Types of headache
Headaches can be quite debilitating, though not typically life-threatening conditions. Most headaches fall into one of five categories:
1. Tension-type headache
2. Migraine headache
3. Cluster headache
4. Chronic daily headache
5. Medication-overuse headache
TENSION TYPE HEADACHE
Symptoms:
• A band like sensation of pressure or tightness affecting both sides of the head and neck.
• Mild to moderate, continuous pain.
• Pain remains unchanged with physical activity.
• Muscular tenderness experienced in the head, neck, or shoulder regions.
Individuals experiencing tension-type headaches often report feeling stress or tension as a precursor to their headache.
MIGRAINE HEADACHES
Symptoms:
• Intense to severe pain exacerbated by exposure to light, noise, and movement.
• Some individuals may also experience nausea and vomiting.
• Migraine headaches typically persist for several hours but can endure for up to three days.
Triggers:
• Emotional stress and anxiety.
• Menstrual periods.
• Use of birth control pills.
• Physical exertion.
• Fatigue.
• Inadequate sleep.
• Hunger.
• Head injuries.
• Consumption of specific foods or
beverages containing chemicals like nitrites, glutamate, aspartate, and tyramine.
Certain medications and substances, including nitroglycerin, estrogens, hydralazine, perfumes, smoke, and strong-smelling organic solvents.
CLUSTER HEADACHE
Cluster headaches are severe headaches recurring over weeks to months, followed by headache-free intervals. This condition predominantly affects men, with the highest incidence between the ages of 25 and 50 years.
Symptoms:
• Onset is rapid and sudden
• Characterized by deep, excruciating pain, often described as explosive.
• These attacks can occur as frequently as eight times a day but tend to be brief in duration, lasting from 15 minutes to three hours.
• The pain usually originates around the eye or temple, although less commonly, it may begin in the face, neck, ear, or the side of the head.
• Importantly, the pain is consistently limited to one side of the head.
• Associated with symptoms such as redness of the eye and increased tear production on that side, a congested and runny nose, sweating, and a sallow complexion.
CHRONIC DAILY HEADACHE
In certain cases, individuals experience headaches with high frequency, even occurring on a daily basis. When a headache persists for more than 15 days each month for at least three consecutive months, it is termed a chronic daily headache.
MEDICATION-OVERUSE HEADACHE (MOH)
Can develop in individuals who tend to excessively use pain-relieving medications. This creates a harmful cycle wherein frequent headaches prompt frequent medication usage (often non-prescription drugs). However, as the effects of the medication wear off, it triggers a rebound headache, compelling the individual to use more medication, perpetuating the cycle.
DIAGNOSIS
Clinicians typically rely on a patient's headache history, supplemented by a thorough examination, to identify the specific type of headache. It's important to note that some individuals may experience more than one type of headache.
In most cases, there is no necessity for X-rays or imaging tests. However, a CT scan or MRI may be recommended under certain circumstances. For instance, when symptoms are unusual, there are concerning signs, or abnormalities are detected during the examination. Other potential reasons for brain imaging include:
• Headaches that progressively worsen despite treatment.
• A sudden alteration in the headache pattern.
• Presence of signs or symptoms indicating the possibility of an underlying medical condition causing the symptoms.
HEADACHE "DANGER SIGNS"
The vast majority of headaches are not life threatening. You should seek medical attention immediately if your headache:
●Comes on suddenly, becomes severe within a few seconds or minutes, or that could be described as "the worst headache of your life"
●Is severe and occurs with a fever or stiff neck
●Occurs with a seizure, personality changes, confusion, or passing out
●Begins quickly after strenuous exercise or minor injury
●Is new and occurs with weakness, numbness, or difficulty seeing. While migraine headaches can sometimes cause these symptoms, you should be evaluated urgently the first time these symptoms appear.
TREATMENT
Treatment can vary slightly accordingly to type of headache.
MIGRAINE HEADACHE TREATMENT – it depends upon the frequency, severity, and symptoms of your headache.
1. Acute treatment for immediate pain relief.
2. Preventive treatment taken on a regular (usually daily) basis to prevent headaches in the future.
Pain medications — Mild migraine attacks may respond to pain relievers. These include drugs like
●Aspirin
●Acetaminophen
●Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, indomethacin, or naproxen
People with gastritis (inflammation of the stomach), ulcers, kidney disease, and bleeding conditions should not take products containing aspirin or NSAIDs.
