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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.

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headache /head·ache/ (hed´āk) pain in the head.

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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.

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head·ache (hdk)

n.

A pain in the head. Also called cephalalgia.

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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.

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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.

See neuralgia, facial, atypical.

See neuralgia, facial, atypical.

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.

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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

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Patient discussion about headachy.

Q. What can i do other than taking Imitrex for my reccuring migraine headaches?

A. My doctor put me on a lose dose of blood pressure medication as a preventive...Nadolol..working up to 40 mg which the
neurologist says that is a low dose( no I have no BP problems)
and gave me Maxalt 10mg...Imitrex didn't work for me. I have neurological affects with min.,
Good Luck!

Q. Is there a natural way to stop a headache? Can you stop headaches without having to take any medicine?

A. I read in a natural remedy book once that to rub mint oil on your temples will eleveate the headache, so I tried it once at a friends house when I had a pounding headache and sure enough, it worked!!! With no medicine at all just mint oil on cotton balls and rub on your temples for a while

Q. I have a pain in the side of my head how can I know if it is serious? In the last two days i have a pain in the side of my head. The pain is more severe after eating but I can feel it almost all the time. how can I know if its something severe or just a temporal mandibular joint (TMJ) syndrome ?

A. IHAVE TO GO TO THE DOCTOR OR U CAN USE TEMPROTAR