Headache

We all have headaches every now and then. Most of us usually tend to ignore them until they start interfering with our daily activities. Although, headache is a symptom itself, the other symptoms of headache are not just restricted to dull or sharp pain in the forehead region, but differ depending on the type of headache. There can be a lot of reasons you might be having a headache such as sinus infections, colds, stress, dehydration, vision problems, hormonal issues, migraine, head injury, and central nervous system (CNS) infections.

Causes #

Tension headache #

A tension headache can be caused by overuse of alcohol, caffeine, or caffeine withdrawal. It can also occur due to fluctuating hormones in women, straining of the eyes, or any injury to the head or neck. Poor posture can also trigger tension-type headaches.

Cluster headache #

The exact cause of cluster headaches is unknown. However, genetic and environmental factors can cause cluster headaches in some individuals. A cluster headache can be triggered by factors such as overuse of alcohol, smoking, high altitude, and overexertion.

Migraine headache #

Migraine refers to a neurological condition where headache may be associated with other symptoms such as aura. The exact cause of migraine is not known, but some studies show that migraine is caused by serotonin along with pathways that cause narrowing of blood vessels and reduced blood flow, followed by widening of these arteries. Migraines can be triggered by certain environmental conditions like cold weather, processed foods, bright light, and sound.

Sinus headache #

Sinus headaches are caused by sinusitis, which is the infection or inflammation of the sinus cavities. This can be triggered by change in weather or allergies.

Other causes #

Apart from the above mentioned causes, some other causes of headache can be serious and potentially life-threatening such as:

• Head or brain injury

• Hypoglycemia (low blood sugar)

• Intracranial bleeding (bleeding inside the skull)

• Brain aneurysm

• Brain tumor

• Concussion

• Meningitis

• Stroke

• Temporal arteritis

• Trigeminal neuralgia

Types #

Primary headaches #

A primary headache means the headache itself is the main medical problem, and not a symptom of an underlying illness. A primary headache is thought to be caused by overactivity of or problems with pain-sensitive structures in your head. The most common types by a very long way are tension headaches and migraines. Here is a rundown on some of the primary headaches:

Tension headaches #

• It is the most common type of headache.

• This headache presents as mild to moderate pressure or tightness on both sides of the head, where the patient complains as if a tight band or rope has been tied on the head. Sometimes, the pain might feel spreading into or from the neck.

• Pain is not throbbing in nature.

• Some tension headaches are triggered by exhaustion, stress, or disorders involving the muscles or joints of the neck or jaw.

• They can be troublesome and tiring, but they usually do not disturb sleep. Most people can continue working with a tension headache.

• However, the headache might worsen during activities like climbing up stairs or bending over.

Migraine #

• Migraine pain is an intense pulsing from deep within the head.

• This pain can last for days. The headache significantly limits the ability to carry out daily chores. Migraine is throbbing and is usually one-sided.

• Although a migraine can start without any warning, it is often set off by a trigger. The triggers may vary from person to person.

• The most common ones are fatigue, stress, lack of sleep, bright flickering lights, loud noises and dietary triggers like red wine, chocolate, aged cheese or an increase or decrease in caffeine.

• Nausea and vomiting also usually occur along with headache. Migraine is often life-long, and characterized by recurring attacks.

Cluster headaches #

• Cluster headaches are relatively uncommon but a severe type of primary headache. It presents like a brief but severe burning, throbbing or constant headache.

• This headache gets its name because the pain tends to come in clusters, with one to eight headaches a day for one to three months every year or two, often at the same time of year.

• They disappear completely or go into remission in between for months to years, only to reoccur later.

• Patients often describe them as unbearable which greatly interferes with their normal routine. Cluster headaches occur around or behind one eye or on one side of the face at a time.

• Sometimes, swelling, redness, flushing, sweating, nasal congestion, and eye tearing can also occur on the side that is affected by the headache.

New daily persistent headaches #

New daily persistent headaches usually start suddenly in a person who does not have a past history of headaches. They persist on a daily basis and can last for more than three months. The pain is moderate to severe and can mimic chronic tension-type headache or chronic migraine.

Exertional headaches #

Exertion headaches happen soon after periods of intense physical activity. Weight lifting, running, rowing, tennis, swimming, and sexual intercourse are common triggers for an exertion headache. It is thought that these activities cause increased blood flow to the head, which can lead to a throbbing headache on both sides of your head. This type of headache usually resolves within a few minutes or several hours.

