Case history
Case history #1
A 37-year-old woman presents with a 12-year history of episodic headaches. She experiences these 4 times a week, typically beginning at the end of a workday. The pain is generalized and described as similar to wearing a tight band around her head. The headaches are bothersome, but not disabling, and she denies any nausea or vomiting. She is slightly sensitive to noise but has no photophobia. Pain during her attacks typically responds to ibuprofen. Examination reveals tenderness of her scalp and both trapezius muscles.
Case history #2
A 56-year-old man presents with a 25-year history of constant headache. The onset was insidious and he is quite certain that the only time he is headache-free is when he sleeps. He states the headache is generalized and his neck and shoulders are always "tight". He denies any associated autonomic symptoms including eye tearing, nasal congestion, light and sound sensitivity, nausea, or vomiting.
Other presentations
Patients may also complain of multiple headache types, such as both migraines and tension-type headaches (TTHs). TTH may be another manifestation of migraine, with pain from the migraine being referred to the back of the neck. For example, a patient may have a migraine that begins with a TTH and then becomes unilateral, pulsatile, and associated with nausea and photophobia. Conversely, a migraine may develop into a TTH with suboccipital pressure-like pain and bitemporal squeezing pain. Many consider TTHs in those with migraines to usually represent mild migraines.
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