headache

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Headache

 

Definition

A headache involves pain in the head which can arise from many disorders or may be a disorder in and of itself.

Description

There are three types of primary headaches: tension-type (muscular contraction headache), migraine (vascular headaches), and cluster. Virtually everyone experiences a tension-type headache at some point. An estimated 18% of American women suffer migraines, compared to 6% of men. Cluster headaches affect fewer than 0.5% of the population, and men account for approximately 80% of all cases. Headaches caused by illness are secondary headaches and are not included in these numbers.
Approximately 40-45 million people in the United States suffer chronic headaches. Headaches have an enormous impact on society due to missed workdays and productivity losses.

Causes and symptoms

Traditional theories about headaches link tension-type headaches to muscle contraction, and migraine and cluster headaches to blood vessel dilation (swelling). Pain-sensitive structures in the head include blood vessel walls, membranous coverings of the brain, and scalp and neck muscles. Brain tissue itself has no sensitivity to pain. Therefore, headaches may result from contraction of the muscles of the scalp, face or neck; dilation of the blood vessels in the head; or brain swelling that stretches the brain's coverings. Involvement of specific nerves of the face and head may also cause characteristic headaches. Sinus inflammation is a common cause of headache. Keeping a headache diary may help link headaches to stressful occurrences, menstrual phases, food triggers, or medication.
Tension-type headaches are often brought on by stress, overexertion, loud noise, and other external factors. The typical tension-type headache is described as a tightening around the head and neck, and an accompanying dull ache.
Migraines are intense throbbing headaches occurring on one or both sides of the head, usually on one side. The pain is accompanied by other symptoms such as nausea, vomiting, blurred vision, and aversion to light, sound, and movement. Migraines often are triggered by food items, such as red wine, chocolate, and aged cheeses. For women, a hormonal connection is likely, since headaches occur at specific points in the menstrual cycle, with use of oral contraceptives, or the use of hormone replacement therapy after menopause. Research shows that a complex interaction of nerves and neurotransmitters in the brain act to cause migraine headaches.
Cluster headaches cause excruciating pain. The severe, stabbing pain centers around one eye, and eye tearing and nasal congestion occur on the same side. The headache lasts from 15 minutes to four hours and may recur several times in a day. Heavy smokers are more likely to suffer cluster headaches, which also are associated with alcohol consumption.

Diagnosis

Since headaches arise from many causes, a physical exam assesses general health and a neurologic exam evaluates the possibility of neurologic disease as a cause for the headache. If the headache is the primary illness, the doctor asks for a thorough history of the headache. Questions revolve around its frequency and duration, when it occurs, pain intensity and location, possible triggers, and any prior symptoms. This information aids in classifying the headache.
Warning signs that should point out the need for prompt medical intervention include:
  • "Worst headache of my life." This may indicate subarachnoid hemorrhage from a ruptured aneurysm (swollen blood vessel) in the head or other neurological emergency.
  • Headache accompanied by one-sided weakness, numbness, visual loss, speech difficulty, or other signs. This may indicate a stroke. Migraines may include neurological symptoms.
  • Headache that becomes worse over a period of 6 months, especially if most prominent in the morning or if accompanied by neurological symptoms. This may indicate a brain tumor.
  • Sudden onset of headache. If accompanied by fever and stiff neck, this can indicate meningitis.
Headache diagnosis may include neurological imaging tests such as computed tomography scan (CT scan) or magnetic resonance imaging (MRI).

