A Headache is defined as a pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes. There are three major categories of headaches
- Primary headaches,
- Secondary headaches, and
- Cranial neuralgia, facial pain, and other headaches
Assessment of headache should be comprehensive for example to include
- Age at onset
- Presence or absence of aura and prodrome
- Frequency, intensity and duration of attack
- Number of headache days per month
- Quality, site, and radiation of pain
- Associated symptoms and abnormalities
Primary headaches include migraine, tension and cluster headaches, as well as a variety of other less common types of headache
This is characterized by a trial of paroxysmal headache, vomiting and focal neurological events (usually visual). It is more common in females than in males often there is a family history of migraine. Associated precipitants include:-
- Dietary (cheese, chocolate or red wine)
- Psychological stress
- Avoidance of precipitants
- Relaxation to reduce stress
In acute attack give analgesics: A:Paracetamol 1g immediately then every 4 hours; Max 4g per day OR A: Aspirin 600mg, repeat after 4 hours if needed. Plus C:Metroclopramide oral/IM, 10 mg 3 times daily.
In severe attack give: C: Ergotamine tartrate 1-2 mg, maximum 4mg in 24 hours, not to be repeated at intervals less than 4 days. For prevention purposes give:
C: Propranolol 80-160mg daily OR C:Amitryptiline 10-50mg at night.
- Patient with additional neurological signs or additional risk factors for an alternate diagnosis, such as immune deficiency. These patients require brain imaging
- Sudden onset of a first severe headache may indicate serious organic pathology, such as subarachnoid hemorrhage
- Acute migraine, not responding to treatment
- Recurrent migraine not controlled with prophylactic therapy
Tension headaches and Cluster headaches
While tension headaches are the most frequently occurring type of headache, the cause is most likely contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may spasm and cause pain. Common sites include the base of the skull, the temple and the forehead. Tension headaches occur because of physical or emotional stress placed on the body.
- The pain begins in the back of the head and upper neck and is described as a band-like tightness or pressure.
- Often is described as pressure encircling the head with the most intense pressure over the eyebrows.
- The pain usually is mild (not disabling) and bilateral (affecting both sides of the head).
- The pain is not associated with an aura, nausea,vomiting, or sensitivity to light and sound.
- The pain occurs sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people.
- The pain allows most people to function normally, despite the headache
- The key to making the diagnosis of any headache is the history given by the patient
- If the health care practitioner finds an abnormality, then the diagnosis of tension headache would not be considered until the potential for other types of headaches have been investigated.
Cluster headaches are headaches that come in groups (clusters) lasting weeks or months, separated by pain-free periods of months or years. The cause of cluster headaches is uncertain. Some evidence shows that brain scans performed on patients who are in the midst of a cluster headache, shows abnormal activity in the hypothalamus. Cluster headaches:
- May tend to run in families and this suggests that there may be a genetic role
- May be triggered by changes in sleep patterns
- May be triggered by medications (for example, nitroglycerin)
If an individual is in a susceptible period for cluster headache, cigarette smoking, alcohol, and some foods (for example, chocolate) also can be potential causes for headache.
- Pain typically occurs once or twice daily and last for 30 to 90 minutes
- Attacks tend to occur at about the same time every day
- The pain typically is excruciating and located around or behind one eye.
- The affected eye may become red, inflamed, and watery
Note: Cluster headaches are much more common in men than women.
Prevention cluster headaches
Since cluster headache episodes may be spaced years apart, and since the first headache of a new cluster episode can’t be predicted, daily medication may not be warranted. Lifestyle changes may help minimize the risk of a cluster headache flare. Stopping smoking and minimizing alcohol may prevent future episodes of cluster headache. The use some spices and herbs like ginger and tumeric have proven to be effective in management of pain