Headache Overview, Causes, Prevention & Treatment -

Headache Overview, Causes, Prevention & Treatment-

Headache Overview:-

Headache is one of the most common symptoms experienced by nearly every individual sometimes. In the United States, Headache is one of the most common reasons for which the patient seeks medical attention. Headache is the condition where the individual experiences mild, moderate, or severe pain in the forehead.

Headache is a very common problem nowadays. Due to the poor work-life balance of the individuals and work pressure, some individuals may commonly experience headaches.

Ignoring the headache for the long term can be dangerous. Although, Headaches can be diagnosed and treated easily depending upon the causes.

Causes of Headaches:-

Headaches can be caused by various reasons. Such as traveling to High altitudes, Drinking Alcohol, Wrong Food Habits, Pregnancy, Adverse effect of Medicines and Drugs.

Below are the most common causes of Headaches: –

a. Stress

b. Anxiety, Depression and Emotional Breakdown

c. Illness or Adverse effect of any Medication

d. Long Working Hours or Driving

e. Insomnia: – Lack of Sleep

f. Refractive Error & Blurred Vision Headache

g. Continuous use of Electronic Gadgets like Mobile, Laptops, Speakers, Headphones, etc.

h. High Radiation Exposure.

k. Excessive Consumption of Fast Food or Junk Food

l. Physical Injury near Forehead such as eye, nose, scalp

j. Excessive Alcohol and Drug Abuse.

Different Types of Headaches

Headaches can be treated easily once you know the type and cause of Headache. You can visit the nearby Doctor for Headache treatment and prevention of further episodes.

International Headache Society has classified headaches broadly into two major types: –

Primary Headaches: –

Primary Headaches are those in which headache and its associated features are the disorder in itself. This means they are not caused by any other underlying disease.

Primary Headache often results in considerable disability and a decrease in patient quality of life. Tension-type Headache is the most common type of Primary Headache.

The most common types of Primary Headaches are:- Tension-Type Headache, Migraine, Cluster Headache, Idiopathic Headache, and Exertional Headache.

Secondary Headaches:-

Secondary Headaches are caused due to some underlying disease or exogenous disorders. Mild Secondary headaches are most common but rarely worry some. Infections are the most common cause of Secondary Headaches.

The most common types of Secondary Headaches are- Systemic Infections, Head Injury, Vascular Disorders, Hemorrhage, and Brain Tumor.

Know your headache type

Headaches are further sub-classified into many types depending on the location, underlying causes, and their treatment-

1. Tension Type Headache

Tension-Type Headache is the most common type of headache experienced by every individual sometimes. The term tension-type headache is commonly used to describe a chronic head pain syndrome characterized by bilateral tight, band-like discomfort. The pain typically builds slowly, fluctuates in severity, and may persist more or less continuously for many days. The headache may be episodic or chronic.

A useful clinical approach is to diagnose Tension-Type Headache(TTH) in patients whose headaches are complete without accompanying features such as nausea, vomiting, photophobia, phonophobia, osmophobia, throbbing, and aggravation with movement. Such an approach neatly separates migraine, which has one or more of these features and is the main differential diagnosis, from Tension-Type Headache.

However, the International headache Society’s definition of Tension-Type Headache allows an admixture of nausea, photophobia, phonophobia in various combinations, illustrating the difficulties in distinguishing these two clinical entities.

2. Migraine Headache

Migraine Headache is the second most cause of Headache after Tension-Type Headache affecting nearly 15% of Women and 6% of men. It is usually an episodic Headache that is associated with certain features like Sensitivity to light, sound, or Movement.

Nausea and Vomiting are often associated with Migraine Headaches. Migraine Headache is a benign and recurring syndrome of headaches. Patients with Migraine Headaches are sensitive to environmental and sensory stimuli. Females, during their Menstrual Periods, are more sensitive to the stimuli and often have episodes of Migraine Headaches. Nausea, Photophobia, Light Headedness, scalp tenderness, vertigo, and seizures are the accompanying symptoms found in severe Migraine patients.

