Headaches

A headache is a very common form of pain and complaint about almost anybody. The pain may start from any of the parts surrounding the skull or the brain. This includes inflammation or irritation of any of the tissues, bones, muscles, blood vessels and nerves in and around the skull.

People experience a headache in different ways – throbbing or squeezing, episodic or persistent, localized or generalized, and mild or intense. The pain may arise all on a sudden or after specific activities. In some cases, particularly migraine headaches, it is associated with vomiting or nausea.

Headaches are categorized into three based on the cause of pain – primary headaches, secondary headaches, and other headaches including facial pain and cranial neuralgias. A person may have symptoms of more than one type of a headache at a time.

Primary headaches include some common forms of pain like migraines, tension, cluster headaches and some less common forms of headaches. Primary headaches are generally not a symptom of any specific disease.

It is usually caused by increased activity of the structures that are sensitive to pain. Some primary headaches are caused by lifestyle factors including alcohol, lack of sleep, skipping meals and stress.

Secondary headaches are caused by structural abnormalities in the head or upper neck. It is often a symptom of a disease like sinusitis, brain aneurysm, dehydration, hypertension, or the flu. Some examples of this form of a headache are a pain due to infected teeth, hangover headaches, and trauma headaches.

Cranial neuralgia refers to the pain arising from inflammation of any of the cranial nerves. Trigeminal neuralgia, caused by inflamed trigeminal nerve, causes intense pain in the face. This category has a number of other forms of less common headaches.

Tension headaches are characterized by mild to moderate pain which has a gradual onset, usually towards the middle of the day. The intensity of chronic tension headache varies throughout the day, but the pain persists.

Migraines, on the other hand, have moderate to severe pain that either affects the whole head or one side. The pain may shift sides as the day progresses. Cluster headaches are throbbing in nature and are often experienced as a piercing pain.

The pain is felt in the eye or behind the eyes. Sinus headaches are felt in the cheekbones and forehead. The pain often increases with movement of the head or with stressful activities. It is usually associated with running nose, fever, and swelling of the face.

Some types of headaches are associated with other symptoms like vomiting and nausea. Tension headaches that are often felt in the front or top side of the head are associated with difficulty in sleeping, fatigue, irritability, and difficulty in concentration.

Migraines are accompanied by sensitivity to light, blurred vision, loss of appetite, fatigue, and dizziness. In most of the cases, headache is not a serious issue and can be resolved easily. In some rare cases, it may indicate something serious like a brain tumor, meningitis or stroke.

A headache may indicate a serious illness if it is: 

• severe and has a sudden onset
• worsens over time
• associated with head injury
• triggered by exercise, coughing or sneezing
• associated with other symptoms like weakness, slurred speech, confusion or drowsiness
• associated with symptoms like high fever, stiff neck, blurred vision, or jaw pain

The above-mentioned symptoms require medical attention.

Treatment depends on the cause of a headache. Many headaches resolve on its own with lifestyle changes and without any specific medications. Over-the-counter pain relievers are commonly used for alleviating pain. Practicing relaxation techniques are also effective in improving the symptom.

Headaches are categorized into three based on the cause of pain.A primary headache is caused by the exaggerated activity of the pain structures in the brain. It may also be caused by abnormal activities of chemicals in the brain.

Blood vessels, muscles, and nerves also play a role in this symptom. For example, inflammation of muscles that cover the skull may cause spasm and thus pain. Migraines are caused by inflammation and irritation of structures around the skull.

Primary headaches may also be triggered by:

• Lifestyle factors
• Alcohol
• Poor posture
• Lack of adequate sleep
• Not having food on time
• Stress
• Certain foods, particularly those that contain nitrates

Secondary headaches are caused by an underlying condition or disease. Thus secondary headache is a symptom of a disease that affects the pain centers.

Some of the possible causes of a secondary headache are:

• Thrombosis in brain
• Sinusitis
• An aneurysm and tumor in brain
• Inflammation of brain
• Giant cell arteritis
• Abnormal formation of blood vessels in brain
• Dehydration
• Carbon monoxide poisoning
• Concussion
• Dental infections and inflammation
• Middle ear infection
• Glaucoma
• Hangover
• Hypertension
• Influenza
• Intracranial hematoma
• Meningitis
• Monosodium glutamate
• Panic disorder
• Stroke

Inflammation of the cranial nerves results in neuralgia. These nerves control the functioning of the muscles and also carry pain signals to and fro. Trigeminal neuralgia is the most common form of cranial neuralgias.