Secondary headaches #

Secondary headaches are caused by an underlying medical condition. Examples of secondary headache causes include:

Sinus headaches #

Sinus headaches are the result of sinusitis or sinus infection, which causes congestion and inflammation in the sinuses which are air-filled spaces in the skull. The pain from these headaches is deep and constant in nature and often focused around the cheekbones, the bridge of the nose or forehead.

Hormone headaches #

Women commonly experience headaches that are linked to hormonal fluctuations. Menstruation, birth control pills, hormone replacement therapies, and pregnancy can affect the estrogen levels, which can cause a headache. When headache occurs two days before periods or in the first 3 days after it starts, they are known as menstrual migraines.

Hypertension headaches #

High blood pressure can cause you to have a headache. This kind of headache signals an emergency. This occurs when your blood pressure becomes dangerously high. You may also experience changes in vision, numbness or tingling, nosebleeds, chest pain, or shortness of breath.

Post-traumatic headaches #

Post-traumatic headaches can develop after any type of head injury. These headaches feel like migraine or tension-type headaches, and usually, last up to 6 to 12 months after your injury occurs. They can become chronic in some cases.

Medication overuse headaches #

• Medication overuse headache (medication induced headache) or rebound headache is caused by long term and regular intake of painkillers usually taken to get relief from headache.
• This headache usually occurs every day and early morning and improves with painkillers but returns as the effect of medication wears off.
• Medication overuse headaches usually stop on cessation of painkillers.
• It is difficult in the short term, but doctors can help recover from medication overuse headaches for a long term relief.

Symptoms #

• Dull pain around the forehead, neck, and back region. These symptoms are more common in tension-type headaches.

• Severe and throbbing pain usually on one or both sides of the head, along with pain in the eye, temple, or back of the head. Sensitivity to light, sound, and aura is common in migraine types of headaches.

• Constant pain that occurs in the sinus regions such as the bridge of the nose or the cheeks along with the feeling of fullness in the sinus is common in sinus headaches.

Diagnosis #

• Complete blood count (CBC): CBC test is carried out to look out for an infection that could be causing your headaches.

• Erthrocyte sedimentation ratio (ESR): ESR test or erythrocyte sedimentation rate is done, if giant cell arteritis (GCA), which is an inflammatory disease of large blood vessels, as well as other systemic disorders, are suspected.

• Computed tomography (CT) scan: CT scan may also be chosen in some cases of headaches. However, due to the radiation, MRI is the preferred option.

• Magnetic resonance imaging (MRI): MRI is often used to identify any structural abnormalities in the brain.

• Cerebrospinal fluid study: Lumbar puncture (LP) and cerebrospinal fluid test may be advised in patients who have headache along with fever, meningeal signs, focal neurological deficits, or suspicion of intracranial hypertension.

Treatments #

Oral analgesics: Analgesics such as ibuprofen and paracetamol are generally the first line treatment for headaches. Oral analgesics such as non-steroidal anti-inflammatory drugs (NSAIDS) are prescribed generally for cluster headaches and tension headaches.

Antiemetics: Antiemetics such as domperidone may also be prescribed in migraine, where headache is accompanied with nausea & vomiting.

Combination analgesics: In some cases of severe headache, analgesics are given adjuvantly with caffeine, barbiturates, and opiates. This therapy is usually short & can only be taken under medical supervision.

Triptans: Triptans such as sumatriptan give long-term relief from migraine headaches. These medicines not only treat migraine but are used as preventive therapy for migraine headaches.

Ditans: Lasmiditan is a newer drug used in the patients with chronic migraine. Its action is similar to triptans but the effect is more specific to the CNS.

Single pulse transcranial magnetic stimulation (STMS) & vagal nerve stimulation (VNS): These procedures are usually recommended for patients who are non-responsive to conventional therapy. These are newer treatment modalities approved by the FDA & used with varying success in the treatment of migraine attacks in adults. In this, electromagnetic probes are placed externally over the head which helps to regulate the neural pathways in the brain to relieve headache.

Behavioral therapy: Behavioral therapy such as cognitive behavioral therapy, relaxation techniques such as meditation helps in reducing the muscle tension, which is common in tension headache.

Physical therapy: Physical therapy for headache includes improving posture, hot and cold packs, exercise programs, and electrical stimulation.