HEADACHE

According to the National Headache Foundation, over 45 million Americans suffer from chronic, recurring headaches and of these, 28 million suffer from migraines. About 20% of children and adolescents also have significant headaches.

What types of headaches are there?

There are several types of headaches - 150 diagnostic headache categories have been established!Below is a list of the most common types of headaches.Tension headaches: Also called chronic daily headaches or chronic non-progressive headaches, tension headaches are the most common type of headaches among adults and adolescents. These muscle contraction headaches cause mild to moderate pain and come and go over a prolonged period of time.Migraines: The exact causes of migraines are unknown, although they are related to blood vessel contractions and other changes in the brain as well as inherited abnormalities in certain areas of the brain. Migraine pain is moderate to severe, often described as pounding, throbbing pain. They can last from 4 hours to 3 days and usually occur 1 to 4 times per month. Migraines are associated with symptoms such as light sensitivity; noise or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain. When a child is having a migraine they often look pale, feel dizzy, have blurred vision, fever, stomach upset, in addition to having the above listed symptoms.A small percentage of pediatric migraines include recurrent (cyclic) gastrointestinal symptoms, in which vomiting is most common. Cyclic vomiting means that the symptoms occur on a regular basis -- about once a month. These types of migraines are sometimes called abdominal migraines.Mixed headache syndrome: Also called transformed migraines, this is a combination of migraine and tension headaches. Both adults and children experience this type of headache.Cluster headaches: The least common, although the most severe, type of primary headache, the pain of a cluster headache is intense and may be described as having a burning or piercing quality that is throbbing or constant. The pain is so severe that most cluster headache sufferers cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term "cluster headache" refers to headaches that have a characteristic grouping of attacks. Cluster headaches occur one to three times per day during a cluster period, which may last 2 weeks to 3 months. The headaches may disappear completely (go into "remission") for months or years, only to recur.Sinus headaches: Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead or bridge of the nose. The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.Acute headaches: Seen in children, these are headaches that occur suddenly and for the first time and have symptoms that subside after a relatively short period of time. Acute headaches most commonly result in a visit to the pediatrician's office and/or the emergency room. If there are no neurological signs or symptoms, the most common cause for acute headaches in children and adolescents is a respiratory or sinus infection.Hormone headaches: Headaches in women are often associated with changing hormone levels that occur during menstruation, pregnancy, and menopause. Chemically induced hormone changes, such as with birth control pills, also trigger headaches in some women.Chronic progressive headaches: Also called traction or inflammatory headaches, chronic progressive headaches get worse and happen more often over time. These are the least common type of headache, accounting for less than 5% of all headaches in adults and less than 2% of all headaches in kids. Chronic progressive headaches may be the result of an illness or disorder of the brain or skull.

Are headaches hereditary?

Yes, headaches, especially migraines, have a tendency to run in families. Most children and adolescents (90%) who have migraines have other family members with migraines. When both parents have a history of migraines, there is a 70% chance that the child will also develop migraines. If only one parent has a history of migraines, the risk drops to 25%-50%.
What causes headaches?
Headache pain results from signals interacting between the brain, blood vessels, and surrounding nerves. During a headache, specific nerves of the blood vessels and head muscles are activated and send pain signals to the brain. It's not clear, however, why these signals are activated in the first place.There is a migraine "pain center" or generator in the mid-brain area. A migraine begins when hyperactive nerve cells send out impulses to the blood vessels, causing constriction, followed by the dilation of these vessels and the release of prostaglandins, serotonin, and other inflammatory substances that cause the pulsation to be painful. Serotonin is a naturally occurring chemical essential for certain body processes.Headaches that occur suddenly (acute-onset) are usually due to an illness, infection, cold or fever. Other conditions that can cause an acute headache include sinusitis (inflammation of the sinuses), pharyngitis (inflammation or infection of the throat) or otitis (ear infection or inflammation).In some cases, the headaches may be the result of a blow to the head (trauma) or rarely a sign of a more serious medical condition.Common causes of tension headaches or chronic nonprogressive headaches include emotional stress related to family and friends, work or school; alcohol use; skipping meals; changes in sleep patterns; excessive medication use; tension and depression. Other causes of tension headaches include eyestrain and neck or back strain due to poor posture.Headaches can also be triggered by specific environmental factors that are shared in a family's household, such as exposure to second-hand tobacco smoke strong odors from household chemicals or perfumes, exposure to certain allergens or eating certain foods. Stress, pollution, noise, lighting and weather changes are other environmental factors that can trigger headaches for some people.Too much physical activity can also trigger a migraine in both adults and children.Be sure to consult apsychiatrist to find out what is causing your headaches.

