Headache

What is a headache?

Headache is our most common form of pain and a major reason cited for days missed at work or school as well as visits to the doctor. Without proper treatment, headaches can be severe and interfere with daily activities.

Headaches can range in frequency and severity of pain. Some individuals may experience headaches once or twice a year, while others may experience them more than 15 days a month. Some headaches may recur or last for weeks at a time. Pain can range from mild to disabling and may be accompanied by symptoms such as nausea or increased sensitivity to noise or light.

Why headaches hurt

The trigeminal nerve has three branches that conduct sensations from the scalp, the blood vessels inside and outside of the skull, the lining around the brain (the meninges), and the face, mouth, neck, ears, eyes, and throat.

The brain tissue itself lacks pain-sensitive nerves and does not feel pain. Headaches occur when pain-sensitive nerve endings called nociceptors react to headache triggers (such as stress, certain foods or odors, or the use of medicines) and send messages through the trigeminal nerve to the thalamus, the brain's "relay station" for pain sensation from all over the body. The following explains what each of these body parts does regularly:

  • The trigeminal nerve—one of 12 pairs of cranial nerves that start at the base of the brain—sends information about touch, pain, temperature, and vibration in the head and neck to the brain.
  • The thalamus controls the body's sensitivity to light and noise and sends messages to brain parts that manage awareness of pain and emotional response to it.
  • Other parts of the brain also may be part of the process, causing nausea, vomiting, diarrhoea, trouble concentrating, and other neurological symptoms.
Who is more likely to get a headache?

Anyone can experience a headache. Certain types of headaches run in families. Migraines occur in both children and adults but affect adult women three times more often than men.

Children and headache

Headaches are common in children. Headaches that begin early in life can develop into migraines as the child grows older. Migraines in children or adolescents can develop into tension-type headaches at any time. Unlike adults with migraine, young children often feel migraine pain on both sides of the head and have headaches that usually last less than 2 hours. Children may look pale and appear restless or irritable before and during an attack. Other children may become nauseous, lose their appetite, or feel pain elsewhere in the body during the headache.

Headaches in children can be caused by several triggers, including:
  • Emotional problems such as tension between family members
  • Stress from school activities
  • Weather changes
  • Irregular eating and sleep
  • Dehydration
  • Certain foods and drinks

Of special concern are headaches that occur after a head injury or those accompanied by rash, fever, or sleepiness.

It may be difficult to identify the type of headache because children often have problems describing where it hurts, how often the headaches occur, and how long they last. Asking a child with a headache to draw a picture of where the pain is and how it feels can make it easier for the doctor to determine the proper treatment.

Migraine is often misdiagnosed in children. Clues to watch for include sensitivity to light and noise, which may be suspected when a child refuses to watch television or use the computer or when the child stops playing to lie down in a dark room. Observe whether or not a child is able to eat during a headache. Very young children may seem cranky or irritable and complain of abdominal pain (abdominal migraine).

Headache treatment in children and teens usually includes rest, fluids, and over-the-counter pain relief medicines. Always consult with a physician before giving headache medicines to a child. Most tension-type headaches in children can be treated with over-the-counter medicines that are marked for children with usage guidelines based on the child's age and weight. Headaches in some children may also be treated effectively using relaxation/behavioural therapy. Children with cluster headaches may be treated with oxygen therapy early in the initial phase of the attacks.

Headache and sleep disorders

Headaches are often a secondary symptom of a sleep disorder. For example, tension-type headache is regularly seen in persons with insomnia or sleep-wake cycle disorders. Nearly 75% of individuals who suffer from narcolepsy complain of either migraine or cluster headache. Migraines and cluster headaches appear to be related to the number of and transition between rapid eye movement (REM) and other sleep periods an individual has during sleep. Hypnic headache awakens individuals mainly at night but may also interrupt daytime naps. Reduced oxygen levels in people with sleep apnea may trigger early morning headaches.

Getting the proper amount of sleep can ease headache pain. Generally, too little or too much sleep can worsen headaches, as can overuse of sleep medicines. Daytime naps often reduce deep sleep at night and can produce headaches in some adults. Some sleep disorders and secondary headaches are treated using antidepressants. Check with a doctor before using over-the-counter medicines to ease sleep-associated headaches.

How is a headache diagnosed and treated?

