Types of Headaches for the Physician Assistant Exam

Headaches are a common reason people visit a healthcare provider, and at their worst, headaches can be debilitating. For Physician Assistant Exam (PANCE) purposes, be familiar with migraine headaches, tension headaches, and cluster headaches.

Migraines

Migraine headaches are probably one of the most common forms of headache. Any migraine sufferer will tell you that these headaches are the worst. Migraines tend to affect the frontal and temporal parts of the head. Common presenting symptoms include photophobia and phonophobia. Picture the person lying quietly in a dark room with an acute migraine headache. The acute phase can sometimes last for 48 to 72 hours before dissipating.

Sometimes migraines occur spontaneously without warning, and sometimes they’re accompanied by an aura, a perceptual preview of coming attractions. People may experience visual auras (the scintillating scotoma, for example) or other auras, including certain sounds and smells. One risk factor for migraine headaches is a positive family history.

Treating migraines involves a two-pronged approach: acute treatment to stop the migraines and medications that attempt to prevent the migraines in the first place (that is, migraine prophylaxis). Various medication classes are used to treat an acute migraine headache. Two common examples are the ergotamine derivatives and the triptans. Medications used to prevent migraines include beta blockers such as propranolol (Inderal) and calcium channel blockers.

Tension headaches

We live in a world of stress. Stress and tension can manifest in many ways, including headaches. Tension headaches, unlike migraine headaches, occur more in the back of the head. The tension headache is a steady ache that won’t go away.

It’s often described as pressure, squeezing, or a vise-like headache. The acute headache can be treated with NSAIDs; ibuprofen is a common med. Muscle relaxants such as cyclobenzaprine (Flexeril) can also be used. Other modalities include exercise and stress management.

Clustering headaches

The cluster headache, also known as the suicide headache because the pain is so severe, occurs predominantly in middle-aged men. The cluster headache usually presents as an acute lancinating pain behind the eye. It can be debilitating. The headaches often occur in cycles that become predictable.

A person can experience several headaches each day for as little as a week to as long as several months. These headache episodes are separated by pain-free intervals of time. Note that the duration of these pain-free intervals can vary from person to person. Other symptoms can include ptosis and increased eye tearing. The treatment can include 100 percent oxygen and steroids.

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