Treatment

Headache treatment is divided into two forms: abortive and prophylactic. Abortive treatment addresses a headache in progress, and prophylactic treatment prevents headache occurrence.
Tension-type headaches can be treated with aspirin, acetaminophen, ibuprofen, or naproxen. In early 1998, the FDA approved extra-strength Excedrin, which includes caffeine, for mild migraines. Physicians continue to investigate and monitor the best treatment for migraines and generally prefer a stepped approach, depending on headache severity, frequency and impact on the patient's quality of life. A group of drugs called triptans are usually preferred for abortive treatment. About seven triptans are available in the United States and the pill forms are considered most effective. They should be taken as early as possible during the typical migraine attack. The most common prophylactic therapies include antidepressants, beta blockers, calcium channel blockers and antiseizure medications. Antiseizure medications have proven particularly effective at blocking the actions of neurotransmitters that start migraine attacks. Topiramate (Topamax) was shown effective in several combined clinical trials in 2004 at 50 to 200 mg per day.
In 2004, a new, large study added evidence to show the effectiveness of botulinum toxin type A (Botox) treatment to prevent headache pain for those with frequent, untreatable tension and migraine headaches. Patients were treated every three months, with two to five injections each time. They typically received relief within two to three weeks.
Cluster headaches may also be treated with ergotamine and sumatriptan, as well as by inhaling pure oxygen. Prophylactic treatments include prednisone, calcium channel blockers, and methysergide.

Alternative treatment

Alternative headache treatments include:
  • acupuncture or acupressure
  • biofeedback
  • chiropractic
  • herbal remedies using feverfew (Chrysanthemum parthenium), valerian (Valeriana officinalis), white willow (Salix alba), or skullcap (Scutellaria lateriflora), among others
  • homeopathic remedies chosen specifically for the individual and his/her type of headache
  • hydrotherapy
  • massage
  • magnesium supplements
  • regular physical exercise
  • relaxation techniques, such as meditation and yoga
  • transcutaneous electrical nerve stimulation (TENS) (A procedure that electrically stimulates nerves and blocks the signals of pain transmission.)

Prognosis

Headaches are typically resolved through the use of analgesics and other treatments. Research in 2004 showed that people who have migraine headaches more often than once a month may be at increased risk for stroke.

Prevention

Some headaches may be prevented by avoiding triggering substances and situations, or by employing alternative therapies, such as yoga and regular exercise. Since food allergies often are linked with headaches, especially cluster headaches, identification and elimination of the allergy-causing food(s) from the diet can be an important preventive measure.

Key terms

Abortive — Referring to treatment that relieves symptoms of a disorder.
Analgesics — A class of pain-relieving medicines, including aspirin and Tylenol.
Biofeedback — A technique in which a person is taught to consciously control the body's response to a stimulus.
Chronic — Referring to a condition that occurs frequently or continuously or on a regular basis.
Prophylactic — Referring to treatment that prevents symptoms of a disorder from appearing.
Transcutaneous electrical nerve stimulation — A method that electrically stimulates nerve and blocks the transmission of pain signals, called TENS.

Resources

Periodicals

Kruit, Mark C., et al. "Migraine as a Risk Factor for Subclinical Brain Lesions." JAMA, Journal of the American Medical Association January 28, 2004: 427-435.
Norton, Patrice G. W. "Botox Stops Headache Pain in Recalcitrant Cases." Clinical Psychiatry News March 2004: 72.
Taylor, Frederick, et al. "Diagnosis and Management of Migraine in Family Practice." Journal of Family Practice January 2004: S3-S25.

Organizations

American Council for Headache Education (ACHE). 19 Mantua Road, Mt. Royal, NJ 08061. (800) 255-2243. http://www.achenet.org.
National Headache Foundation. 428 W. St. James Place, Chicago, IL 60614. (800) 843-2256. http://www.headaches.org.

headache

 [hed´āk]
pain in the head; see also migraine. One of the most common ailments of humans, it is a symptom rather than a disorder in itself; it accompanies many diseases and conditions, including emotional distress. Although recurring headache may be an early sign of serious organic disease, relatively few headaches are caused by disease-induced structural changes. Most result from vasodilation of blood vessels in tissues surrounding the brain, or from tension in the neck and scalp muscles.

