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Headaches come in many varieties, all of which have symptoms that may vary slightly from one another.
Primary headaches (including
migraines,
Cluster Headaches
and tension-type of headaches) are a result of neurochemical changes within the nervous system.
Secondary headaches result from underlying causes, such as post-traumatic injuries,
brain tumors
, changes in intracranial
pressure(N), infections, drugs, etc.
Many systemic
disorders(N)
and diseases, along with their usual symptoms, can be associated with headaches. Some of these
disorders(N)
include hypertension
, anemia(N),
hypothyroidism,
heart(N)
disease, lung disease,
high Blood Pressure , sleep
disorders(N),
arthritis(N), and AIDS.
The challenge of identifying the type of headache that
you are suffering can be approached by understanding the history of the headache. Important features
include character of pain(N)
(dull, sharp, etc.), location of
pain(N), temporal aspect of
pain(N) (time of day, duration), associated factors, environmental exposures,
and presence or absence of neurologic symptoms (numbness,
tingling,
weakness, etc.). When such information about the headache is available,
it will point toward a particular type of headache that will require a specific therapy for that
pain(N).
Most Primary Headaches are due to factors that trigger
neurochemical changes within the nervous system.
1.
Migraines
- Recurring one-sided headaches that are sometimes accompanied by
nausea,
vomiting, sensitivity to light, sound, throbbing
pain(N)
, and blurred vision. The
pain(N)
experienced is usually moderate to severe in intensity, pulsates, and is aggravated by physical activity.
2. Cluster Headaches
- Usually last about 20 minutes to 2 hours and may recur at the same time of the day. They cause
pain(N) behind one eye,
and possibly redness, tearing, and
nasal congestion on the involved side. They usually are not accompanied by
nausea or photophobia, which distinguishes them from
migraine headaches.
3. Tension-type headaches - Due to muscle tension and contraction, which can be
Stress or non-
Stress related. They may last 30 minutes to 7 days, and be only mild to moderate in
pain(N)
intensity, with pain(N)
in both sides of the head. Generally, no
Nausea or photophobia is present, and the headache is not aggravated by
physical activity.
Secondary Headaches are a result of an underlying cause, including:
1. Post-traumatic injuries or concussion - headache may be accompanied by
vertigo or light-headedness, lack of energy, poor concentration and memory,
or irritability.
2. Changes in intracranial pressure
(e.g. brain hemorrhage,
subarachnoid hemorrhage). Both low and high
pressure(N)
in the head may cause pain(N)
, usually on both sides of the head.
nausea,
vomiting,
Dizziness, and blurred vision may accompany moderate to severe headache.
3. Intracranial infection (e.g.
meningitis) -
pain(N) is experienced on both sides of head, due to inflamed meninges
(membranes that normally cover the brain and spinal cord).
4. Cerebrovascular disease,
including infarction, brain hemorrhage (ruptured aneurysm), and arteritis
(inflammation of the brain arteries or other structures in the head or neck, e.g.
temporal arteritis
). Inflammatory causes such as arteritis may be
pain(N)ful; but
Stroke
is usually without complaints of headache.
5.Brain Tumors
- less than 1% of people with headaches have
brain tumors
; that is, most of the time, people with
brain tumors
are without headaches. Symptoms include increased intensity of
pain(N),
lack of response to analgesics, aggravation of headache due to cough or
sneezing, anorexia,
nausea, and
vomiting.
6. Sinus or ear infections - localized
pain(N)
to the affected area, possibly with
fever and discharge. Applying
pressure(N)
to the affected sinus may cause or reproduce the
pain(N).
7. Licit and illicit drug use, abuse or withdrawal - a headache may occur:
a) during withdrawal,
or going "cold-turkey" on substances including caffeinated beverages and
pain(N)
medications;
b) after a sustained period of in-take of a specific drug, the drug becomes no
longer effective and seemingly begins to contribute or worsen your headache. This is called a
"Rebound headache";
c) when there is a vasodilatation of blood vessels
(increased diameter of the artery) in the brain due to the use of medications,
such as nitrates, which cause a mild to moderate diffused headache.
8. Exertion due to
exercise(N),
straining, or sexual intercourse (coital headaches occur around the time of intercourse,
and last from minutes to hours).
9.
Eyestrain(P), which is associated with prolonged staring at a TV, computer screen or
reading.
10. Systemic infections (e.g.
flu
, common cold
, AIDS), which may be accompanied by headache,
fever, loss of appetite, or diarrhea.
11. Metabolic and systemic disorders
(e.g. diabetes(N)
,
thyroid diseases, etc.) yield variable symptoms with organ dysfunction and
lab abnormalities.
12. Temporomandibular Joint Syndrome (TMJ) is brought on by motion of the jaw
and tenderness of the joint, which may cause headache on the side affected.
13. Neuralgias (nerve
pain(N)) and related
conditions such as shingles
infection, may produce sharp
pain(N) in the head following a specific distribution of an affected nerve.
Lips, gums, cheek, and chin may be affected.