Anti-nausea medications — If you have nausea and vomiting with a migraine, you can take an anti-emetics like metoclopramide or prochlorperazine.
Triptans — Migraine-specific treatment. This includes sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan, and frovatriptan.
Ergots — Ergotamine is an older, migraine-specific drug. Ergots can be recommended for people with migraines of a long duration (greater than 48 hours) or that frequently recur. People with high blood pressure, coronary artery disease, or kidney or liver disease should not use ergotamines.
Preventive treatment
Preventive treatment effectively controls migraine headaches in most people, although the benefits of this treatment are evident in three to four weeks.
Beta blockers — Commonly used beta blockers include propranolol, nadolol, atenolol, and metoprolol.
Antidepressant medications — Tricyclic antidepressants (TCAs) and certain other antidepressant medications are often recommended for migraine prevention. These include amitriptyline, nortriptyline, and doxepin. Of these, amitriptyline has proven benefit for migraine prevention, while there is less data for the other tricyclics. These drugs are usually taken at bedtime and started at a low dose to avoid side effects.
Anti-seizure medications — The anti-seizure medications valproate (also called divalproex), gabapentin, and topiramate are sometimes used to prevent migraines.
Calcium channel blockers — Calcium channel blockers are widely used for migraine prevention. Examples include verapamil and nifedipine extended-release. Verapamil is frequently used as a first choice for preventive migraine therapy because it is easy to use and has few side effects.
Herbal therapies — not generally recommended.
Avoiding medication overuse
CLUSTER HEADACHE TREATMENT — Most people who suffer with cluster headaches will need both acute and preventive medicines.
Acute therapy
●Inhaling 100 percent oxygen through a face mask for 20 minutes. Oxygen treatment is often recommended first because it has few side effects.
● Triptans (especially injections of sumatriptan) can stop a cluster headache, often within 20 to 30 minutes. If you are unable to give yourself an injection, options include inhaled (nasal spray) sumatriptan or zolmitriptan.
Preventive treatment
●Verapamil, a calcium channel blocker
●The glucocorticoid drug prednisone (a pill) is an effective preventive therapy. However, long-term use of glucocorticoids is not recommended due to the risk of side effects.
TENSION TYPE HEADACHE TREATMENT
Acute treatment
· Pain reliever — A pain reliever may be recommended first for the treatment of tension type headache. Pain relievers should not be used too often because overuse can lead to medication-overuse headaches or chronic daily headaches.
· Combination medicines containing butalbital and opioids — such medications may be considered in special situations where simple pain relievers are ineffective or contraindicated.
Preventive treatment
Antidepressant medicines called tricyclics (TCAs) are often used to help prevent frequent tension headaches.
Complementary Approaches to Headache Treatment
In addition to medical treatment, several complementary therapies can be employed for individuals dealing with headaches.
Lifestyle Modifications:
• Smoking Cessation: Quitting smoking can contribute to reducing the frequency of headaches.
• Alcohol Reduction: Cutting down on alcohol consumption can be beneficial.
• Caffeine Reduction: Reducing or eliminating caffeine intake from drinks and food.
• Regular Routine: Maintaining consistent eating and sleeping schedules.
• Regular Exercise: Engaging in physical activity several times a week.
• Physical Therapy: Some individuals who experience frequent headaches may find relief through sessions with a physical therapist specializing in headache management. This approach may be considered if a person doesn't respond well to medications or only experiences partial or temporary relief.
• Acupuncture: Acupuncture involves the insertion of hair-thin, painless metal needles at specific points on the body. Electrical stimulation may sometimes accompany this technique.
Behavioural Therapy: Behavioural therapy aims to address the stress, anger, or frustration often associated with chronic or frequent headache pain. Different forms of behavioural therapy include:
• Psychotherapy
• Group Psychotherapy
• Relaxation Techniques: Methods like meditation, progressive muscle relaxation, self-hypnosis, and biofeedback can help alleviate muscle tension.
• Group Skill-Building Exercises: These exercises assist individuals in learning how to cope with pain, improve relationships, build resilience, overcome negative thinking, and manage pain flares.
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