Some headaches are caused as a side effect of medication, while certain others are caused due to an overdose of painkillers. Women suffer from hormonal headaches, which is linked to menstrual periods.

Certain contraceptive pills, menopause, and pregnancy may also cause headaches in women. Spinal headaches are caused by low pressure or low volume in the cerebrospinal fluid. This may result from spinal anesthesia or spinal tap.

Some headgears like helmet may cause external compression headaches. Sleep apnea, a condition characterized by relaxation and narrowing of the throat during sleep, is also known to cause headaches.

In most of the cases, a headache is not a serious condition. It is likely to be a serious issue if it occurs suddenly and is severe. If it is accompanied by any of the symptoms of brain disease, like weakness, confusion, slurred speech, memory loss, or drowsiness, it requires immediate medical attention.

Some other symptoms like high fever, stiff neck, pain in the jaw while chewing, vision problems, and pain in one of the eyes, also should be considered serious. Headache accompanying head injury is also serious and needs attention.

Diagnosis of a headache is usually based on the description of the type, occurrence, pattern, and timing of pain attacks. Evaluation of other symptoms and medical history also help in the diagnosis of the specific cause.

Among the primary headaches, tension headaches are usually diagnosed based on responses to questions about the duration and quality of pain. Physical and neurologic examination check for tenderness in scalp or neck.

Any abnormality in the neurologic examination may require further tests to confirm the diagnosis of underlying disease or cause. Diagnosis of cluster headaches often depends on the history of pain. The patient may present with running nose and watering eyes if the patient comes during an episode of a cluster headache.

Secondary headaches are diagnosed based on patient history and physical examination followed by laboratory and imaging tests. Tests suggested will depend on the evaluation and the probable cause of a headache.

Some common tests recommended in the diagnosis of headache include: 

• Blood tests
• Lumbar puncture
• Imaging techniques like x-ray, CT scan, and MRI

Blood tests show increased levels of white blood cells in case of inflammation and infection in the body. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are two tests that are commonly used in the diagnosis of inflammation and infections.

Blood tests also help in detecting electrolyte imbalance, and also problems related to any of the organs including liver or kidney. Toxicology tests are suggested for patients who have a history of drug or alcohol abuse. This is also helpful in case of drug overdose.

Imaging techniques like CT scan are useful in detecting bleeding, inflammation, aneurysms and tumors in the brain. It is also useful in indicating the previous stroke. MRI is often used to have a better picture of the structures in the brain.

Lumbar puncture is a procedure in which the cerebrospinal fluid is obtained with the help of a needle inserted into the spine. Examination of cerebrospinal fluid helps to detect infection and hemorrhage in the brain and spinal cord.

Increased pressure during insertion of a needle for lumbar puncture indicates idiopathic intracranial hypertension. Primary headaches are not life-threatening but affect the daily activities of the person. In most of the cases, over-the-counter pain medications are helpful in controlling pain. 

Medications like aspirin, ibuprofen, acetaminophen, and naproxen are commonly used in relieving pain associated with tension headaches. Cluster headaches do not have any specific treatment method and are usually individual-centric.

Treatment method for cluster headaches usually has two stages – 1. Control of pain of the first episode of a headache, and 2. Prevention of a following headache. Spraying lidocaine into the nostril, triptan injections, and inhalation of high concentration of oxygen are useful in controlling pain from the first episode.

The next cluster headache can be controlled by antidepressant medications, prednisone, and calcium channel blockers. Rebound headaches caused by excessive use of pain medications can be controlled by reduction of the medication.

Many home remedies and lifestyle changes help to control primary headaches. Regular exercise, enough sleep, adequate hydration, stress reduction, and elimination of certain food from the diet may all help in controlling headaches. Physical therapy, massage, and biofeedback are also suggested in the control of headaches.

Treatment of a secondary headache depends on the underlying cause of a headache. This may require medication, hospitalization, or surgery, based on the cause. In any case, an unusual headache should be evaluated by a doctor and self-prescription should be avoided. But in most of the cases, headaches can be treated at home and resolved successfully.