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First establish if headaches are primary or secondary variants
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As long as physicians have been treating patients, headaches have been – well, quite frankly – a headache. As far back as the Neolithic era, physicians grappled with the concept of headache. Then, headaches were believed to have been the result of bad spirits, and treatment involved boring holes in the skull to release said spirits. Fortunately, medicine has grown significantly over the past 5,000 years, now electing to perform craniotomy in a much more select group of patients.
That being said, headaches remain enigmatic, impacting a wide demographic, with quite varied presentations and often requiring multiple therapies. Given the plurality of headaches, it’s easy to understand why they are so challenging for all medical specialties, optometry included.
Headache is the most common type of pain reported by the population at large. It is also among the most common reasons individuals miss work or school and seek medical care. Given the widespread nature of headaches, attempts to differentiate and classify headache pain have been nearly impossible. In fact, The International Headache Society has identified more than 150 different types of headache. So, where do we begin in pinpointing the nature of one’s headache? This is an especially important consideration if we’re being asked to provide patient consultation by another medical colleague.
From an optometric perspective, the key differential is to establish whether the headache is a primary or secondary variant. The vast majority of headaches are primary, entities in and of themselves, and not associated with an underlying condition. Tension, migraine, cluster and eye strain headaches are all primary and, while each can be debilitating, they are generally not a harbinger of more serious disease. Secondary headaches, on the other hand, are an extension of an underlying pathology and can be indicative of tumor, aneurysm or pituitary apoplexy, for instance.
While we have grown dependent on technologies such as imaging, which can be invaluable in working up the headache sufferer, nothing replaces a detailed history. Asking the right questions and allowing a detailed answer often narrows the differential significantly. In this month’s Primary Care Optometry News, our feature article, “Compile a complete case history for patients with headache” provides exceptional advice on differentiating primary vs. secondary headaches. I’m confident that it will not only help you more effectively manage patients’ headaches but will likely mitigate headaches of your own.
- Reference:
- The International Classification of Headache Disorders, 3rd ed. Cephalalgia. 2018;doi:10.1177/0333102417738202.
Editor’s note:
While I traditionally reserve my editorial comments to clinical content, I’d like to momentarily digress to recognize and congratulate Nancy Hemphill, ELS, FAAO. Nancy recently celebrated her 30th anniversary with SLACK Inc./Wyanoke Group. During her distinguished career, she has provided editorial expertise across many medical specialties, ranging from infectious disease to gastroenterology. Most of us, however, recognize Nancy as the Editor in Chief of Primary Care Optometry News, a publication she helped launch in 1996. Nancy’s expertise, sage guidance and tireless efforts have been instrumental in PCON’s growth over the years. While her journalistic accomplishments are too numerous to list, it is worth mentioning Nancy’s fellowship in the American Academy of Optometry – a true testimony of her commitment to our profession. She is the consummate professional and an exceptional ambassador for optometry. Please join me in congratulating Nancy for her tremendous accomplishments and for reaching such an exceptional milestone!