Headache

Get to know about headache

Headache and its implications have become a major neurological problem for patients to seek medical attention. Headache is described as pain in any region of the head including neck and face. It is commonly found in both male and female, with all age groups. Headache may occur on one or both sides of the head or radiate across the head from one point. It can also be isolated to a certain location. The severity of headache depends on the types and pain characteristics. A headache may appear as a sharp pain, a throbbing sensation or a dull ache. Headaches can develop gradually or suddenly and may last from less than an hour to several days. Headaches can be categorized into two major types as follows:

Primary headaches

A primary headache is caused by problems with pain-sensitive structures in the head. A primary headache is not a symptom coming from an underlying disease. Chemical activity in the brain, the nerves or blood vessels surrounding the skull, or the muscles of head and neck can play a role in primary headaches. Radiological imaging tests and laboratory tests might not show any abnormalities. The most common primary headaches are

• Migraine; with and without aura

• Tension headache

• Trigeminal autonomic cephalalgia (TAC) headaches such as cluster headache

Some primary headaches can be triggered by lifestyle factors including alcohol, certain foods such as processed meats that contain nitrates, hormonal disturbance, changes in sleep and stress.

• Secondary Headache A secondary headache is a symptom of other diseases that can activate pain and sensitive nerves of the head. Varying greatly in headache severity, possible causes of secondary headaches include brain tumor, brain hemorrhage, blood clot (venous thrombosis), brain aneurysm (a bulge in an artery in the brain), brain inflammation and infection such as encephalitis and meningitis, traumatic brain injuries and abnormal intracranial pressure. Extracranial origin of secondary headaches include acute sinusitis, glaucoma (acute angle closure glaucoma), trigeminal neuralgia (inflammation of the trigeminal nerve at the jaw area) from root canal infections and the abnormalities of mandible bone.

Different types of primary headaches manifest differently in pain characteristics, other related symptoms, pain duration and pain severity. The most common types of primary headaches are:

• Migraine Headache  Migraines are a neurological disease characterized by recurrent moderate to severe headaches often in association with a number of autonomic nervous system symptoms and prodome which is notice subtle changes that warn of an upcoming migraine. One or two days before a migraine, prodome may include frequent yawning, weakness and food cravings especially sweets. Approximately 25% of cases experience “aura” that might occur before or during migraines. Auras are described as reversible symptoms of the nervous system. Examples of migraine aura include visual changes such as seeing bright spots or flashes of light, vision loss, pins and needles sensations in the hands,  numbness around the lips and difficulty speaking. Some patients might also have weakness or numbness in the leg which is typically a temporary paralysis on one side of the body, known as hemiplegic migraine.

Unique characteristic of migraine is pain that usually affects on one side of the head. It might radiate across another side. Pain is typically characterized as throbbing or pulsing sensation. The severity of pain is in the range of moderate to severe pain which walking and vibration of the head usually aggravate the symptoms. Resting with a stable position, cool temperature in darkened room greatly alleviates pain. If migraine is not treated, symptoms can last for 3 days. Other associated symptoms may include nausea, vomiting and sensitivity to light, sound, or smell.

• Tension Headache A tension headache is generally a diffuse, mild to moderate pain in the head. Signs and symptoms of a tension headache include dull head pain with sensation of tightness or pressure across forehead or on the sides and back of the head. It usually lasts for 30 minutes to several hours, though it can last up to 1 week. The average pain duration is less than 24 hours. Other related symptom in some patients is mild nausea, usually without vomiting. Bright light, body movement and loud noise do not usually worsen the symptoms

• Cluster Headache Cluster headache is classified as a part of the trigeminal autonomic cephalalgias or (TACs). Cluster headaches are more prevalent in men than women. Pain is characterized by recurrent, severe headache on one side of the head, typically around the eye. It generally occurs in cyclical patterns or cluster periods. Main symptoms include excruciating pain that is situated in, behind or around affected eye which may radiate to other areas of face, head and neck, severe eye pain with burning sensation on the affected side and drooping eyelid on the affected side. Other autonomic symptoms are redness of affected eye, excessive tearing, stuffy or runny nose on the affected side, swelling eyelid, forehead or facial sweating on the affected side. Restlessness and tinnitus (the perception of noise or ringing in the ears) are possible symptoms during attack.

Without treatment, it may last from 30 minutes to 3 hours  (average pain duration is an hour). A unique characteristic of cluster headache is that attacks occur at specific times in waves (cluster) as a cyclical rhythm with cluster bout such as cluster pain during a particular month of each year and may last for days or up to weeks. After the attack, symptoms will disappear. Following the episode, there may be no headaches until the same month of the following year.