Immediate attention by a health care provider is indicated when (1) a severe headache comes on suddenly without apparent cause; (2) there are accompanying symptoms of neurological abnormality, for example, blurring of vision, mental confusion, loss of mental acuity or consciousness, motor dysfunction, or sensory loss; or (3) the headache is highly localized, as behind the eye or near the ear, or in one location in the head. Fever and stiffness of the neck accompanying the headache may indicate meningitis.
cluster headache a migraine-like disorder marked by attacks of unilateral intense pain over the eye and forehead, with flushing and watering of the eyes and nose; attacks last about an hour and occur in clusters.
exertional headache one occurring after exercise.
histamine headache cluster headache.
lumbar puncture headache headache in the erect position, and relieved by recumbency, following lumbar puncture, due to lowering of intracranial pressure by leakage of cerebrospinal fluid through the needle tract.
migraine headache migraine.
organic headache headache due to intracranial disease or other organic disease.
tension headache a type due to prolonged overwork or emotional strain, or both, affecting especially the occipital region.
toxic headache headache due to systemic poisoning or associated with illness.
vascular headache a classification for certain types of headaches, based on a proposed etiology involving abnormal functioning of the blood vessels or vascular system of the brain; included are migraine, cluster headache, toxic headache, and headache caused by elevated blood pressure.

cyclosporine ophthalmic emulsion

Restasis, Sandimmun (UK)CNS: tremor, headache, confusion, paresthesia, insomnia, anxiety, depression, lethargy, weakness

Pharmacologic class: Polypeptide antibiotic

Therapeutic class: Immunosuppressant

Pregnancy risk category C

Respiratory: cough, dyspnea, Pneumocystis jiroveci pneumonia, bronchospasm

FDA Box Warning

• Drug should be prescribed only by physicians experienced in managing systemic immunosuppressive therapy for indicated disease. At doses used for solid-organ transplantation, it should be prescribed only by physicians experienced in immunosuppressive therapy and management of organ transplant recipients. Patient should be managed in facility with adequate laboratory and medical resources. Physician responsible for maintenance therapy should have complete information needed for patient follow-up.

• Neoral may increase susceptibility to infection and neoplasia. In kidney, liver, and heart transplant patients, drug may be given with other immunosuppressants.

• Sandimmune should be given with adrenal corticosteroids but not other immunosuppressants. In transplant patients, increased susceptibility to infection and development of lymphoma and other neoplasms may result from increased immunosuppression.

• Sandimmune and Neoral aren't bioequivalent. Don't use interchangeably without physician supervision.

• In patients receiving Sandimmune soft-gelatin capsules and oral solution, monitor at repeated intervals (due to erratic absorption).

Action

Unclear. Thought to act by specific, reversible inhibition of immunocompetent lymphocytes in G0-G1 phase of cell cycle. Preferentially inhibits T lymphocytes; also inhibits lymphokine production. Ophthalmic action is unknown.

Availability

Capsules: 25 mg, 100 mg

Injection: 50 mg/ml

Oral solution: 100 mg/ml

Solution (ophthalmic): 0.05% (0.4 ml in 0.9 ml single-use vial)

Indications and dosages

Psoriasis

Adults:Neoral only-1.25 mg/kg P.O. b.i.d. for 4 weeks. Based on patient response, may increase by 0.5 mg/kg/day once q 2 weeks, to a maximum dosage of 4 mg/kg/day.

Severe active rheumatoid arthritis

Adults:Neoral only-1.25 mg/kg P.O. b.i.d. May adjust dosage by 0.5 to 0.75 mg/kg/day after 8 weeks and again after 12 weeks, to a maximum dosage of 4 mg/kg/day. If no response occurs after 16 weeks, discontinue therapy. Gengraf only-2.5 mg/kg P.O. daily given in two divided doses; after 8 weeks, may increase to a maximum dosage of 4 mg/kg/day.

To prevent organ rejection in kidney, liver, or heart transplantation

Adults and children:Sandimmune only-Initially, 15 mg/kg P.O. 4 to 12 hours before transplantation, then daily for 1 to 2 weeks postoperatively. Reduce dosage by 5% weekly to a maintenance level of 5 to 10 mg/kg/day. Or 5 to 6 mg/kg I.V. as a continuous infusion 4 to 12 hours before transplantation.

To increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca

Adults: 1 drop in each eye b.i.d. given 12 hours apart

Off-label uses

• Aplastic anemia
• Atopic dermatitis

Contraindications

• Hypersensitivity to drug and any ophthalmic components
• Rheumatoid arthritis, psoriasis in patients with abnormal renal function, uncontrolled hypertension, cancer (Gengraf, Neoral)
• Active ocular infections (ophthalmic use)

Precautions

Use cautiously in:
• hepatic impairment, renal dysfunction, active infection, hypertension
• herpes keratitis (ophthalmic use)
• pregnant or breastfeeding patients
• children younger than age 16 (safety and efficacy not established for ophthalmic use).

Administration

• For I.V. infusion, dilute as ordered with dextrose 5% in water or 0.9% normal saline solution. Administer over 2 to 6 hours.
• Mix Neoral solution with orange juice or apple juice to improve its taste.
• Dilute Sandimmune oral solution with milk, chocolate milk, or orange juice. Be aware that grapefruit and grapefruit juice affect drug metabolism.
• In postoperative patients, switch to P.O. dosage as tolerance allows.
• Be aware that Sandimmune and Neoral aren't bioequivalent. Don't use interchangeably.
• Before administering eyedrops, invert unit-dose vial a few times to obtain a uniform, white, opaque emulsion.
• Know that eyedrops can be used concomitantly with artificial tears, allowing a 15-minute interval between products.

Adverse reactions

CNS: tremor, headache, confusion, paresthesia, insomnia, anxiety, depression, lethargy, weakness

CV: hypertension, chest pain, myocardial infarction

EENT: visual disturbances, hearing loss, tinnitus, rhinitis; (with ophthalmic use) ocular burning, conjunctival hyperemia, discharge, epiphora, eye pain, foreign body sensation, itching, stinging, blurring

GI: nausea, vomiting, diarrhea, constipation, abdominal discomfort, gastritis, peptic ulcer, mouth sores, difficulty swallowing, anorexia, upper GI bleeding, pancreatitis

GU: gynecomastia, hematuria, nephrotoxicity, renal dysfunction, glomerular capillary thrombosis Hematologic: anemia, leukopenia, thrombocytopenia

Metabolic: hyperglycemia, hypomagnesemia, hyperuricemia, hyperkalemia, metabolic acidosis

Musculoskeletal: muscle and joint pain

Respiratory: cough, dyspnea, Pneumocystis jiroveci pneumonia, bronchospasm

Skin: acne, hirsutism, brittle fingernails, hair breakage, night sweats

Other: gum hyperplasia, flulike symptoms, edema, fever, weight loss, hiccups, anaphylaxis

Interactions

The following interactions pertain to oral and I.V. routes only.

Drug-drug.Acyclovir, aminoglycosides, amphotericin B, cimetidine, diclofenac, gentamicin, ketoconazole, melphalan, naproxen, ranitidine, sulindac, sulfamethoxazole, tacrolimus, tobramycin, trimethoprim, vancomycin: increased risk of nephrotoxicity

Allopurinol, amiodarone, bromocriptine, clarithromycin, colchicine, danazol, diltiazem, erythromycin, fluconazole, imipenem and cilastatin, itraconazole, ketoconazole, methylprednisolone, nicardipine, prednisolone, quinupristin/dalfopristin, verapamil: increased cyclosporine blood level

Azathioprine, corticosteroids, cyclophosphamide: increased immunosuppression Carbamazepine, isoniazid, nafcillin, octreotide, orlistat, phenobarbital, phenytoin, rifabutin, rifampin, ticlopidine: decreased cyclosporine blood level

Digoxin: decreased digoxin clearance

Live-virus vaccines: decreased antibody response to vaccine

Lovastatin: decreased lovastatin clearance, increased risk of myopathy and rhabdomyolysis

Potassium-sparing diuretics: increased risk of hyperkalemia

Drug-diagnostic tests.Alanine aminotransferase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, glucose, low-density lipoproteins: increased levels

Hemoglobin, platelets, white blood cells: decreased values

Drug-food.Grapefruit, grapefruit juice: decreased cyclosporine metabolism, increased cyclosporine blood level

High-fat diet: decreased drug absorption (Neoral)

Drug-herbs.Alfalfa sprouts, astragalus, echinacea, licorice: interference with immunosuppressant action St. John's wort: reduced cyclosporine blood level, possibly leading to organ rejection

Patient monitoring

• Observe patient for first 30 to 60 minutes of infusion. Monitor frequently thereafter.
• Monitor cyclosporine blood level, electrolyte levels, and liver and kidney function test results.
• Assess for signs and symptoms of hyperkalemia in patients receiving concurrent potassium-sparing diuretic.