There is the involvement of neurotransmitter serotonin and dopamine in the pathophysiology of Migraines.

Clinical Features of Migraine Headache:-

Migraine Aura
Visual Disturabances
Neurological Sympotoms
Nausia & Vomiting
Vertigo
Dizziness

Migraine can be diagnosed if there are repeated attacks of Headaches lasting 4 to 72 hours in patients with Normal Physical examination and no other cause of Headache found. There can be Unilateral pain, Throbbing Pain, Pain aggravated by movement, Pain of Moderate or Severe intensity, and Nausea Vomiting, and Photophobia.

For Diagnosis of Migraine Headache, various investigation can help like CT scan, MRI, PET scan etc.

Management of Migraine Headache:-

Migraine can be managed to some degree via a variety of approaches. For examples:-

Identification and Avoidance of Headache trigger factors.
Regulated Life style by including Healthful Diet, Regular Exercise.
Proper and Regular Sleep pattern.
Avpiding excessive Caffeine and Alcohol.
Reducing stress level and Yoga can be helpful in reducing the stress level of individuals.
There are certain Drugs which can be helpful like Over the counter Painkillers and Neurotransmitter antagonists which can be taken only after consultation and prescription by Physician.

3. Trigeminal Autonomic Cephalgia

Trigeminal Autonomic Cephalgia is a group of primary headaches that includes cluster headache, paroxysmal hemicrania and short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing(SUNCT). Trigeminal Autonomic Cephalgia is characterized by relatively short lasting attacks of head pain associated with symptoms such as lacrimation, conjunctival injection, nasal congestion. Pain is usually severe and occurs more than one time a day. Because of nasal congestion or rhinorrhea patients are often misdiagnosed as patients of sinus headache.

Trigeminal Autonomic Cephalgia must be differentiated from short-lasting headaches that do not have prominent cranial autonomic syndromes, notable Trigeminal neuralgia, primary stabbing headaches. and hypnic headaches. The cycling pattern and lengthy, frequency and timing of attacks are useful in classifying patients. Patients with Trigeminal Autonomic Cephalgia should undergo pituitary imaging and pituitary function tests as there is an excess of Trigeminal Autonomic Cephalgia presentations in patients with pituitary tumour-related headaches.

4. Cluster Headache

Cluster Headache is a rare form of primary headache. Cluster headache affects around 0.1 % of the population. The pain of cluster Headache is deep, retroorbital, excruciating intensity, non fluctuating and explosive in quality.

The pain of cluster Headache occurs daily at about the same hour each day. The patient of cluster headache has daily bouts of one to two attacks of relatively short duration unilateral pain for 8 to 10 weeks a year. Cluster headache is characterized as chronic when there is no period of sustained remission.

Patients are perfectly well in between the episodes. The pain usually occurs at night in about 50% of patients. Men are affected 3 times more than women from Cluster headaches.

Cluster headache is associated with symptoms like lacrimation, rhinorrhea, nasale conjunction, ptosis.

Management of Cluster Headache

The most satisfactory treatment of cluster headache is the administration of drugs to prevent cluster attacks until the bout is over. However, treatment of acute attack is required for all cluster headache patients at some time. The treatment of cluster headache includes High flow Oxygen inhalation, Drug Sumatriptan, Nasal spray zolmitriptan, oral glucocorticoids, ergotamine after prescription of Doctor.

When medical therapies fail in chronic cluster headaches, Neurostimulation Therapy can be employed and can help patients get relieved from cluster headaches.

4. Paroxysmal Hemicrania

Paroxysmal hemicrania is characterised by frequent unilateral, severe, short-lasting episodes of headache. Like cluster headache, the pain tends to be retro-orbital but may be experienced all over the head and is associated with an autonomic phenomenon such as lacrimation and nasal congestion patients with remissions are said to have episodic paroxysmal hemicrania, while those with the non-remittance form are said to have chronic paroxysmal hemicrania the essential features of paroxysmal hemicrania are unilateral coma very severe pain short-lasting attacks very frequent attacks ipsilateral pain Rapid course and excellent response to indomethacin.

