Headache Episodes

Most of these episodic headaches are diagnosed (correctly) as migraine or tension-type headache.

You need to know whether the head pains are provoked. You also need to know how long each headache episode typically lasts.

Are the Episodic Headaches Provoked?

Causes of Provoked Episodes of Headache:

1. Cough Headache
• This is usually sudden pain on both sides, or on top of the head. It comes on within seconds of coughing.

  It can last seconds only, or up to 30 minutes.

  Between 20-40% will have a structural problem identified on a brain scan. It is one of the reasons where a brain scan is essential for a new headache complaint. Indomethacin can be effective.

2. Exercise Headache
• This is almost identical to cough headache, except they are brought on by exercise - swimming, lifting, bending over or straining.

  About 20% will have a structural abnormality on brain scans called Chiari Malformation.

  Heart Disease can also cause an exercise headache called cardiac cephalalgia

3. Orgasm Headache
• Headache at orgasm is distressing and upsetting.

  This headache is similar to cough headache and exertional headache.

  After a first episode, investigation is required, especially if the headache was explosive in onset - what is known as thunderclap headache.

  Triptan drugs, indomethacin or beta-blockers can help reduce the intensity of the headache in people who have had serious causes ruled-out by investiation.

4. Hypnic Headache
• This is usually a headache of people in the 50+ years age group. Almost every night at around the same time they are woken by an intense, diffuse headache that prevents them from going back to sleep.

  The pain of hypnic headache can be confused for migraine.

  The treatment which seems to work best is Lithium Carbonate. Indomethacin and triptan drugs also have an effect if Lithium is not tolerated or is contra-indicated.

  Lithium should only be adminsitered under medical supervision as it requires monitoring for kidney and thyroid side-effects.

These specific provoking factors should be asked about when people report discrete episodes of headache.

The Episodes of Headache are Unprovoked

1. Duration more than 4 hours per headache
• Episodic Tension-type Headache
• Migraine
2. Duration lasting seconds
• Ice-pick headache
• Occipital Neuralgia
• Supraorbital Neuralgia
3. Duration of minutes, but less than 4 hours
• Cluster Headache
• Paroxysmal Hemicrania

Can be both Provoked and Unprovoked

1. Trigeminal Neuralgia
• This can cause both provoked and unprovoked headache episodes, although the pain, strictly speaking, is actually in the face.

  The provoked episodes are due to touching the face, chewing, brushing teeth, shaving, applying make-up or by a draught or breeze across the face.

  As well as provoked episodes there will unprovoked bursts of severe shooting pain usually into the jaw and cheek, rather than the eye.

2. SUNCT
• SUNCT stands for Sudden Unilateral Neuralgiform headache with Conjunctival injection and Tears. It can be both provoked and unprovoked. The pain is usually in the eye or around the eye. A watery eye which is bloodshot also accompanies the pain.It is difficult to treat - Lamotrigine thought to work best. It is one of the rarest headache disorders known.