Patient teaching

• Advise patient to dilute Neoral oral solution with orange or apple juice (preferably at room temperature) to improve its flavor.
• Instruct patient to use glass container when taking oral solution. Tell him not to let solution stand before drinking, to stir solution well and then drink all at once, and to rinse glass with same liquid and then drink again to ensure that he takes entire dose.
• Tell patient taking Neoral to avoid high-fat meals, grapefruit, and grapefruit juice.
• Advise patient to dilute Sandimmune oral solution with milk, chocolate milk, or orange juice to improve its flavor.
• Instruct patient to invert vial a few times to obtain a uniform, white, opaque emulsion before using eyedrops and to discard vial immediately after use.
• Inform patient that eyedrops can be used with artificial tears but to allow 15-minute interval between products.
• Caution patient not to wear contact lenses because of decreased tear production; however, if contact lenses are used, advise patient to remove them before administering eyedrops and to reinsert 15 minutes after administration.
• Inform patient that he's at increased risk for infection. Caution him to avoid crowds and exposure to illness.
• Instruct patient not to take potassium supplements, herbal products, or dietary supplements without consulting prescriber.
• Tell patient he'll need to undergo repeated laboratory testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.

head·ache

(hed'āk),
Pain in various parts of the head, not confined to the area of distribution of any nerve.
See also: cephalodynia.

headache

/head·ache/ (hed´āk) pain in the head.
cluster headache  a migraine-like disorder marked by attacks of unilateral intense pain over the eye and forehead, with flushing and watering of the eyes and nose; attacks last about an hour and occur in clusters.
exertional headache  one occurring after exercise.
histamine headache  cluster h.
lumbar puncture headache  headache in the erect position, relieved by recumbency, after lumbar puncture; due to lowering of intracranial pressure by leakage of cerebrospinal fluid through the needle tract.
migraine headache  migraine.
organic headache  headache due to intracranial disease or other organic disease.
postcoital headache  one occurring during or after sexual activity, usually in males.
sick headache  migraine.
tension headache  a type due to prolonged overwork, emotional strain, or both, affecting especially the occipital region.
toxic headache  headache due to systemic poisoning or associated with illness.
vascular headache  a classification for certain types of headaches, based on a proposed etiology involving abnormal functioning of the blood vessels or vascular system of the brain; included are migraine, cluster headache, toxic headache, and headache caused by elevated blood pressure.

headache

(hĕd′āk′)
n.
A pain in the head.

head′ach′y (-ā′kē) adj.

headache

[hed′āk]
Etymology: AS, heafod + acan, to hurt
a pain in the head from any cause. Kinds of headaches include cluster headache, functional headache, histamine headache, migraine headache, organic headache, sinus headache, and tension headache. Also called cephalalgia, cephalgia.

headache

Pain management A painful sensation localized in the cranium. Related terms are Alarm clock headache, Benign headache, Benign exertional headache, Cluster headache, Food headache, Hangover headache, Hotdog headache, Ice cream headache, Migraine headache, Orgasmic headache, Postoperative headache, Roller coaster headache, Tension headache, Weight-lifter's headache

head·ache

(HA) (hed'āk)
Pain in various parts of the head, not confined to the area of distribution of any nerve.
See also: cephalodynia
Synonym(s): cephalalgia, encephalalgia.

head·ache

(hed'āk)
Pain in various cranial areas.

headache,

n a pain in the cranial vault resulting from intracranial, extracranial, or psychogenic causes: intracranial vascular dilation; space-occupying lesions; diseases of the eyes, ears, and sinuses; extracranial vascular dilation; sustained muscular contraction; hysteria; certain habit patterns (clenching); and reaction to stress.
headache, migraine,
n a vascular type of headache, typically unilateral in the temporal, frontal, and retroorbital area, but may occur midface. It is described as throbbing, burning, pulsating, exploding, or pressure and may become generalized and persist for hours or days. Onset of pain is usually preceded by prodromal symptoms that may include visual disturbances, scotomas, vomiting, and nausea. A migraine headache is usually considered to be a psychophysiologic (psychosomatic) disorder.

