Comparison of Clinical Characteristics of Migraine and Tension Type Headache

Article excerpt

Byline: Ravi. Gupta, Manjeet. Bhatia

Context: Migraine and tension type headache (TTH) are two most common types of primary headaches. Though the International Classification of Headache Disorders-2 (ICHD-2) describes the diagnostic criteria, even then in clinical practice, patients may not respect these boundaries resulting in the difficulty in diagnosis of these pains. Materials and Methods: This cross-sectional study involved 50 subjects in each of the two groups - migraine and TTH - after screening for the inclusion and exclusion criteria. Diagnosis was made according to the ICHD-2 criteria. Their clinical history was taken in detail and noted in a semi-structured performa. They were examined for the presence of a number of factors like pericranial tenderness and muscle parafunction. Statistical analysis was done with the help of SPSS v 11.0. To compare the non-parametric issues, chi-square test was run and continuous variables were analyzed using independent sample t test. Results: In general, migraineurs had progressive illness (?2=9.45; P=0.002) with increasing severity (?2 =21.86; P<0.001), frequency (?2 =8.5; P=0.04) and duration of each headache episode (?2 =4.45; P=0.03) as compared to TTH subjects. Along with the headache, they more commonly suffered orthostatic pre-syncope (?2 =19.94; P<0.001), palpitations (42%vs.18% among TTH patients; ?2 =6.87; P=0.009), nausea and vomiting (68% vs. 6% in TTH; ?2 =41.22; P<0.001, and 38% vs. none in TTH; ?2 =23.45, P<0.001, respectively), phonophobia (?2 =44.98; P<0.001), photophobia (?2 =46.53; P<0.001), and osmophobia (?2 =15.94; P<0.001). Their pain tended to be aggravated by head bending (?2 =50.17; P<0.001) and exercise (?2 =11.41; P<0.001). Analgesics were more likely to relieve pain in migraineurs (?2 =21.16; P<0.001). In addition, post-headache lethargy was more frequent among the migraineurs (?2 =22.01; P<0.001). On the other hand, stressful situations used to trigger TTH (?2 =9.33; P=0.002) and muscle parafunction was more common in TTH patients (46% vs. 20%; ?2 =7.64; P=0.006). All the cranial autonomic symptoms were more common in migraineurs as compared to TTH subjects (conjunctival injection: ?2 =10.74, P=0.001; lacrimation: ?2 =17.82, P<0.001; periorbital swelling: ?2 =23.45, P<0.001; and nasal symptoms: ?2 =6.38, P=0.01). Conclusion: A number of symptoms that are presently not included in the ICHD-2 classification may help in differe-ntiating the migraine from the TTH.

Introduction

Headache is an important accompaniment with a number of psychiatric illnesses. [sup][1],[2],[3],[4] It has been also reported that in subjects with moderate to severe depression, it is more likely to progress toward chronification. [sup][5] Hence, psychiatrists tend to see a number of headache patients and exact diagnosis is required for the proper management of the patient. Though the International Headache Society had proposed clear criteria for differentiating them, in clinical conditions it may sometimes be very difficult to differentiate between them. [sup][6],[7] A number of factors defying the International Classification of Headache Disorders-2 (ICHD-2) criteria pose obstacles, for example, the migraine may be bilateral, may not be having classical pulsating pain during the acute attack, and may be sometimes devoid of nausea, vomiting, phonophobia and photophobia. [sup][6],[8] On the other hand, tension type headache (TTH) may present with throbbing pain, phonophobia, nausea, vomiting and may be unilateral. [sup][8],[9]

In addition, migraine pain usually takes time to evolve and initial features of its attack may mimic that of TTH and dilemma worsens further with the use of analgesics. [sup][8]

Attempts have been made to clinically differentiate migraine from TTH in the past. These studies assessed the factors that are not included in ICHD-2. Unalp et al. reported that TTH in adolescents presents with temporal pain and there is a frequent history of TTH in siblings while migraineurs show more school absenteeism. …