Not all headaches require a physician's attention. However, headaches can signal a more serious disorder that requires prompt medical care. Immediately call or see a physician if you or someone you're with experience any of these symptoms:

  • Sudden, severe headache that a stiff neck may accompany
  • Severe headache accompanied by fever, nausea, or vomiting that is not related to another illness
  • "First" or "worst" headache, often accompanied by confusion, weakness, double vision, or loss of consciousness
  • Headache that worsens over days or weeks or has changed in pattern or behaviour
  • Recurring headaches in children
  • Headache following a head injury
  • Headache and a loss of sensation or weakness in any part of the body, which could be a sign of a stroke
  • Headache associated with convulsions and shortness of breath
  • Two or more headaches a week
  • Persistent headache in someone who has been previously headache-free, particularly in someone over age 50
  • New headaches in someone with a history of cancer or HIV/AIDS
Diagnosing headache

How and under what circumstances a person experiences a headache can be key to diagnosing its cause. Keeping a headache journal can help a physician better diagnose your type of headache and determine the best treatment. After each headache, note:

  • The time of day when it occurred
  • Its intensity and duration
  • Any sensitivity to light, odors, or sound
  • Activity immediately before the headache
  • Use of prescription and nonprescription medicines
  • Amount of sleep the previous night
  • Any stressful or emotional conditions
  • Any influence from weather or daily activity
  • Foods and fluids consumed in the past 24 hours
  • Any known health conditions at that time

Women should record the days of their menstrual cycles. Include notes about other family members who have a history of headaches or other disorders. A pattern may emerge that can help reduce or prevent headaches.

Once your doctor reviews your medical and headache history and conducts physical and neurological exams, lab screening and diagnostic tests may be ordered to either rule out or identify conditions that might be the cause of your headaches.

Blood and urine tests can help diagnose brain or spinal cord infections, blood vessel damage, and toxins that affect the nervous system. Testing the fluid surrounding the brain and spinal cord can detect infections and bleeding in the brain (called a brain haemorrhage) and measure any pressure buildup within the skull.

Diagnostic imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), can detect irregularities in blood vessels and bones, certain brain tumours and cysts, brain damage from a head injury, brain haemorrhage, inflammation, infection, and other disorders. Neuroimaging also gives doctors a way to see what's happening in the brain during headache attacks. An electroencephalogram (EEG) measures brain wave activity and can help diagnose brain tumors, seizures, head injury, and inflammation that may lead to headaches.

Headaches and their types of treatment

Primary headaches occur independently and are not caused by another medical condition. A cascade of events that affect blood vessels and nerves inside and outside the head causes pain signals to be sent to the brain. Brain chemicals called neurotransmitters are involved in creating head pain, as are changes in nerve cell activity.

Primary headache disorders are divided into four main groups:

  1. Migraine
  2. Tension-type headache
  3. Trigeminal autonomic cephalgias (including cluster headache)
  4. Miscellaneous primary headache

Source From Ninds.nih.gov

FAQs

Generally, migraine begins as a dull ache and then develops into a constant throbbing and pulsating pain that you may feel at the temples, as well as the front or back of one or both sides of the head. A combination of nausea, vomiting, and sensitivity to light and noise usually accompanies the pain. Some people (about 15% of those living with migraine disease) experience an aura before an attack. The cause of migraine is believed to be chemical reactions in the brain. Migraine treatment may include over-the-counter or prescription medications, as well as self-help techniques such as relaxation training and biofeedback.

Certain physical or environmental factors, such as foods, hormonal changes, weather, and stress, can lead to or “trigger” a migraine. However, it’s important to remember that triggers are different for everyone. That’s why, to help prevent migraine attacks, you need to figure out which triggers affect you and which ones don’t. Keeping a headache diary is an effective way to track triggers, and it will help you talk to your healthcare professional about your condition.

Bright sunshine, hot, humid conditions, and drastic changes in barometric pressure may lead to or “trigger” a migraine attack in some. However, studies have shown that weather does not act as a trigger for everyone who has migraine.

Hormones initiate and regulate many of your body’s functions, keeping your body in balance within a constantly changing environment. When the levels of hormones in your body are unbalanced – during menstruation, pregnancy, or menopause – it can lead to a migraine attack. In fact, about three-quarters of all women with migraine report that their attacks are related to the menstrual cycle.

While the severity of a migraine attack often causes patients to fear they are having a stroke, the likelihood of a migraine attack causing a stroke is very remote. That is not to say that migraine sufferers cannot have a stroke associated with their migraines. In persons under age 40, the most common associated factor for stroke is migraine headache. However, throughout a person’s normal life span, the occurrence of migraine headaches may be associated with a reduced risk of dying from cerebrovascular disease due to stroke.

Acute medications – sometimes referred to as acute abortive medications – are used to treat the pain of the headache after it has started. Examples of acute abortive medications include over-the-counter medications, NSAIDs, ergots, and triptans.

Source From Headache.org

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