Caring for Face Pain and Sleep Apnea
Rich Hirschinger, DDS, MBA
Diplomate American Board of Orofacial Pain
9615 Brighton Way, Suite 323
Beverly Hills, CA 90210
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Primary Headaches on One Page

A primary headache is defined as a headache without any other cause such as a tumor, a stroke, systemic diseases, etc. There are four categories of primary headaches, which are:

  1. Migraine
  2. Tension-type headache (TTH)
  3. Trigeminal Autonomic Cephalalgias (TACs)
  4. Other

The following are some crazy mnemonics that Dr. Hirschinger created as an easy way to teach orofacial residents how to remember the various criteria for the primary headaches. There are variations of these headaches but what follows below is the classical definition of each headache as defined by the International Headache Society criteria

1. Migraine 5472 PUMA PPNV ACE

5472 = History of 5 headaches lasting between 4 and 72 hours
PUMA = at least 2 of 4: Pulsating, Unilateral, Moderate to severe, Aggravation with exertion or the avoidance thereof.
PPNV = at least 1 of 2 (1) Photophobia and Phonophobia (2) Nausea and/or Vomiting
ACE = remember to ask about Aura. Chronic = 15 or more headaches/month. Episodic = less than 15 headaches/month

2. Tension-type headache (TTH) 307 Almost the exact opposite of migrainegentle-jaw-tmj-muscle-stretching.png

A. At least 10 episodes of headache occurring on an fulfilling criteria B-D:
Infrequent: <1 day/month on average (<12 days/year) ​
Frequent: At least 10 episodes of headache occurring on 1-14 days/month on average for >3 months (≥12 and <180 days/year)
Chronic: Headache occurring on ≥15 days/month on average for >3 months (≥180 days/year)
B. Lasting from 30 minutes to 7 days for infrequent and frequent. Chronic lasts hours to days, or is unremitting.
C. Headache has at least two of the following characteristics:

1. bilateral location
2. pressing/tightening (non-pulsating) quality
3. mild or moderate intensity
4. not aggravated by routine physical activity such as walking or climbing stairs

D. Both of the following:

1. no nausea or vomiting. Chronic can report mild nausea. 
2. no more than one of photophobia or phonophobia

The gentle jaw is very effective in helping treat tension-type headaches.*

3. Trigeminal Autonomic Cephalalgias (TACs) Quarter to 3, 2:30, 1:10, greater than 3 months. The headache must be one sided and meet the criteria below:

3.1 Cluster: Quarter to 3 = 15 minutes to 3 hours. Must have an autonomic sign and/or restlessness/agitation.
3.2 Paroxysmal hemicrania: 2:30 = 2 minutes to 30 minutes. Must have an autonomic sign and/or restlessness/agitation.
*Responds absolutely to therapeutic doses of indomethacin.
3.3 SUNCT/SUNA: 1:10 = 1 second to 10 minutes. Must have an autonomic sign. SUNCT both conjunctival injection and lacrimation (tearing)*. SUNA only one or neither of conjunctival injection and lacrimation (tearing)*. *Ipsilateral to the pain.
3.4 Hemicrania continua: greater than 3 months Must have an autonomic sign and/or restlessness/agitation.
*Responds absolutely to therapeutic doses of indomethacin.

4. Other primary headache disorders - MRI is required.

"I was stabbed, I became numb, I coughed, I had exertional sex outside at a cold picnic, where I heard persistent thunder.”

4.1 Primary cough headache (headache due to coughing) = coughed
4.2 Primary exercise headache (headache occurs during exercise) = exertional
4.3 Primary headache associated with sexual activity (headache occurs at or before orgasm) = sex
4.4 Primary thunderclap headache = thunder
4.5 Cold stimulus headache (headache due to consuming something cold) = cold
4.6 External-pressure headache (headache due to hat, headband, goggles, ponytail, etc.) = outside
4.7 Primary stabbing headache (sharp stabs in temporal region lasting a few seconds) = stabbing
4.8 Nummular headache (headache in temporal region the size of a half dollar) = numb
4.9 Hypnic headache (headache occurs at the same time during sleep) = picnic
4.10 New daily-persistent headache (NDPH) (patients can recall time, day, and what they were doing when the headache started) = persistent

Here is a link to a downloadable PDF of the Primary Headaches on One Page, which you are free to share as long as the document remains unedited. 

*Dr. Hirschinger is the inventor of the gentle jaw®, a passive stretching device for treatment of acute and chronic TMJ and muscle pain. gentle jaw is "yoga for the jaw®."​