February 7, 2017

Headache

Headaches are one of the most common neurological problems presented to GPs and neurologists. They are painful and debilitating for individuals, an important cause of absence from work or school and a substantial burden on society.

A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better by making lifestyle changes, learning ways to relax, and sometimes by taking medicines.

Anyone can experience a headache. Nearly 2 out of 3 children will have a headache by age 15. More than 9 in 10 adults will experience a headache sometime in their life. Headache is our most common form of pain and a major reason cited for days missed at work or school as well as visits to the doctor. Without proper treatment, headaches can be severe and interfere with daily activities. Certain types of headache run in families. Episodes of headache may ease or even disappear for a time and recur later in life. It’s possible to have more than one type of headache at the same time.

Symptoms & Types

There are two types of headaches –

Primary headaches – This occur independently and are not caused by another medical condition. It’s uncertain what sets the process of a primary headache in motion. A cascade of events that affect blood vessels and nerves inside and outside the head causes pain signals to be sent to the brain. Brain chemicals called neurotransmitters are involved in creating head pain, as are changes in nerve cell activity (called cortical spreading depression). Migraine, cluster, and tension-type headache are the more familiar types of primary headache.

  • Tension headaches – These are caused by muscle tension in the shoulders, neck, and head. The tension may  come from fatigue, an uncomfortable body position, or emotional stress. Tension headaches typically begin in the  morning or early afternoon and can get worse during the day. They often involve a tight pressure feeling like a band  around the forehead, but pain may spread over the entire head and downward into the neck and shoulders.
  • Cluster headaches – These types of headaches can be very painful. The intensely sharp pain usually involves one side of the head and spreads around the eye. Cluster headaches start suddenly and generally last about an hour. Attacks come in groups hence the name “cluster” occurring several times a day or each week and continuing for 6 to  8 weeks.
  • Migraine headaches – Often marked by intense throbbing head pain… blurred vision with shimmering light specks, dizziness or nausea, sensitivity to light, sound, or odors. Migraines are certainly a different type of headache.

Secondary headaches – These are  symptoms of another health disorder that causes pain-sensitive nerve endings to be pressed on or pulled or pushed out of place. They may result from underlying conditions including fever, infection, medication overuse, stress or emotional conflict, high blood pressure, psychiatric disorders, head injury or trauma, stroke, tumors, and nerve disorders (particularly trigeminal neuralgia, a chronic pain condition that typically affects a major nerve on one side of the jaw or cheek).

  • Headaches related to high blood pressure – As the blood vessels and circulatory system throughout the body  are affected by high blood pressure, headaches may result. The pain is typified by a throbbing sensation throughout the  head, though the headaches are generally not chronic in nature.
  • Headaches resulting from eye or sinus problems – Sinus congestion or built­up pressure in the eyes due to  glaucoma are examples of the types of physical problems that can occur with your eyes, ears, nose and/or throat that result  in headaches. These headaches will often disappear when the underlying condition is effectively treated.
  • Headaches associated with facial disorders – One such disorder (originally known as temporomandibular joint or TMJ syndrome), now known as myofascial pain dysfunction (MPD), is characterized by a dull aching pain in and  around the ear that is associated with chewing food. The pain may radiate to the side of the scalp causing a headache. Difficulty opening the mouth or a clicking/popping sound in the jaw joint may also be present. Once symptoms are recognized, treatment can be effective.

Causes

Anything that stimulates the pain receptors in a person’s head or neck can cause a headache, including –

  • Stress
  • Muscular tension
  • Dental or jaw problems
  • Infections
  • Diet
  • Eye problems
  • Hormonal influences
  • Medications
  • Disorders of the ear nose or throat
  • Disorders of the nervous system
  • Injury to the head, neck or spine
  • High blood pressure
  • Poor posture – puts unnecessary strain on the muscles of the back and neck
  • Hangover from abuse of alcohol or drugs
  • Temperature – extremes of heat or cold
  • Dehydration – affects blood pressure
  • Noise – especially loud noises
  • Temporal arteritis – inflammation of the artery at the temple, most common in elderly people
  • Arthritis

In rare cases, a headache can be a sign of something more serious, such as:

  • Bleeding in the area between the brain and the thin tissue that covers the brain (subarachnoid hemorrhage)
  • Blood pressure that is very high
  • Brain infection, such as meningitis or encephalitis, or abscess
  • Brain tumor
  • Buildup of fluid inside the skull that leads to brain swelling (hydrocephalus)
  • Buildup of pressure inside the skull that appears to be, but is not a tumor (pseudomotor cerebri)
  • Carbon monoxide poisoning
  • Lack of oxygen during sleep (sleep apnea)
  • Problems with the blood vessels and bleeding in the brain, such as arteriovenous malformation (AVM), brain aneurysm, or stroke

Treatment

Pain reliever — A pain reliever may be recommended first for the treatment of tension type headache. These drugs include –

  • Aspirin
  • Acetaminophen (eg, Tylenol®)
  • Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen (eg, Motrin or Advil), indomethacin, or naproxen (eg, Naprosyn or Aleve).

Pain medicine combinations — Mild pain relievers are also available in combination with caffeine, which enhances the drug’s effect. As an example, Excedrin® contains a combination of acetaminophen-aspirin-caffeine. This combination may be recommended if a pain reliever alone does not relieve the headache. However, this combination is not recommended more than nine days per month due to the potential risk of developing medication-overuse headaches.

Antidepressants — Antidepressant medicines called tricyclics (TCAs) are often used to help prevent frequent tension headaches. Examples of TCAs include amitriptyline (used most commonly), nortriptyline, and protriptyline.

The dose of TCAs used for people with headaches is typically much lower than that used for treating depression. It is believed that these drugs reduce pain perception when used in low doses, although it is not exactly clear how the medicines work.

Other treatments — Tricyclic antidepressants are sometimes used in combination with behavioral therapy to prevent tension-type headaches. The goal of behavioral therapy is to identify and try to avoid behaviors that can trigger a headache. (See ‘Lifestyle changes’ below.)

Alternative treatment

Magnesium – Magnesium plays a vital role in multiple physiologic processes and therefore it is a vital component in a healthy diet. It is absorbed through the gastrointestinal tract (gut), with more absorbed when the internal content is lower. Magnesium also appears to facilitate calcium absorption.

Feverfew (Tanacetum parthenium) – Feverfew (Tanacetum parthenium) is a species in the chrysanthemum family, whose dried leaves have long been used as a headache remedy.

Coenzyme Q10 (CoQ10) – Coenzyme Q10 (CoQ10) is often described as a vitamin, or a vitamin-like substance. CoQ10 is involved in the creation of the important substance in the body known as adenosine triphosphate (ATP). ATP serves as the cell’s major energy source and drives a number of biological processes including muscle contraction and the production of protein. CoQ10 also works as an antioxidant.

Riboflavin – Riboflavin, also known as vitamin B2, is found in small amounts in many foods. It is needed for converting food to energy, and like CoQ10 also works as an antioxidant by mopping up the damaging free radicals.

Butterbur (Petasites hybridus) – Butterbur is a perennial shrub, found throughout Europe as well as parts of Asia and North America. It is usually found in wet, marshy ground, in damp forests, and adjacent to rivers or streams. The common name is attributed to the large leaves being used to wrap butter during warm weather.

Melatonin – There are many reasons melatonin should be beneficial in headache, but no proof exists presently. It has been shown to be useful for insomnia.

Vitamin D3 – Vitamin D deficiency/insufficiency is common and harmful.

Acupuncture – This ancient technique uses hair-thin needles inserted into several areas of the skin at defined points. While the results are mixed, some studies have shown that acupuncture helps reduce the frequency and intensity of chronic headaches.

Biofeedback – Patients might be able to control headaches by becoming more aware of and then changing certain bodily responses, such as muscle tension, heart rate and skin temperature.

Massage – Massage can reduce stress, relieve pain and promote relaxation. Although its value as a headache treatment hasn’t been determined, massage may be particularly helpful if someone has tight muscles in the back of the head, neck and shoulders.

 

Reference –

http://www.mayoclinic.org/symptoms/headache/basics/causes/sym-20050800

http://www.medicalnewstoday.com/articles/73936.php#signs_and_symptoms

http://www.healthline.com/health/tension-headache#Causes2

https://www.wtamu.edu/webres/File/Student%20Life/Medical%20Services/Headaches.pdf

http://www.ihs-classification.org/_downloads/mixed/International-Headache-Classification-III-ICHD-III-2013-Beta.pdf

http://www.sign.ac.uk/pdf/sign107.pdf

https://www.nice.org.uk/guidance/cg150