The male: female ratio of having Paroxysmal hemicrania is 1:1. Indomethacin is the main drug for the treatment of Paroxysmal hemicrania. Secondary Paroxysmal hemicrania has been seen in cases of lesions in regions of sella turcica, including AV malformations, cavernous sinus meningioma, and epidermoid tumours. Paroxysmal hemicrania can be diagnosed by MRI.

5. SUNCT:- Short lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing

SUNCT is a rare primary headache syndrome characterized by severe, unilateral, orbital for temporal pain that is stabbing or throwing in quality. diagnosis requires at least 20 attacks, lasting for 5-240 seconds. ipsilateral conjunctival injection and lacrimation should be present. in some patients, injectable Injection or lacrimation are missing, and the diagnosis of SUNA (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing ) has been suggested.

Diagnosis of SUNCT/SUNA

The pain of SUNCT/SUNA is unilateral and may be located anywhere in the head. Three basic patterns can be seen: single stabs, which are usually short-lived; groups of stabs; or longer attacks comprising of many stabs between which pain does not completely resolve.

The SUNA can be misdiagnosed as Trigeminal Neuralgia many times which should be accurately diagnosed by a Physician.

6. Chronic daily Headache:

When a person experiences headache for 15 days or more in one-month duration, it is diagnosed as Chronic Daily Headache. As per the various studies, about 4% adults have daily or near daily headaches. CDH is not a single entity but it includes chronic tension type headache as well as headache secondary to trauma, inflammation, infection, medicine overuse and some other causes also.

Types of Chronic Daily Headache:

Chronic daily Headache are classified into various type depending on the duration and underlying cause of the headache like:

Chronic migraine
Chronic tension type headache
Hemicrania continua
New daily persistent headache
Chronic cluster headache
Chronic paroxysmal hemicrania
SUNA
Hypnic headache
Post traumatic headache
Headache after head injury
Post infection headache
Chronic CNS infection
Medication overuse headache

Diagnosis and management of Chronic Daily Headache

Diagnosis can be made by taking a good history from the patient about the onset, duration and relieving factors of headache. Some investigations like MRI, CT scan, Blood tests may also help in making the correct diagnosis.

Management or treatment of headache includes the treatment of underlying cause like appropriate management of CNS infections, relieving the stress factors, counselling in patients of post traumatic headaches, triptans in migraine headaches, etc.

7. Medication overuse headache:

Medication overuse headache is caused by the overuse of analgesic medicines for headache. It can lead to a state of refractory daily or near daily headache. Some patients can get relief by stopping the use of analgesics while in other patients, even after cessation of medication they do not get relief from the headache.

Management of Medication overuse headache:

This type of headache can be managed by reducing the dose of analgesics. Most studies recommend a 10% reduction in dose every 1-2 weeks. Once the patient has substantially reduced analgesic use, preventive therapy can also be introduced at that time “It should be emphasized that preventives generally stops working in the presence of analgesic overuse.”.

Some patients may also require hospital admission for detoxification. In admitted patients, various drugs can be used like intravenous aspirin, intramuscular chlorpromazine, intravenous dihydroergotamine etc. After advice and prescription by the treating physician.

New daily persistent headache:

As the name suggests, it is the headache type that occurs daily and is recent in onset. It needs to be differentiated from other daily headaches like migraines, tension type headaches, low CSF volume headache, raised CSF pressure headache, chronic headache etc. The patient will present to clinic with the symptoms of daily or near daily headache which is recent in onset. History of headache is clearly recalled by the patient. It should be timely differentiated from secondary causes of headaches which can be fatal in some cases. It can occur in both genders i.e males and females. Preventive therapies can be tried for this type of headache but are often found ineffective.