Do children outgrow headaches?

Headaches may improve as children gets older. The headaches may disappear and then return later in life. By junior high school, many boys who have migraines outgrow them, but in girls, migraine frequency increases because of hormone changes. Migraines in adolescent girls are three times more likely to occur than in boys.

How are headaches evaluated and diagnosed?

The good news for headache sufferers is that once a correct headache diagnosis is made, an effective treatment plan can be started.If you have headache symptoms, the first step is to go to your doctor. He or she will perform a complete physical examination and a headache evaluation. During the headache evaluation, your headache history and description of the headaches will be evaluated. You will be asked to describe your headache symptoms and characteristics as completely as possible.A headache evaluation may include a CT scan or MRI if a structural disorder of the central nervous system is suspected. Both of these tests produce cross-sectional images of the brain that can reveal abnormal areas or problems. Skull X-rays are not helpful. An EEG (electroencephalogram) is also unnecessary unless you have experienced a loss of consciousness with a headache.If your headache symptoms become worse or become more frequent despite treatment, ask your doctor for a referral to a specialist. Your family doctor should be able to provide the names of headache specialists. If you need more information, contact one of the organizations in the resource list for a list of member doctors in your state.

How are headaches treated


Your doctor may recommend different types of treatment to try or he or she may recommend further testing, or refer you to a headache specialist. You should establish a reasonable time frame with your family doctor to evaluate your headache symptoms.The proper treatment will depend on several factors, including the type and frequency of the headache and its cause. Not all headaches require medical attention. Treatment may include education, counseling, stress management, biofeedback and medications. The treatment prescribed for you will be tailored to meet your specific needs.






What happens after I start treatment?

When your doctor starts a treatment program, keep track of the results and how the treatment program is working. Keep your scheduled follow-up appointments so your doctor can monitor your progress and make changes in the treatment program as needed.

Tension headaches are the most common type of headaches among adults. They are commonly referred to as muscle contraction headaches or stress headaches.A tension headache may appear periodically ("episodic," less than 15 days per month) or daily ("chronic," more than 15 days per month). An episodic tension headache may be described as a mild to moderate constant band-like pain or tightness or pressure around the forehead or back of the head and neck.These headaches may last from 30 minutes to several days. Episodic tension headaches usually begin gradually, and often occur in the middle of the day.The "severity" of a tension headache increases significantly with its frequency. Chronic tension headaches come and go over a prolonged period of time. The pain is usually throbbing and affects the front, top or sides of the head. Although the pain may vary in intensity throughout the day, the pain is almost always present. Chronic tension headaches do not affect vision, balance or strength.

Who gets tension headaches?

About 30%-80% of the adult population suffers from occasional tension headaches; approximately 3% suffer from chronic daily tension headaches. Women are twice as likely to suffer from tension-type headaches as men.Most people with episodic tension headaches have them no more than once or twice a month, but the headaches can occur more frequently.Chronic tension headaches tend to be more common in females. Many people with chronic tension headaches have usually had the headaches for more than 60-90 days.



What causes tension headaches

There is no single cause for tension headaches. This type of headache is not an inherited trait that runs in families. In some people, tension headaches are caused by tightened muscles in the back of the neck and scalp. This muscle tension may be caused by:
Inadequate rest
Poor posture
Emotional or mental stress, including depression
Anxiety
Fatigue
Hunger
Overexertion
In others, tightened muscles are not part of tension headaches, and the cause is unknown.Tension headaches are usually triggered by some type of environmental or internal stress. The most common sources of stress include family, social relationships, friends, work and school. Examples of stressors include:
Having problems at home/difficult family life
Having a new child
Having no close friends
Returning to school or training; preparing for tests or exams
Going on a vacation
Starting a new job
Losing a job
Being overweight
Deadlines at work
Competing in sports or other activities
Being a perfectionist
Not getting enough sleep
Being over-extended (involved in too many activities/organizations)
Episodic tension headaches are usually triggered by an isolated stressful situation or a build-up of stress. Daily stress, such as from a high-pressured job, can lead to chronic tension headaches.


What are the symptoms of tension headaches?

