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Key Questions for Dr. Courtney Seebadri-White, MD on the Topic of Beginner’s Guide to Headache Types (Migraine World Summit- Day 1)
Migraine World Summit- Day 1
Key Questions:
What is the difference between primary and secondary headache disorders?
Primary headache disorders arise from dysfunction of the nervous system itself, not as a symptom of another underlying condition. Secondary headache disorders occur due to another medical cause like brain lesions, trauma, vascular problems, etc.
What proportion of headache conditions are primary headache disorders?
Primary headaches are more commonly seen in outpatient settings, whereas in urgent care/ER settings, secondary headaches are more prevalent.
Which primary headache types are the most prevalent?
The four main primary headache types discussed are:
- Migraine (and its subtypes like chronic, menstrual, vestibular)
- Tension-type headache
- Cluster headache
- New daily persistent headache (NDPH)
How is a treatment plan affected by the diagnosis of primary vs. secondary headache?
For primary headaches, treatment focuses on managing symptoms and reducing attack frequency, as there is no cure. For secondary headaches, treating the underlying cause is the priority.
How are migraine, tension-type headache, and cluster headache differentiated? What diagnostic tests?
There are no definitive diagnostic tests. Differentiation relies on the patient's description of symptoms and characteristics like:
- If resting in a dark room improves symptoms (migraine) vs restlessness (cluster)
- Severity of pain
- Presence of autonomic symptoms like eye tearing/redness (cluster)
- Ability to function during attack (tension-type)
What are some secondary headache types and their main signs/symptoms?
- Idiopathic intracranial hypertension (IIH) - Increased CSF pressure causing headache, visual issues, pulsatile tinnitus
- Spontaneous intracranial hypotension (SIH) - Low CSF pressure, orthostatic headaches, cognitive/visual disturbances
- Post-traumatic headaches after head/neck injury
- Headaches from vascular causes like stroke, hemorrhage
- Headaches from metabolic disturbances like hypertension, dehydration
How critical are proper diagnoses and which professionals can make them?
Accurate diagnosis is extremely critical but very challenging due to overlapping symptoms. Primary care can diagnose some primary headaches initially. Neurologists are trained in headache diagnosis/management. Headache specialists are most qualified for complex, refractory or unclear cases.
When should a patient seek specialized care?
Patients should seek neurologist/headache specialist evaluation if their primary headache disorder is not responding adequately to treatments from their primary care provider, or if there are concerning/unclear features in their presentation.
