 1981), nearly 42 million Americans seek the opinion of a physician for the relief of their headache. This issue, Chiropractic OnLine Today presents an introduction (or in some cases, a review) of headaches. Future issues of Chiropractic OnLine Today will examine specific types of headaches in greater detail, but for this issue, the goal is to simply present an overview.
(Please note: While Chiropractic OnLine Today presents this overview, it is strongly recommended that the practitioner review the current literature for the most recent information concerning headaches, and that the patient seek the care of a qualified health care provider)
Seymour Diamond, MD, has devoted his time to the study and treatment of headaches, being the director of the Diamond Headache Clinic. Again citing from the 1981 CIBA Clinical Symposia, Dr. Diamond divides headaches into 3 main groups:
Vascular headaches;
He also mentions a fourth group:
Following is a brief discussion from the CIBA pamphlet of the first three groups. Next, an historic look at the classification of headaches over the years. Finally, a brief summary of news and notes.
Vascular Headaches
Many people suffer from these types of headaches, with Migraine and Cluster headaches representative of this group. While there are various types of migraine headaches, the classic form is represented by an Aura or Prodrome (blurred cloudy vision, flashes of light, etc.) preceding, and sometimes accompanying, the headache. Once the attack occurs, some of the following may occur:
Severe, throbbing headache
Local redness
Pallor
Perspiration
Confusion, poor memory
Speech is in low voice
Vomiting
Cluster headaches are representative of headaches which occur in groups, sometimes several a day, over a period of weeks or months, followed by a remission for a period of time. Some indications of a Cluster headache include the following:
Severe pain behind the eye;
Tearing;
Sweating;
Nasal congestion;
Temporal artery bulging and pulsating.
Muscular Contraction Headaches
These headaches present with the following characteristics:
Intermittent, recurrent or constant head pain
May be located in Forehead, Temples or back of head and neck
Commonly described as "bandlike," "tightness" or "viselike"
Soreness of scalp
Occipital tension
Rigidity of neck
Traction and Inflammatory Headache
Organic diseases may cause headache when the pain-sensitive structures of the head become distended, displaced or involved in an inflammatory process. Masses, such as hematomas, abscesses and tumors are examples of disorders which may cause traction headaches; meningitis and intra- or extracranial arteritis or phlebitis are examples of inflammatory processes.
In 1962, an Ad Hoc Committee on Classification of Headache, from the National Institute of Neurological Diseases and Blindness, proposed a classification scheme for diagnosing headaches. The presented their paper in the Journal of the American Medical Association (JAMA) in 1962. They felt that "a useful scheme for the classification of the varieties of headache is one based on pain mechanisms." Readers are referred to the reference listed below for a more in-depth explanation.
JAMA CLASSIFICATION:
Table View
Non-Table view
The Ad Hoc Committee's Classification scheme was utilized until 1988. At this time, in an effort to improve reliability of diagnosis, the International Headache Society (IHS) established their own committee to develop criteria to classify headaches. This classification system was published in 1988, that provided specific criteria in an effort to assure greater consistency and reproducibility of headache diagnosis.
The IHS classification system, while generally accepted, has also caused some debate. The reader again is urged to see the reference for the IHS classification, listed below, for an explanation about utilizing their diagnostic criteria.
At least 5 attacks fulfilling criteria below
Duration 4-72 hours:
At least 2 of the following:
At least 1 of the following:
At least 10 attacks fulfilling criteria below
Duration 30 minutes to 7 days
At least 2 of the following:
Both of the following:
At least 5 attacks fulfilling criteria below
Severe unilateral orbital, supraorbital and/or temporal pain
lasting 15-180 minutes without treatment.
At least one of the following on the painful side:
Frequency: 1 every other day to 8 per day
Pain in the neck and occiput; may project to forehead, orbits,
temples, vertex, or ears
Pain precipitated or aggravated by special neck movements or
sustained neck posture
At least one of the following:
Radiological evidence of at least one of the following:
As mentioned earlier, there is some debate in the literature concerning these IHS classifications. For example, in a study entitled CLASSIFICATION OF DAILY AND NEAR-DAILY HEADACHES: PROPOSED REVISIONS TO THE IHS CRITERIA (Headache 1994; 34:1-7), the authors state that the IHS classification is not comprehensive, for there is a large subset of patients with daily headache who are not well classified.
In another study, THE DIAGNOSIS OF HEADACHE IN PRIMARY CARE: FACTORS IN THE AGREEMENT OF CLINICAL AND STANDARDIZED DIAGNOSES (Headache 1994; 34:138-142), the authors stated: "Primary care physicians need to be aware that migraine and tension-type headache frequently co-exist."
Chiropractic OnLine Today has presented a brief overview of various methods of classifying headaches. This article touched lightly on a few of the types of headaches found in patients. Readers are urged to seek references listed below, along with other sources, for a complete understanding of the clinical entity known as headaches.
If you suffer from headaches, seek help. The Internet has become a resourceful arena for discussion groups who suffer from headaches. If you would like to subscribe to the Headache List-Serve, send a message to the following address:
LISTSERV@SHSU.edu
In the body of the message, type
SUBSCRIBE Headache "Your E-Mail address"
For more information concerning Chiropractic's treatment of headaches, CLICK HERE.
2) Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain. Cephalalgia 1988; 8 (Suppl. 7): 19-28;
3) Ad hoc Committee on the Classification of Headache. Classification of headache. JAMA 1962; 179: 717-718.