People with tension headaches commonly report these symptoms:
Mild to moderate pain or pressure affecting the front, top or sides of the head
Headache upon awakening
Difficulty falling asleep and staying asleep
Chronic fatigue
Irritability
Disturbed concentration
Mild sensitivity to light or noise
General muscle aching
A tension headache may appear periodically (episodic, less than 15 days per month) or daily (chronic, more than 15 days per month). Chronic tension headaches may vary in intensity throughout the day, but the pain is almost always present.Unlike migraine headaches, there are no associated neurological symptoms (such as muscle weakness, or blurred vision) in people with tension headaches. In addition, severe sensitivity to light or noise, stomach pain, nausea and vomiting are not symptoms usually associated with tension headaches.


How are tension headaches treated?

The goals of treatment are to prevent further attacks and relieve any current pain. Prevention includes:
Taking the medications recommended by your doctor
Pain relievers
Muscle relaxants
Antidepressants
Others
Avoiding or minimizing the causes or triggers
Stress management/relaxation training
Biofeedback
Home treatments
The goals of treatment are to prevent further attacks and relieve any current pain. Prevention includes:
Taking the medications recommended by your doctor
Pain relievers
Muscle relaxants
Antidepressants
Others
Avoiding or minimizing the causes or triggers
Stress management/relaxation training
Biofeedback
Home treatments
Treating the HeadacheOver-the-counter (OTC) painkiller medications are often the first treatments recommended for tension headaches.Some of these painkillers can also be used to prevent headaches in people with chronic tension headaches.If OTC pain relievers don't help, your doctor may recommend a prescription strength pain reliever or an muscle relaxant.Preventing headaches in chronic sufferersPreventive treatments include painkillers. If those don't work, your health care provider may recommend an antidepressant or another drug to prevent the headache.Keep in mind that medications don't cure headaches and that, over time, pain-relievers and other medications may lose their effectiveness. In addition, all medications have side effects. If you take medication regularly, including products you buy over-the-counter, discuss the risks and benefits with your doctor. Also, remember that pain medications are not a substitute for recognizing and dealing with the stressors that may be causing your headaches.Regardless of the treatment, tension headaches are best treated when the symptoms first begin and are mild, before they become more frequent and painful.

Cluster Headaches
The term "cluster headache" refers to a type of headache that recurs over a period of time. People who have cluster headaches experience an episode one to three times per day during a period of time (the cluster period), which may last from 2 weeks to 3 months. The headaches may disappear completely (go into "remission") for months or years, only to recur. A cluster headache typically awakens a person from sleep 1 to 2 hours after going to bed. These nocturnal attacks can be more severe than the daytime attacks. Attacks appear to be linked to the circadian (or "biological") clock. Most people with cluster headaches will develop cluster periods at the same time each year -- either in the spring or fall or the winter or summer.Cluster headaches are one of the most severe types of headache. It can be 100 times more intense than a migraine attack.

Who gets cluster headaches?


Cluster headaches are the least common type of headaches, affecting less than 1 in 1,000 people. Cluster headaches are a young person's disease: the headaches typically start before age 30. Cluster headaches are more common in men, but more women are starting to be diagnosed with this problem. The male to female ratio is 2-3:1.

What causes cluster headaches


The true biochemical cause of cluster headaches is unknown. However, the headaches occur when a nerve pathway in the base of the brain (the trigeminal-autonomic reflex pathway) is activated. The trigeminal nerve is the main nerve of the face responsible for sensations (such as heat or pain.)When activated, the trigeminal nerve causes the eye pain associated with cluster headaches. The trigeminal nerve also stimulates another group of nerves that causes the eye tearing and redness, nasal congestion and discharge associated with cluster attacks.The activation of the trigeminal nerve appears to come from a deeper part of the brain called the hypothalamus. The hypothalamus is home to our "internal biologic clock" which regulates our sleep and wake cycles on a 24-hour schedule. Recent imaging studies have shown activation or stimulation of the hypothalamus during a cluster attack.Cluster headaches usually are not caused by an underlying brain condition such as a tumor or aneurysm.

What triggers cluster headaches?

The season is the most common trigger for cluster headaches, which often occur in the spring or autumn. Due to their seasonal nature, cluster headaches are often mistakenly associated with allergies or business stress. The seasonal nature of cluster headaches most likely results from stimulation or activation of the hypothalamus (see above).Cluster headaches are also common in people who smoke and drink alcohol frequently. During a cluster period, the sufferer is more sensitive to the action of alcohol and nicotine, and minimal amounts of alcohol can trigger the headaches. During headache-free periods the person can consume alcohol without provoking a headache.

