Suffering from Headaches
Headache
is one of the reasons to visit a pain
clinic which seems to be on the rise
lately!!!
With all the stress around us on
different fronts, it seems understandable
problem.
Patients give different description to
the problem but the common thing is
experiencing Pain in/ around the
head or neck region.
Such problem could be either a
disorder in its own right or a symptom of
an underlying medical condition or
disease. The medical term for headache is
cephalalgia. Headaches are one of the
most common and universal human ailments,
described in the Bible as well as in
medical writings from ancient Egypt,
Babylonia, Greece, Rome, India, and
China. Severe chronic headaches were once
treated by the oldest known surgical
procedure, known as trepanning or
trephining, in which the surgeon drilled
a hole as large as 12 in diameter
in the patients skull without
benefit of anesthesia. Evidence of
trepanning has been found in skulls from
Cro-Magnon people that are about 40,000
years old.
Demographics
Headaches in general are very common in
the adult population in North America.
The American Council for Headache
Education (ACHE) estimates that 95% of
women and 90% of men in the United States
and Canada have had at least one headache
in the past 12 months. Most of these are
tension headaches. Tension headaches may
begin in childhood in some patients, but
most commonly start in adolescence or the
early 20s. The gender ratio for episodic
tension headaches is about 1.4 Female: 1
Male; for chronic tension headaches, 1.9
F: 1 M.
Migraine and cluster headaches have
distinctive demographic patterns.
Migraine headaches are less common than
tension headaches, affecting about 11% of
the population in the United States and
15% in Canada. Several studies done in
the United Kingdom and the United States,
however, indicate that doctors tend to
underdiagnose migraine headache; thus the
true number of patients with migraine may
be considerably higher than the usual
statistics indicate. Migraines are a
major economic burden; it is estimated
that the annual cost of time lost from
work due to migraines in the United
States alone is $17.2 billion. Most
people who experience migraines have
their first episode in childhood or
adolescence, although some experience
their first migraine after age 20.
Migraines occur most frequently in adults
between the ages of 25 and 55; the gender
ratio is about 3 F: 1 M. Although
migraine headaches occur in people of all
races and ethnic groups, they are thought
to affect Caucasians more often than
African or Asian Americans.
Classification
Doctors divide headaches into two large
categories, primary and secondary,
according to guidelines established by
the International Headache Society (IHS)
in 1988 and revised for republication in
2004. Primary headaches are those that
are not caused by an underlying medical
condition. There are three types of
primary headaches: migraine, cluster, and
tension headaches. More than 90% of all
headaches are primary headaches.
Secondary headaches are caused by disease
or medical condition; they account for
fewer than 10% of all headaches.
I- PRIMARY HEADACHE:
* MIGRAINE HEADACHES Migraine headaches
are characterized by throbbing or
pulsating pain of moderate or severe
intensity lasting from four hours to as
long as three days. The pain is typically
felt on one side of the head; in fact,
the English word migraine is
a combination of two Greek words that
mean half and head.
Migraine headaches become worse with
physical activity and are often
accompanied by nausea and vomiting. In
addition, patients with migraine
headaches are hypersensitive to lights,
sounds, and odors.
The two most common types of migraines
are known as classic and common migraine,
respectively. Classic migraine, which
accounts for 1020% of the cases of
migraine, is distinguished by a brief
period of warning symptoms 1060
minutes before an acute attack. This
prodrome, which is known as an aura, may
include such symptoms as seeing flashing
lights or zigzag patterns, temporary loss
of vision, difficulty speaking, weakness
in an arm or leg, and tingling sensations
in the face or hands. Common migraine is
not preceded by an aura, although some
patients experience mood changes, unusual
tiredness, or fluid retention shortly
before an attack. An attack of common
migraine may include diarrhea and
frequent urination, as well as nausea and
vomiting.
Less common types of migraines include
hemiplegic migraine, characterized by
temporary paralysis on one side of the
body; ophthalmoplegic migraine, in which
the pain is felt in the area around the
eye; basilar artery migraine, which
involves a major artery at the base of
the brain and primarily affects young
women; and headache-free migraine, which
is characterized by the gastrointestinal
and visual symptoms of classic migraine,
but does not involve head pain.
* CLUSTER HEADACHES Cluster headaches are
recurrent brief attacks of sudden and
severe pain on one side of the head,
usually most intense in the area around
the eye. Cluster headaches may last
between five minutes and three hours;
they may occur once every other day or as
often as eight times per day.
