Cognitive behavioural therapy for posttraumatic headaches
Birgit Gurr in Headaches and Mild Brain Trauma, 2021
The therapy philosophy shifts from directly managing the head pain initially, via explorations of challenges, towards value-driven lifestyle improvements. The proposed headache programme can be delivered in the form of one-off headache clinics, as well as individual and/or group therapy interventions. Individual therapy sessions increase opportunities for tailoring therapeutic strategies exactly to the patient’s situation and headache experience. Group interventions offer the benefit of interactions and support between peers. The pace and the structure of sessions for five to eight participants can make a real difference for people who otherwise might struggle with low motivation or self-doubt. Headache therapy sessions are supplemented by participants practising their developing skills between sessions. The semi-structured guideline that follows facilitates the narrative assessment of headache symptoms and contextual factors on the basis of a cognitive behavioural approach.
Classification and diagnosis of headache
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby in Headache, 2018
Headache, like back pain or abdominal pain, is a symptom that can have many causes. Since a range of disorders can produce headache, a systematic approach to headache classification and diagnosis is an essential prelude to its management and treatment. In 1988, the International Headache Society (IHS) instituted a classification system that has become the standard for headache diagnosis, particularly for clinical research. For the primary headache disorders, the IHS criteria provide a descriptive system that classifies headaches based on their symptom profiles. Because many headaches follow typical pain patterns, pain localization at onset and the pattern of spread assist diagnosis. Pain severity and the rapidity of onset and resolution are important diagnostic clues. Migraine pain is characteristically throbbing or pulsatile, but it often begins as a dull, steady ache that slowly evolves; it may not acquire a throbbing quality until the pain becomes moderate or severe in intensity.
Migraine: diagnosis and treatment
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby in Headache, 2018
Many famous individuals from the worlds of arts and sciences have suffered from migraine headaches. Formal diagnostic criteria for migraine and other headache disorders were published by the International Headache Society (IHS) in 1988; however, these remain a guide and have a well-recognized group of false-negatives. This chapter describes the migraine attack and its variants and their acute and preventive treatment based, in part, on the presence of any coexistent or comorbid disease. The typical headache of migraine is unilateral, throbbing, moderate to marked in severity, and aggravated by physical activity. The headache and associated symptoms of migraine with aura are similar to those of migraine without aura. In contrast to a transient ischemic attack (TIA), the aura of migraine evolves gradually and consists of both positive and negative features. Familial Hemiplegic Migraine (FHM) is an autosomal dominant, genetically heterogenous form of migraine with aura with variable penetration.
Recognizing Exercise-Related Headache
Published in The Physician and Sportsmedicine, 1997
Active patients may suffer not only from the common headache syndromes that plague the general population, but also from headache brought on by exercise. Valsalva-type maneuvers can bring on exertional headache; maximal or submaximal aerobic activity can precipitate effort headache. Trauma to the head and neck can lead to posttraumatic headache. Other headache syndromes in athletes include cervicogenic headache, goggle headache, diver's headache, and altitude headache.
Therapeutic options in the management of headache attributed to rhinosinusitis
Published in Expert Opinion on Pharmacotherapy, 2005
Madhavi Gupta, Stephen D Silberstein
Sinus headache is a common diagnosis when patients have facial pain and pressure accompanying their headache. However, acute sinus headache is in fact rare, and the headache must accompany acute bacterial rhinosinusitis (ABRS), a diagnosis which is based both on clinical and radiological evidence. In fact, sinus headache is a misnomer. The only headache related to sinus disease, as recognised by the International Headache Society (IHS), is headache attributed to rhinosinusitis (HARS; section 11.5 of IHS criteria). Many patients who are diagnosed with sinus headache and treated with antibiotics have a primary headache, usually migraine. This is an important distinction and the treatment is very different. This review covers the most recent definitions, epidemiology, pathophysiology, diagnostics and treatment of ABRS and the resulting headache as defined by the IHS.
Sleep apnea headache: a growing concern in an increasingly obese population?
Published in Expert Review of Neurotherapeutics, 2013
Sleep apnea headache is a recurrent universal pressing headache without accompanying symptoms at awakening that resolves within 4 h. The diagnosis requires polysomnography-verified apnea hypopnea index ≥5, that is, obstructive sleep apnea (OSA). Morning headache has similar symptomatology without OSA. The prevalence of sleep apnea headache is 10–15% in people with OSA, whereas morning headache occurs in 5%. The severity of OSA only slightly affects the prevalence of sleep apnea headache. The pathophysiology of sleep apnea headache remains an enigma, since average oxygen desaturation and lowest oxygen saturation are similar in OSA people without sleep apnea headache. Migraine and tension-type headache are unrelated to OSA. Thus, growing concern of sleep apnea headache in an increasingly obese population is unfounded with our current knowledge.
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