What are the symptoms of a cluster headache

Cluster headaches generally reach their full force within five or ten minutes after onset. The attacks are usually very similar, varying only slightly from one attack to another.
Type of Pain: The pain of cluster headache is almost always one-sided, and during a headache period, the pain remains on the same side. When a new headache period starts, it rarely occurs on the opposite side.
Severity/Intensity of Pain: The pain of a cluster headache is generally very intense and severe and is often described as having a burning or piercing quality. It may be throbbing or constant. The pain is so intense that most cluster headache sufferers cannot sit still and will often pace during an attack.
Location of Pain: The pain is located behind one eye or in the eye region, without changing sides. It may radiate to the forehead, temple, nose, cheek, or upper gum on the affected side. The scalp may be tender, and the pulsing in the arteries often can be felt.
Duration of Pain: The pain of a cluster headache lasts a short time, generally 30 to 90 minutes. It may, however, last from 15 minutes to three hours. The headache will disappear only to recur later that day. Typically, in between attacks, people with cluster headaches are headache free.
Frequency of Headaches: Most sufferers get one to three headaches per day during a cluster period (the time when the headache sufferer is experiencing daily attacks). They occur very regularly, generally at the same time each day, and have been called "alarm clock headaches" because they often awaken the person at the same time during the night.
Most cluster sufferers (80%-90%) have episodic cluster headaches that occur in periods lasting seven days to one year, separated by pain-free episodes lasting 14 days or more.In about 20% of people with cluster headaches, the attacks may be chronic, meaning there are less than 14 headache-free days per year. Chronic cluster headaches vary from episodic cluster headaches, as they are continuous without remission periods.Cluster headaches are not typically associated with nausea or vomiting. It is possible for someone with cluster headaches to also suffer from migraines.

Is there any way to tell that a cluster headache is coming?

Although the pain of a cluster headache starts suddenly, there may be a few subtle signs of the oncoming headache. Some signs include:
Feeling of discomfort or a mild, one-sided burning sensation.
The eye on the side of the headache may become swollen or droop. The pupil of the eye may get smaller and the conjunctiva (the pink tissue that lines the inside of the eyelid) will redden.
Nasal discharge. There may be nasal discharge or congestion and tearing of the eye during an attack, which occur on the same side as the pain.
Excessive sweating.
Flushing of the face on the affected side.
Light sensitivity.

How are cluster headaches treated?

Abortive medications: The most successful treatments are Imitrex (sumatriptan) injections and breathing oxygen through a face mask for twenty minutes. Other choices include: Zomig (zolmitriptan) tablets, ergotamine drugs and intranasal lidocaine.
Preventive medications: Your doctor can prescribe preventive medications to shorten the length of the cluster headache period as well as decrease the severity of the headaches. All cluster headache sufferers should take preventive medication unless their cluster periods last less than two weeks. Some medications used in the prevention of cluster headaches include: calcium channel blockers (verapamil), lithium, divalproex sodium, corticosteroids (only short courses), methysergide, melatonin and Topamax.
Surgery: This may be an option for people with chronic cluster headaches who have not been helped with standard therapy. Most of the procedures involve blocking the trigeminal nerve.
All of these treatments should be used under the direction of a doctor familiar with treating cluster headaches. As with any medication, it is important to carefully follow the label instructions and your doctor's advice.


Migraine headache
A migraine headache is a vascular headache associated with changes in the size of the arteries within and outside of the brain.

Who gets migraines


The National Headache Foundation estimates that 28 million Americans suffer from migraines. More women than men get migraines and a quarter of all women with migraines suffer four or more attacks a month; 35% experience 1-4 severe attacks a month, and 40% experience one or less than one severe attack a month. Each migraine can last from four hours to three days. Occasionally, it will last longer.



What causes migraine headaches

The exact causes of migraines are unknown, but the headaches are linked to changes in the brain as well as to genetic causes. Experts believe that migraines may be caused by inherited abnormalities in certain areas of the brain. People with migraines may inherit the tendency to be affected by certain migraine triggers, such as fatigue, bright lights, and weather changes. Additional possible triggers include:
Emotional stress
Sensitivity to specific chemicals and preservatives in food. Certain foods, beverages and food additives may be responsible for triggering up to 30% of migraines. Aged cheeses, alcoholic beverages, nitrates (sometimes found in processed meats), and monosodium glutamate (MSG) have been linked to migraines.
Caffeine. Excessive caffeine consumption or withdrawal from caffeine can cause headaches when the caffeine level abruptly drops. The blood vessels seem to become sensitized to caffeine. When caffeine is not ingested, a headache may occur. Caffeine itself is often helpful in treating acute migraine attacks.
Changing weather conditions. Storm fronts, barometric pressure changes, strong winds, and altitude changes have been linked to migraines.
Menstrual periods
Tension
Excessive fatigue
Skipping meals
Changes in normal sleep patterns



What are the symptoms of migraines?