The pain of a cluster headache is
excruciating; some patients describe it
as severe enough to make them consider
suicide. Patients with cluster headaches
are restless; they may pace the floor,
weep, rock back and forth, or bang their
heads against a wall in desperation to
stop the pain. In addition to severe
pain, patients with cluster headaches
often have a runny or congested nose,
watery or inflamed eyes, drooping
eyelids, swelling in the area of the
eyebrows, and heavy facial perspiration.
Because of the nasal symptoms and the
relative rarity of cluster headaches,
these episodes have sometimes been
misdiagnosed as sinusitis.
* TENSION HEADACHES Tension headaches are
the most common headaches in the general
population; other names for them include
muscle contraction headache, ordinary
headache, psychomyogenic headache, and
stress headache. The IHS classifies
tension headaches as either episodic or
chronic; episodic tension headaches occur
15 or fewer times per month, whereas
chronic tension headaches occur on 15 or
more days per month over a period of six
months or longer.
Tension headaches rarely last more than a
few hours; 82% resolve in less than a
day.
The patient will usually describe the
pain of a tension headache as mild to
moderate in severity. The doctor will not
find anything abnormal in the course of a
general physical or neurological
examination, although sore or tense areas
(trigger points) in the muscles of the
patients forehead, neck, or upper
shoulder area may be detected.
* REBOUND HEADACHES Rebound headaches,
which are also known as analgesic-abuse
headaches, are a subtype of primary
headache caused by overuse of headache
drugs. They may be associated with
medications taken for tension and
migraine headaches.
II- SECONDARY HEADACHE:
Secondary headaches, which are caused by
diseases or disorders, are categorized as
either traction or inflammatory
headaches. Traction headaches result from
the pulling, stretching, or displacing of
structures that are sensitive to pain, as
when a brain tumor presses on the outer
layer of nerve tissue that covers the
brain. Inflammatory headaches are caused
by infectious diseases of the ears,
teeth, sinuses, or other parts of the
head.
Major causes of secondary headaches
include the following:
* Brain tumors. Headaches associated with
brain tumors usually begin as episodic
nighttime headaches that are accompanied
by projectile vomiting. The headaches may
become continuous over time, and usually
get worse if the patient coughs, sneezes,
bears down while using the toilet, or
does something else that increases the
pressure inside the head.
* Meningitis. Meningitis is an
inflammation of the meninges, the three
layers of membranes that cover the brain
and spinal cord. Meningitis is usually
caused by bacteria or viruses, and may
produce chronic headaches.
* Head trauma. Patients may complain of
headaches as well as memory problems,
general irritability, and fatigue for
months or even years after a head injury.
These symptoms are sometimes grouped
together as post-concussion syndrome. In
some cases, a blow on the head may cause
some blood vessels to rupture and produce
a hematoma, or mass of blood that
displaces brain tissue, and can cause
seizures or weakness as well as
headaches.
* Temporal arteritis. First described in
1890, temporal arteritis is an
inflammation of the temporal artery that
most commonly affects people over 50. In
addition to headache, patients with
temporal arteritis may have fever, loss
of appetite, and blurring or loss of
vision. Temporal arteritis is treated
with steroid medications.
* Stroke. Headaches may be associated
with several conditions that may lead to
stroke, including high blood pressure and
heart disease. Headaches may also result
from completed stroke or from the
mini-strokes known as transient ischemic
attacks, or TIAs.
* Lumbar puncture. About 25% of patients
who undergo a lumbar puncture (spinal
tap) develop a headache from the lowered
cerebrospinal fluid pressure around the
brain and spinal cord. Lumbar puncture
headaches usually go away on their own
after a few hours.
* Sinus infections. Acute sinusitis is
characterized by fluid buildup inside
sinus cavities inflamed by a bacterial or
viral infection. Chronic sinusitis
usually results from an allergic reaction
to smoke, dust, animal fur, or similar
irritants.
* Referred pain. This type of pain is
felt in a part of the body at a distance
from the injured or diseased area.
Headache pain may be referred from
diseased teeth; disks in the cervical
spine that have been damaged by
spondylosis (degeneration of the spinal
vertebrae caused by osteoarthritis); or
the temporomandibular joint, the small
joint in front of the ear where the lower
jaw is attached to the skull.
* Idiopathic intracranial hypertension.
Also known as pseudotumor cerebri, this
disorder is caused by increased pressure
inside the skull in the absence of any
abnormality of the central nervous system
or blockage in the flow of the
cerebrospinal fluid. In addition to
headache, patients with this disorder
experience diplopia (seeing double) and
other visual symptoms.
References:
1- Medicinenet.com,
2- The National Headache foundation,
3- The Journal of Headache and face
pain, 4- The American Headache
Society, 5- Headaches By Robert S.
Kunkel, Cleveland clinic press
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