Headache: The ‘heads’ and ‘tales’ uncovered…

A headache is among the most common reasons to seek medical advice. Although it is always considered a minor problem, it can actually be debilitating and might be a warning sign of some other serious medical disorder. In today’s article I’ll be describing some of the common types of headaches, their treatment options and the warning signs of some serious types of headaches.

Tension type headache
Tension type headaches (TTH) cause tightness around both sides of the head or neck, with mild to moderate pain that is steady and does not throb, and pain that is not worsened by activity. The pain can increase or decrease in severity over the course of the headache. There may be tenderness in the muscles of the head, neck, or shoulders.

People with TTH often note a feeling of mental stress or tension before their headache. Unlike migraine, tension headaches occur without other symptoms such as nausea, vomiting, sensitivity to light and sound, or an aura. However, some people have symptoms of both tension and migraine headache.

People with frequent or chronic TTH often overuse over-the-counter medications in an attempt to treat their pain. This can lead to medication-overuse headaches

Migraine headaches
Migraine is the second most common type of headache causing an ‘episodic’ headache which is on one side, throbbing, worsened by movement and can range from being moderate to severe in intensity.  Migraine headaches are often accompanied by nausea and vomiting, as well as sensitivity to light and noise. A few people with migraine also experience nasal stuffiness and a runny nose, tearing, or changes in skin tone or body temperature.

Aura: About 20 per cent of people with migraines experience visual or other symptoms prior to the onset of the headache; this is called an aura. The aura may include flashing lights or bright spots, zigzag lines, loss of part of the field of vision, numbness or tingling of the fingers, lips, tongue, or lower face. Auras may also involve other senses, and can occasionally cause temporary muscle weakness or changes in speech. A person can have several types of aura symptoms that vary with the headache attack. Aura symptoms typically last for five to 20 minutes and rarely last more than 60 minutes, with the headache occurring soon after the aura stops.

Migraine triggers
Migraines can be triggered by stress, worry, menstrual periods, birth control pills, physical exertion, fatigue, lack of sleep, hunger, head trauma, and certain foods or drinks that contain chemicals such as nitrites, glutamate, aspartate, tyramine.

Certain substances can also trigger a migraine, like strong perfumes, smoke, and organic solvents with a strong odour.

Cluster headache
They are severe, debilitating headaches occurring repeatedly for weeks to months at a time, followed by periods with no headache. The pain begins quickly without any warning and reaches a peak within a few minutes. The pain is severe and continuous although occasionally it may be pulsatile. The pain is always on one side; it remains on the same side of the head during a single cluster, but can switch sides during the next cluster.

A cluster headache is associated with eye redness and tears, runny nose, sweating, pale appearance, and possibly drooping of the eyelid. Alcohol can bring on a cluster headache in more than 50 per cent of persons who suffer with the complaint; this sensitivity to alcohol stops when the cluster ends

Chronic daily headache
When a headache is present for more than 15 days per month for at least three months, it is described as a chronic daily headache.
Chronic daily headache is not a type of headache but a category that includes frequent headaches of various kinds like migraine, TTH, etc.

Medication-overuse headache (MOH)
MOH may occur in people who have frequent headaches, which leads them to overuse pain medication. A vicious cycle occurs whereby frequent headaches cause the person to take medication frequently (often over-the-counter), which then causes a rebound headache as the medications wear off, causing more medication use, and so on.

Headaches and brain tumour
Headaches occur in approximately 50 per cent of people who have brain tumours. However, headaches are very common and brain tumours are rarely found in people who are evaluated for headaches. Many people with brain tumours have chronic headaches that are worse with bending over, or occur with nausea and vomiting, although these symptoms can also occur with headaches not related to a brain tumour.

Other types of headache

There are a number of other causes of headache such as inflammation of blood vessels (Giant Cell Arteritis), headache in sinusitis, post herpetic neuralgia, headache after head injury, trigeminal neuralgia, etc. Description of all of them is not necessary in this article but what is more important is to know the warning signs of some serious problem.

Headache symptoms that suggest a serious underlying disorder
1.  ‘Worst’ headache ever
2.  First severe headache
3.  Gradual worsening over days or weeks
4.  Fever or unexplained weakness
5.  Vomiting that precedes headache
6.  Pain induced by bending, lifting, cough
7.  Pain that disturbs sleep or presents immediately upon awakening
8.  Known systemic illness
9.  Onset after age 55
10. Pain associated with local tenderness

Treatment options
Different options are available to tackle each of these different types of headaches. Options range from multiple over-the-counter drugs and life-style modification to interventional nerve blocks, but the decision should be best left to your physician.

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