Differentiating Headache Types, Diagnostic Clusters and Red Flags

The International Headache Society defines migraine as attacks of 4 to 72 hours, often unilateral and pulsing, aggravated by activity and with nausea or sensitivity to light and sound. Tension-type headache is bilateral, pressing and not aggravated by activity. Cervicogenic headache is side dominant without side shift, starts in the neck and is less severe, but many patients have more than one headache type. No single test identifies cervicogenic headache. Palpation of the upper cervical spine reproduced headache in all but one of 34 people with migraine or tension-type headache, so a positive palpation alone is not enough. Gwen Jull's cluster of reduced neck extension, painful upper cervical palpation reproducing headache and poor performance on the craniocervical flexion test separates cervicogenic headache from other types and correlates with anesthetic blocks. A case of a dentist with daily left-sided headache and medication overuse leads into screening for yellow and red flags. Following Lucy Thomas, three of five features, including age under 55, recent minor trauma or infection, new dizziness and focal neurological signs, signal possible cervical artery dissection.