14. A headache due to Indigestion,
especially stress-related
indigestion, causes frontal, throbbing headaches. Relaxing or sleeping after
taking antacids such as Mylanta or Maalox can relieve it. Massaging the
stomach area, or putting a hot pack on the abdomen also will relieve the
indigestion
, as well as the headache.
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A headache occurs when nociceptors, or
pain(N) sensing nerve endings, are triggered by
Stress, muscular tension, or the dilation of blood vessels. The areas of the head that contain nociceptors are
the scalp, face, mouth, throat, muscles of the head, and blood vessels at the base of the brain. The bones of the skull and tissues of
the brain do not contain nociceptors.
Nociceptors transmit a message to the deep structures of the brain, which receives
the signal and detects where the pain(N) has originated.
Involved in this pathway of signal transmission are many
chemicals known as neurotransmitters, which include
epinephrine, serotonin, histamine, gamma-aminobutyric acid
(GABA), glutamate, beta-endorphin, enkephalin, substance P,
bradykinin, neuropeptide Y, dopamine, acetylcholine,
norepinephrine, and many others. Many scientists believe that
most headaches occur due to the alteration in levels and
functioning of some of these chemicals.
More recent theories suggest that some headaches, particularly
migraines
, may occur when blood vessels overreact to various triggers, such as a certain foods or beverages, bright lights, odors,
anxiety, or weather changes.
This causes spasms that close and severely constrict several arteries supplying oxygen-rich blood to the brain and the areas nearby. As the arteries narrow, blood clotting(N) elements, such as platelets, clump together - a process that is believed to release serotonin (a brain neurotransmitter).
Serotonin acts as a powerful constrictor of arteries, further reducing the blood supply to the brain. In response to this reduction of oxygen-rich blood, other arteries within the brain dilate (open wider) to meet the brain's required oxygen and energy levels. The dilation of arteries leads to the release of pain-producing substances called prostaglandins and other chemicals that cause inflammation and swelling, and increase sensitivity to pain(N) by stimulating the nociceptors. This vicious cycle of events results in a headache and other symptoms associated with migraines and,
potentially, other types of headaches.
Most headaches are diagnosed and treated without diagnostic tests or a specialist. Generally, a history and physical exam point to the right diagnosis. Some persistent and enigmatic headaches may require neurological imaging, such as MRI and or neurological consultation.
The assessment of a headache sufferer should start with the physician taking a complete history of the patient's condition. It should include when the headache occurs, where they occur, how often, what aggravates and what retriggers them. Identifying the trigger factors may be helpful in treating and preventing further attacks.
Examples of some triggers are:
- Emotional: family problems, work related problems, career changes, anticipation , anxiety.
- Stress: strenuous physical exercise(N) or work, illness, too much or too little sleep.
- Environmental: bright lights, perfume, tobacco, loud noises, changes in altitude, weather, or barometric pressure changes.
- Chemical: menstrual changes, low blood sugar.
- Medication use
- Food and beverages: hard cheese(N), hot dogs, chocolate, nuts, food additives such as monosodium glutamate, wheat, sugar, or milk products.
- Digestion problems
The evaluation then continues with a very thorough neurological exam and a detailed examination of the head and neck including scalp, blood vessels, eyes, ears, sinuses, temporomandibular joint, teeth, and the bones and muscles of the neck, shoulders and upper back.
If a diagnosis is uncertain, a number of tests can be useful, such as:
- Blood tests - may include a complete blood count; a reading for levels of electrolytes, sodium, chloride, bicarbonate, potassium including calcium magnesium, and liver enzymes; an analysis of kidney(N) functions (BUN, creatinine levels); and the erythrocyte sedimentation rate.
- Imaging tests - cervical spine X-Rays, sinus X-Rays, head CT scan, and
head and neck MRI may be performed if necessary.
- Lumbar puncture and electroencephalography, only
if necessary.
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Treatment depends on the type and
severity of the headache and includes a wide variety of
medicines ranging from mild over-the-counter painkillers (e.g.
Aspirin, Tylenol, Excedrin, Advil, Ibuprofen, Naproxen, etc.)
to stronger narcotic opiate painkillers (Codeine, Morphine,
Demerol), "tryptans" such as Imitrex for Migraines, and
seizure medications (Valporic Acid). See treatments for
specific headache.
Other treatments include:
oxygen therapy.
Antihypertensive medications such as beta-blockers, calcium channel blockers
Sleep hygiene
Alternative therapies, such as chiropractic manipulation, massage, acupuncture, mind-body therapy, aromatherapy (e.g. peppermint oil extract), herbal remedies (e.g. fever few for migraines; guarana, ginger, gingko or valerian root for milder headaches).
Behavioral therapies, including Biofeedback, guided imagery, relaxation and Stress reduction training.
Nutritional therapies (e.g. use of minerals and vitamins, including Magnesium, riboflavin, vitamin B2, etc.).
Physical approaches, such as regular and frequent aerobic exercise(N).
dietary changes (avoid triggering factors such as chocolate, processed foods, alcohol(N)).
surgical options in refractory cases.
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