8. Post-traumatic headache:

A traumatic event can trigger a headache process that lasts for many months or even years after the event. In this type of headache episodess, complains of dizziness, vertigo, and impaired memory can also accompany the headache. Symptoms may resolve themselves after months to years. Neurological examination of patient is generally found normal. Some investigations like MRI, CT scan can be performed to rule out other causes of headache.

Treatment is largely empirical. Tricyclic antidepressant, and anticonvulsants have been used for the management and also found effective. The headache usually resolves in 3-5 years, but it can be quite disabling for the patient.

9. Hemicrania Continua:

In this type of headache, patient suffers from moderate and continuous unilateral pain associated with fluctuations of severe pain. It is twice more common in females than in men. The age of onset of this headache varies from 11 to 58 years. This headache may be associated with lacrimation, conjunctival injection and photophobia on affected side. Treatment is done by indomethacin while other NSAIDs appears to provide little or no benefit. The patients who are not able to tolerate indomethacin occipital nerve stimulation may also help in management.

10. Primary stabbing headache:

The essential features of primary stabbing headache are stabbing pain confined to the head or the face lasting from seconds to minutes and occurring as single stab or series of stabs. There is a pattern of recurrence at irregular intervals. The pain severity e is described as “ icepick pains” or “ jabs and jolts.” Migraine and hemicranias continua patients may experience primary stabbing headache many times in their lives. Indomethacin acts excellently in the treatment of primary stabbing headaches. After the treatment with indomethacin, it is appropriate to withdraw the drug and observe the patient.

11. Primary cough headache:

Primary cough headache is a generalized headache. It begins suddenly and may last for several minutes to hours. As the name suggest, it is precipitated by cough. It can be prevented by avoiding coughing and other precipitating factors, which can include sneezing, straining, laughing or stooping. In all patient’s serious etiology must be ruled out before a diagnosis of benign primary cough headache. Benin cough headache can resemble or match the patients of benign exertional headache which must be differentiated by the treating physician. This headache can be relieved by indomethacin as prescribed by the physician. However, in some patients they get relief by lumbar puncture. The mechanism for this response is still not clear.

12. Primary exertional headache:

Primary exertional headache resembles both cough headache and migraine. It is precipitated by any form of exercise. The pain can last from 5 minutes to 24 hours. The pain is usually bilateral, and throbbing in onset. This headache can be prevented by avoiding excessive exertional activities or exercises, also avoiding high altitudes and hot weather. The mechanism of this headache is still unclear.

13. Primary sex headache:

As the name suggests, it is precipitated by sexual activity & sexual excitement. In this, pain is usually bilateral in location and is of dull type and sudden in onset. Pain is usually aggravated by orgasm. Men are more affected by this headache when compared to women. This headache can initiate at any age when the person is sexually active. The pain can remain present for 2-3 minutes to sometimes for hours. Its management is done by stopping the sexual activity for some time or just by reassuring the patient that everything is fine and he need not to worry. In many cases, this reassurance is found quite effective.

14. Primary thunderclap headache:

This headache usually manifests as sudden onset ad severe headache like a thunderclap. There can be various other causes of headache of this type which needs to be differentiated from thunderclap headache by the doctor by taking proper history of patient and examining the patient. Some investigations like MRI, MR angiography, CT scan may also help in making the correct diagnosis. Drug nimodipin is found effective in the treatment of primary thunderclap headache.

15. Hypnic headache:

This headache usually occurs during sleep. It occurs for nearly half an hour. It is of moderate to severe intensity and it can be unilateral or bilateral. It is commonly seen in females. It is commonly precipitated by day sleep as in case of night shift workers etc. it can also be seen in patients of hypertension which is uncontrolled. So, regular monitoring of BP is advised to the patient. Lithium and flunarizine may help in resolving the headache and should be taken only after prescription by doctor.