In this video we will take a look at the
characteristics and presentation of migraines Get our very own Assessment
Ebook and mobile app! Links are in the video description Hi and welcome back to
Physiotutors! Headaches can manifest on their own but are also a very common
symptom in neck pain patients as more than 60% of patients with a primary neck
pain complaint report of having concordant episodes of headache.
Therefore, it’s essential to find out what kind of headache the patient is
suffering from. To start off let’s differentiate between primary and
secondary types of headaches – but what does that mean?
Simply put, primary headaches are a disease themselves whereas in secondary headaches the headache is a symptom of another condition. So, primary headaches
would be migraines, tension-type headaches and cluster headaches.
secondary type headaches are headaches caused by tumors, hemorrhage, other trauma, TMJ dysfunction, substance overdose or neck pain aka the cervicogenic
headache. Now let’s take a closer look at migraines, which are a primary type
headache. Migraines have mean 1-year prevalence of 11.2% around the world
with women being more often affected than men in an age range between 20 to
50 years Migraines exist in two distinct forms that is either with or without the presence of a phenomenon called aura, but we will get
to that later. In order for a headache to qualify as migraines it has to fulfill
certain criteria: A) there have to have been a minimum of 5 attacks
fulfilling the following criteria: B)the headache lasts from 4-72 hours. The duration is an essential characteristic, because if in an untreated episode lasts
less than 4 or more than 72 hours migraines are excluded. C) the headache
has at least 2 of the 4 following characteristics which are: 1)
it’s a unilateral headache 2) the headache has a pulsating quality 3) it has a moderate to severe pain intensity Or 4) the headache is
aggravated by routine physical activity such as climbing stairs and D) Next to
the headache patients have at least 1 of the following additional symptoms. These
are 1) nausea or vomiting and 2) being sensitive to bright lights and sounds
called photo- and phonophobia respectively. In order for a headache to
be classified as migraine with aura the patient has to present with the
previously mentioned criteria and one or more reversible aura symptoms.
These are disturbances in the following subsystems: visual, sensory, speech motor, brainstem or retina. Imagine vision changes, numbness, dizziness, confusion etc. Furthermore at least 2 of the 4 characteristics have to apply: 1)
at least one aura symptom spreads gradually over more than five minutes
and/or two or more symptoms occur in succession. 2) Each individual aura
symptom lasts 5 – 60 minutes. 3) At least aura symptom is unilateral and 4)
The aura is accompanied or followed within 60 minutes by headache. While aura symptoms resemble those of a CVA they build up much slower over 5 minutes
compared to within seconds in a CVA. Tools you can use to assess the impact
of a headache on your patient are the HIT-6 questionnaire which you can find
in the video description down below. Also note that it can be difficult for a
patient to answer all the questions on duration, intensity and characteristics
of their headache during your assessment. Therefore asking them to complete
something like a headache diary can help in the assessment and management of the headache and you should be aware that there can be an overlap between multiple
headache disorders. Okay in the intro I mentioned that
headaches are quite often associated with neck pain, so be sure to click
on our neck pain guideline playlist on the left. Please check the links in the
video description down below to learn more about ways to support us, such as
our Ebook, app or online course and as always this was Andreas
Physiotutors I’ll see you next time – bye!

5 thoughts on “Migraines”

  1. very helpful as usual….. could you guys please make a video on documentation in physiotherapy ?.. in formats like SOATAP/SOAP. .. just a request…. cheers

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