Headache: A devastating hamper in day to day life.

Headache: Know better

headache

Headache is a pain in any region of the head. Headaches may occur on one or both sides of the head, be isolated to a specific location, radiate across the head from one point, or have an extremely tight and firm quality. It may appears as a sharp pain, a dull ache, or a throbbing sensation.

It is one of the most familiar symptoms of medical practice. Not all of the structures forming the head are pain sensitive, nor do all the sensitive one responds to all the stimuli.

Causes:

Raised intracranial pressure due to:

  • Expanding lesion within the bony skull. Like- tumors, abscesses, or hemorrhage.
  • Outflow obstruction of venous blood from the skull.
  • Disturbance of absorption of CSF into brain stream.

Meningitis                                 

Migraine

Rupture intracranial aneurysm

Pain from head and neck muscles

  • Grinding teeth at night
  • Impacted wisdom teeth
  • Temporomandibular joint dysfunction
  • Clinches the jaw too tightly

Cervical spondylosis

Temporal arteritis

Tension Headache

Sinusitis

Symptoms:

Raised intracranial pressure:

Sudden onset of headache and initially intermittent and become increasingly severe.

It is usually worst in the morning and is exaggerated by exertion or low position of head.

Nearly always in the frontal region but may present at other areas of the head.

Associated with nausea and vomiting

Papilledema, bradycardia, systolic HTN, and depressed respiration

Meningitis:

Fever, headache, neck rigidity, nausea, and vomiting

Brudzinski sign and Kernig’s sign positive.

Neck pain and sometimes over the entire spine

Pain is usually generalized but prominent, particularly over the back of the head.

Migraine:

Pain may be unilateral or bilateral, may be frontal, Occipital, or generalized.

It associated with nausea, vomiting and /or photophobia and phonophobia.

It is a paroxysmal disorder; attacks last for a portion of or a whole day, rearly 2-3 days with total disease free between episodes.

Rupture intracranial aneurysm:

  1. Acute in onset like a hammer-blow to the head (when caused by ruptured aneurysm)
  2. Sudden onset of intense pain within (or around) one eye which may last for hours, days, or even weeks.
  3. Paralysis of oculomotor is usual.
  4. Features are as like meningitis except for fever

Pain from head and neck muscles:

  1. Pain may radiate over the head or refer to the forehead.
  2. Cervical spondylosis: Neck pain which radiates to head

Temporal arteritis:

Pain chiefly over the temple and frontal region or the occiput or both. It is intense, intolerable, and constant. Throbbing, and occasionally lancinating in nature. With or without visual impairment.

Tension headache:

1. Anxiety symptoms or obvious depression, stress, and tension usually accompanying headache.

2. Tightness, pressure, or constriction (vice-like) may be confined to a small area at

the glabella or extend across the whole forehead like a hat.

Sinusitis:

Nasal symptoms may present with headache, usually on the affected side.

Investigations:

Diagnosis is mainly based on clinical symptoms.

The doctor may advise-

  1. MRI of brain
  2. CT scan of brain and neck
  3. CBC

Treatment:

Treatment is based on the cause. However, the doctor may advise some lifestyle modifications and some symptoms relieving medications. Some treatments are as below-

1. Explanation and reassurance

2. Avoidance of precipitating factors.

3. Medications:

  • Ergometrine tartrate.
  • Analgesic- NSAID (Ibuprofen), Paracetamol, acetylsalicylic acid and cateine
  • Triptans (e.g., sumatriptan, zolmitriptan)
  • Metoclopramide 1Omg for nausea
  • Prochlorperazine (vergon)

4. For prevention: Options for medical prevention include-

  • anti-epileptic drugs (e.g., topiramate, sodium valproate),
  • antidepressants, e.g., amitriptyline.
  • beta-blockers (e.g. propranolol, metoprolol),
  • beta-adrenergic receptor antagonists (e.g. timolol),
  • Botulinum toxin type A administered intra-muscularly to between 31 and 39
  • sites around the head and back of the neck.

5. Lifestyle modification:

  • Getting enough sleep
  • Reducing stress ab senssn,
  • Drinking plenty of water
  • Avoiding certain foods
  • Regular physical exercise

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