The pain of a migraine can be described as a pounding or throbbing. The headache often begins as a dull ache and develops into a throbbing pain. The pain is usually aggravated by physical activity. Migraine pain can be classified as mild, moderate, or severe. Some other associated symptoms of migraine headaches include:
Sensitivity to light, noise, and odors
Nausea and vomiting, stomach upset, abdominal pain
Loss of appetite
Sensations of being very warm or cold
Paleness
Fatigue
Dizziness
Blurred vision
Types of MigrainesThere are several tyoes of migraine headaches, including:
Migraine with aura (classic migraine): This type is usually preceded by an aura. Most often, an aura is a visual disturbance (outlines of lights or jagged light images). This type of migraine usually is much worse than a common migraine.
Migraine without aura (common migraine): This type accounts for 80% of migraine headaches. There is no aura before a common migraine.
Status migrainosus: This is the term used to describe a long-lasting migraine that does not go away on its own.




How are migraines treated?

People with migraine headaches can manage mild-to-moderate attacks at home with the following strategies:
Applying a cold compress to the area of pain
Resting with pillows comfortably supporting the head or neck
Drinking a moderate amount of caffeine
Trying certain over-the-counter headache medications
Resting in a room with little or no sensory stimulation (light, sound, odors)
Withdrawing from stressful surroundings
Sleeping
When these efforts do not help, migraine headaches may be eased with prescription medications. Migraines can be treated in two ways: with abortive therapy or preventive therapy.The goal of abortive therapy is to prevent a migraine attack or to stop it once it starts. Some
Preventive treatments are considered if migraine headaches occur more than once a week. These drugs are meant to lessen the frequency and severity of the migraine attacks.
Medications used to treat high blood pressure.
Antidepressants.
Antiseizure medications.
Some antihistamines and anti-allergy drugs.
Hormones and Headaches

It has been estimated that 70% of migraine sufferers are female. Of these female migraine sufferers, 60%-70% report a menstrual relationship to their migraine attacks.

What is the relationship between hormones and headaches?


Headaches in women, particularly migraines, have been related to changes in the levels of the female hormone estrogen during a woman's menstrual cycle. Estrogen levels drop immediately before the start of the menstrual flow.Premenstrual migraines regularly occur during or after the time when the female hormones, estrogen and progesterone, decrease to their lowest levels.Migraine attacks typically disappear during pregnancy. In one study, 64% of women who described a menstrual link to their headaches noted that their headaches disappeared during pregnancy. However, some women have reported the initial onset of migraines during the first trimester of pregnancy, with disappearance of their headaches after the third month of pregnancy.


What triggers migraines in women?


Birth control pills as well as hormone replacement therapy during menopause have been recognized as migraine triggers in some women. As early as 1966, investigators noted that migraines can become more severe in women taking birth control pills, especially those containing high doses of estrogen.The frequency of side effects, such as headache, decreased in those who took birth control pills containing lower doses of estrogen and did not occur in those who took birth control pills containing progesterone.

What are the treatment options for menstrual migraines?

The medications of choice in the treatment of menstrual migraines are non-steroidal anti-inflammatory medications (NSAIDs).NSAID treatment should be started 2 to 3 days before the menstrual period starts and continue til the period ends. Because the therapy is of short duration, the risk of gastrointestinal side effects is limited.For people who have severe menstrual migraines or who want to continue taking their birth control pills, doctors recommend taking a NSAID, starting on the l9th day of the cycle and continuing through the second day of the next cycle.Other medications prescribed include:
Small doses of ergotamine (including Bellergal-S) or a similar compound, methylergonovine maleate (for example, Methergine)
Beta-blocker drugs such as propranolol
Anticonvulsants such as valproate (Depakote)
Calcium channel blockers such as verapamil
These drugs should also be started 2 to 3 days pre-menses, and continued throughout the menstrual flow.Because fluid retention is often associated with menses, diuretics have been used to prevent menstrual migraine. Some doctors may recommend limiting salt-intake immediately before the start of menses.








What are the treatment options for migraines during pregnancy?

During pregnancy, no treatment is recommended to treat migraines. Medication therapy used to treat migraines can affect the uterus and can cross the placenta and affect the baby, so these medications should be strictly avoided during pregnancy.A mild pain-reliever can be used, such as Tylenol. It is important that pregnant women suffering from headaches discuss the safety of headache medications with their obstetricians and headache specialists before taking anything



Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com