Patient discussion about headache

Q. Are there different Kinds of Headaches? I noticed that my headaches don't always feel the same way. Are there different kinds of headaches?

A. There are a few kinds of headaches:
1. Tension headaches: caused by stress, fatigue, poor posture, eye strain, tobacco and alcohol use or before and after a period (for women).
2. Migraine headache: Migraine is the cause of 20 per cent of all headaches. This type of headache occurs when blood vessels of the head and neck constrict, resulting in a decrease in blood flow to the vessels.

Q. What are some ways to treat headaches? I have been suffering from headaches for a long time now. How can I treat them?

A. If the doctor has examined you without finding any serious cause for the headaches, these tips might help:
• Avoid excessive use of alcohol and tobacco.
• Engage in correct posture while sitting and working. The type of chair you use is important. It should be one that maximizes comfort and good posture and may need to be adjusted to suit your needs.
• Perform relaxation techniques on a consistent basis.
• Get plenty of fresh air and exercise.
• Some people find that taking the natural herbal treatment Feverfew is very effective at reducing or preventing their headaches occurring. This needs to be taken daily – even if no headache is present – to have an effect. Consult your GP before starting this.

Q. How common are headaches in fibromyalgia? Recently my friend was diagnosed as fibromyalgia. He often suffers from headaches. How common are headaches in fibromyalgia?

A. Yes, headaches are seen in person with fibromyalgia which is called as tension-type or recurrent migraine headaches. These headaches are seen in about seventy percent of fibromyalgia. For some people, aggressive treatment of the migraines also provides tremendous relief of the overall pain of fibromyalgia. A comprehensive article on the causes and treatments of headaches in people with fibromyalgia was provided in the July 2005 issue of the Fibromyalgia Network Journal.

More discussions about headache
References in classic literature ?
As soon as the former lady had got better of her headache, he waited upon her in her apartment; and, after the proper inquiries in regard to her health, he asked her if she had observed in the hotel an American family--a mamma, a daughter, and a little boy.
He awoke to the joys of a solitary tea, for his mother never came down, and Fanny shut herself and her headache up in her own room.
I do truly wish I could have had the headache in your place, Marilla.
The only remedy for such a headache as mine is going to bed.
Who will wonder that Barbara had a headache, or that Barbara's mother was disposed to be cross, or that she slightly underrated Astley's, and thought the clown was older than they had taken him to be last night?
When Augustine, pale as death, was found lying on the sofa, and pleaded sudden sick-headache as the cause of his distress, she recommended to him to smell of hartshorn; and when the paleness and headache came on week after week, she only said that she never thought Mr.
Miss Dearborn commonly went home with a headache, and never left her bed during the rest of the afternoon or evening; and the casual female parent who attended the exercises sat on a front bench with beads of cold sweat on her forehead, listening to the all-too-familiar halts and stammers.
When she had had a headache in India she had done her best to see that everybody else also had a headache or something quite as bad.
She sent a message downstairs, after they had assembled at the table, to say that a headache was keeping her in her own room.
It was the popular theme for jests; it was the best cure for headache, it infallibly prevented the hair from turning grey, it imparted a peculiar delicacy to the complexion, it was the National Razor which shaved close: who kissed La Guillotine, looked through the little window and sneezed into the sack.
Fanny," said Edmund, after looking at her attentively, "I am sure you have the headache.
Sometimes after a heavy night he had such a headache that he could not drink his coffee, and he gave his lesson with heaviness of spirit.