Headache is a loosely used word that it is not uncommon to hear parents say to children when bothered, “don’t give me headache”. In medical terms, headach
e is pain or discomfort that arises from anywhere above the eyes or ears, in the head or the upper part of the neck (towards the back). It is so common that almost everyone has had one form of headache or the other at some point in their lifetime.

The severity and duration of the headache, the presence or absence of associated symptoms, age at which the headache begins and other background medical problems are some of the things that determine the seriousness of headaches in general.

Types of Headache

There are so many types of headache that they cannot be exhausted in this write up. One way of categorizing headache is to divide them into primary and secondary.

Primary headaches consist of three types namely: tension, migraine and cluster headaches. Headaches that occur as a result of other problems are called secondary headaches and will be discussed in the next issue.

 

Tension Headache

• Presents as dull ache, tight feeling or pressure around the forehead, sides or upper neck. It is commoner in women than men.
• The pain may last for just a couple of minutes to days. , with varying severity.
• It may occur in the morning, during the process of work or when stress is anticipated.
• Occurrence less than 15 times a month is called episodic, if more then it is chronic.
• Associated symptoms may include becoming irritable, difficulty sleeping or concentrating and tiredness.
• Tension headache triggers include anxiety, depression, and stress, lack of proper sleep, abnormal postures, no physical activity, hunger, and overuse of pain medications.

Causes

• The exact cause is not known. A disturbance in the chemical materials produced in the brain is thought to be responsible. It has been long believed that muscle contraction in the head and neck may also be contributory.

 

Migraine Headache

It’s a form of moderate to severe pain in the head that usually disturbs the person from routine activities. It affects about 28 million people in the U.S., with women been affected more than men.

• Affects one side of the head usually, though may involve both sides.
• The headache is usually throbbing, sometimes pounding.
• It may last hours to days if untreated.
• Affected person is very sensitive to noise and light.
• Some people have the same type of ‘warning’ sign (aura) prior to the headache. These signs are usually visual likes light flashes, floating spots and so on.

 

Causes of Migraine headache

Migraine is thought to be caused by interplay between chemical imbalance (low serotonin) and the function of one of the pain regulating nerves in the brain (trigeminal nerve). The blood vessels in the brain at that time increase in size (dilate) and become inflamed in response to one of the chemicals released (neuropeptides) as a result of low serotonin. It occurs more frequently in people with a family history of migraines.

 

Migraine headache Triggers

Hormonal: In women low estrogen levels can trigger headache. This may explain why some women have headaches around the time of menstruation and in the estrogen free week when oral contraceptives are used. Some people have reported increase migraine headaches in pregnancy. The exact hormonal mechanism is not clear.

Sleep disturbances: too much or too little sleep may trigger migraine.

Food: Tyramine a substance found in cheese, wine, beer, sausages can precipitate migraines. Red wine and chocolates have also been implicated. Caffeine in high doses may cause disturbed sleep and migraine. Food abstinence as in prolonged fasting can be a trigger.

Stress: at work or in the home.

Physical activity and conditions: excessive physical activity, sexual activity inclusive may trigger migraine. Bright lights, glaring at the sun and change in weather are potential triggers.

 

CLUSTER HEADACHES

This is headache that occurs in cycles, it is severe but not life threatening. It is characterized by the following:

• Headache about the same time of day when it occurs.
• It lasts weeks or months with headache free intervals of months to years.
• Pain is usually severe, often behind one eye.
• Restlessness with tendency to bang the head on something displayed by sufferers.
• The eye involved may become red and watery.
• The nose on the affected side may be stuffy with watery discharge.
• There may be associated sweaty and pale skin.
• It is commoner in men than women.
• Tends to occur around age 20-40.

 

Treatment of Primary Headaches

In general start with over the counter (OTC) pain medicines. Avoid overuse as these medications themselves may cause headaches. Special prescription medications called triptans are also useful. The suddenness of cluster headache makes OTC medications ineffective. Nasal sprays, injections of triptans are available. Oxygen is also used to treat cluster headaches. People with recurrent migraines may require daily medications (prophylaxis) to prevent attacks.

 

Take Home Message

Excessive use of pain medication itself is a common cause of headache.

Serious causes of headaches that may be life threatening require immediate medical treatment. These will be discussed in the next write up.

 

Dr Oluwatoyosi Dairo can be contacted on phone at 718 526 7600 or in person at Amazing Medical Services located at 110-16 Sutphin Blvd. Jamaica, New York, NY 11435.