Headaches and Dizziness
Introduction[edit | edit source]
Headaches and dizziness have numerous causes and there are many different types. This page will explore some of the key types of headaches and causes of dizziness that may be encountered in clinical practice, as well as highlighting red flags and other signs / symptoms which warrant referral.
Headache Classification[edit | edit source]
Headaches are grouped into three main areas:[1]
- Primary headaches
- Secondary headaches
- Neuropathies, facial pain and other headaches
Primary Headache[edit | edit source]
Primary headaches are the most common headache type.[2] These headaches, which include migraines, tension headaches, trigeminal autonomic cephalgias, and other primary headache disorders.[3][1] They are not caused by other anatomical or physiological abnormalities. Nor are they related to inflammation or infections.[2]
Migraine[edit | edit source]
Migraine is a recurrent headache disorder which affects around fifteen percent of the population aged 22-55 years.[4] It generally begins in childhood to early adulthood although it can start later in life for some perimenopausal / menopausal women.[3] It is estimated that ten percent of children experience migraines.[5] It affects women more than men.[4] As it tends to run in families, it is considered a genetic disorder.[4] It has significant personal and economic effects[1] and is listed as the sixth most prevalent out of 328 diseases and injuries assessed in the Global Burden of Disease Study from 2016.[6]
Migraines are characterised as recurrent episodes of headaches associated with visual or sensory symptoms.[3] In some cases of migraine, a headache will occur with no warning signs and resolve with sleep.[4] However, sometimes prior to migraine, patients will experience a prodromal phase, with symptoms such as fatigue, euphoria, depression, irritability, food cravings, constipation, neck stiffness, increased yawning, and / or abnormal sensitivity to light, sound, and smell.[4] Migraines can also present with transient hemiplegic episodes. These cases require further medical investigation.[3]
Migraine headaches are usually unilateral, have a pulsating quality and are aggravated by activity. They last from a few hours up to a few days.[4] Migraines in children are generally bilateral frontal temporal headaches. It has been considered a red flag symptom if they occur in the occipital region,[3] but this has been disputed in some recent research.[7]
Migraines can occur with or without aura.
- Migraine without aura: will generally last from four to 72 hours. Typically, pain is unilateral and of a moderate to severe pulsing type and it is aggravated by physical activity. Nausea, vomiting, photophobia, and phonophobia often accompany it[1][3]
- Migraine with an aura: an aura refers to a sensory or neurological symptom that occurs before the migraine starts. It is usually visual - typically some type of a zigzagging crescent shape formation that occurs in the visual field,[3] but it can also refer to sensory and / or speech or language symptoms. There is no motor weakness and it develops gradually. Each symptom typically lasts no longer than an hour[1]
- ↑ 1.0 1.1 1.2 1.3 1.4 International Headache Society. International Classification of Headache Disorders (ICHD-3). Available from https://ichd-3.org/classification-outline/ (accessed 7 September 2020).
- ↑ 2.0 2.1 Manzoni GC, Stovner LJ. Epidemiology of headache. Handb Clin Neurol. 2010;97:3-22.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Dent D. Headaches and Dizziness Course. Physioplus. 2020.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Burstein R, Noseda R, Borsook D. Migraine: multiple processes, complex pathophysiology. J Neurosci. 2015;35(17):6619-6629.
- ↑ Rao R, Hershey AD. An update on acute and preventive treatments for migraine in children and adolescents. Expert Review of Neurotherapeutics. 2020. Published online.
- ↑ GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17(11):954-976.
- ↑ Genizi J, Khourieh-Matar A, Assaf N, Chistyakov I, Srugo I. Occipital Headaches in Children: Are They a Red Flag?. J Child Neurol. 2017;32(11):942-946.
