Headache Quiz: Cluster Headache, Triggers, Orofacial Pain

Question 1: Cluster Headache

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Answer

D.Osmophobia

According to the International Classification of Headache Disorders, 3rd edition, cluster headache is classified as a trigeminal autonomic disorder. Signs of cluster headache include short attacks of 15 to 180 minutes, severe unilateral orbital, supraorbital or temporal pain, along with autonomic symptoms including tearing, conjunctival injection, rhinorrhea/nasal congestion, and restlessness.

Migraineurs may experience various sensitivities, including osmophobia (increased sensitivity to odors)' phonophobia (increased sensitivity to sound); and photophobia (increased sensitivity to light).

See: Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2013 Jul;33:629-808.

Question 2: Triggers

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Answer

A. True

A recent review and meta-analysis found that caffeine can enhance the efficacy of over the counter analgesics. However, research also suggests that some migraines may be triggered by caffeine withdrawal, and that complete abstinence from caffeine, following a staged cessation and elimination approach, may be beneficial in migraine prevention.

When used excessively, caffeine-containing analgesics may also increase the risk of medication overuse headache and/or chronic migraine.

See: Lipton RB, Diener HC, Robbins MS, et al. Caffeine in the management of patients with headache. J Headache Pain. 2017;18:107.

Question 3: Orofacial Pain

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Answer

D. Orthodontics

Orthodontics have not been proven to be beneficial in relieving the pain of temporomandibular joint disorder (TMD). NSAIDs like Naprosyn are often used in orofacial disorders to decrease pain associated with inflammation. Physical therapy can be beneficial in patients with TMD, especially when combined with an occlusal splint (also called a night guard).

Techniques like relaxation, biofeedback, postural exercises, passive stretching, and active exercises can improve joint mobility and decrease pain. Tricyclic antidepressants like amitryptiline are often used for tension type headache in chronic TMD.

See: Graff-Radford SB, Bassiur JP. Temporomandibular disorders and headaches. Neurol Clin. 2014 May;32(2):525-37. doi: 10.1016/j.ncl.2013.11.009. Epub 2014 Feb 28.