Are you suffering for headache?
Headache is far most common problem in adults and adolescents. It causes numerous clinic visits and often be a single reason to absent from schools. Most causes of headaches are benign. Generally, recurrent headaches are most common secondary to stress, anxiety and depression. Very rarely it is associated with intracranial pathology. On the other hand, chronic headache may also be related to migraine or tension due to activity of daily living. Single acute headache may be related to CNS (central nervous system) or systemic disease and prompt investigation should be done accordingly.
Usually, there is a tale tell about what might cause the headache you are suffering. Below are a few tips of how to recognize the headache. Bare to mind that this is not a diagnosis, if you do have this symptom please consult your doctor.
- Tension headache is often manifests itself with a tight band like throbbing pain. The pain worsens with stress at the end of the day. This can also be associated with temporomandibular joint dysfunction (TMJ) syndrome.
- Migraine usually begins with aura or sensory disturbances. Some patients complain of photophobia and phonophobia. The pain commonly unilateral.
- Cluster headache is also known as migrainous neuralgia. It tends to occur at the same particular time during day or night. Lateral pain is common (only involve one side of the head). It may present with ocular pain (pain in the eye). Horner’s syndrome (ipsilateral ptosis/drooping of one side of eyelid, miosis or anhidrosis)
- Benign intracranial hypertension is also known as pseudotumor cerebri. It presents as a dull pain with visual obscuration (transient dimming or loss of vision with straining. On fundoscopy, papilloedema may be present. This headache also associated with excessive vitamin A and D intake.
- Depressive headache is associated with excessive disability of activity of daily living. This may lead to social isolation and absent from school. One may say “this headache occurs all day long and nothing can be done to relief the pain”. This headache may be accompanied by other type of depressive symptoms.
- TMJ dysfunction syndrome causes headache and facial pain by chewing food. Trigeminal or glossopharyngeal neuralgia may also be precipitated by chewing.
- Intracranial mass – related headache is characterized by dull or steady pain. The pain is worse in the morning and often associated with nausea and vomiting once wake up. Posterior fossa tumors often cause occipital pain and supratentorial lesions may lead to bifrontal headache. However, the finding is inconsistent and the headache may vary in character and severity.
- Post traumatic headache may appear within a day or so following injury. It may worsen over the ensuing weeks and gradually subsides. It usually presented with constant dull ache with superimposed throbbing that may be localized, lateralized or generalized. Occasionally, it is also accompanied by nausea, vomiting and scintillating scotomas.
- Cough headache is usually a severe head pain that is produced after coughing (and also by straining, sneezing and laughing). Fortunately it only lasts for a few minutes or less. This disorder is usually self limited with no underlying structural lesions.
- Headache due to giant cell arteritis (either temporal or cranial) usually occurs in elderly. The major symptom is headache associated with other nonspecific complaints like myalgia, malaise, anorexia and weight loss. Most feared manifestation is a loss of vision of that particular site unfortunately occurs quite commonly. Examination reveals scalp tenderness over the temporal arteries.
- Subarachnoid hemorrhage is characterized by sudden onset of severe headache. This may followed by nausea, vomiting and may lead to coma. If consciousness is regain, the affected person may be confuse, irritable and have mental status alteration. Neurological findings include nuchal rigidity or neck stiffeness and other signs of meningeal irritation. Some complaint of low back pain, photophobia and seizure activity. They may describe the pain as “thunderclap headache” or “the worst headache of my life”.
There are also some other differential that should be taken into consideration when a diagnosis of headache is made. These are severe hypertension, otitis media, acute periodontal disease and carbon monoxide poisoning. Meningitis and head injury should be excluded because this may cause serious consequence if no immediate action taken. Nevertheles, withdrawal from caffeine, alcohol or drugs may also manifest as headache. No doubt that headache can be a big masquerade for depression and this also should be taken into account when a person complains of recurrent and continuous headache.
Diagnosis can be made from the history alone. Sometimes, other investigations are necessary. Onset and pattern of the headache should be identified. Detail history regarding the chronology, precipitants of specific episodes such as stress, foods, medication and drugs should be taken. Any substance abuse and depressive symptoms will give a big clue in diagnosing headache. Precipitating factors such as recent sinusitis, dental surgery and head injury is also very important. In cases where meningitis is suspected, lumbar puncture should be done, ideally before any antibiotic is started. Cranial MRI and CT brain scan will be arranged to exclude intracranial mass (in patients present with progressive headache disorder). Other indications are symptoms of subarachnoid hemorrhage (SAH), headaches related to exertion and neurologic symptoms and also severe headache that disturb the sleep.
Treatment of headache is basically depends on the underlying causes. For example, for recurrent headaches, headache diary should be encouraged to identify the possible cause. The possible cause should be avoided. This diary will include diet history, stressors, substance use and sleep pattern. For tension headache, sometimes massage alone is enough, however, NSAIDs and acetaminophen can be prescribed to reduce the pain. For migraines, there are a wide range of available medications to reduce the pain and associated symptoms. Common drugs are NSAIDs, acetaminophen, antiemetics, ergotamines and triptans. Prophylaxis medication includes beta blockers, tricyclic antidepressants (TCAs) and calcium channel blockers.
Ones should be concern if he/she present with recurrent headache or one single acute headache. Consult your doctor if you think that your headache is severe enough to irritate you or has been going long enough. Early management of headache can prevent complications and functional limitations. However, don’t let your headache gives you “headache”.
Reference:
1) Stephen J McPhee et al. Current Medical Diagnosis and Treatment 2008. McGraw Hill Lange.
2) Tao Le et al. First aid for the Family Medicine Boards. 2008. McGraw Hill Lange.
Tags: cluster, depression, headache, migraine, subarachnoid hemorrhage, tension
Technorati Tags: cluster, depression, headache, migraine, subarachnoid hemorrhage, tension
One thing more to headache that you didn’t mention and this is the cause of salt depletion. If you live in a country or state like Florida it is common that you can get salt depletion and with it comes headache!!! In this case you just drink a lot and take some salt and it will be fine.
Studies have proven that any prolonged inflammation or intense pain for several days/months may lead to the creation of a tumor, resulting in the development of a cancer.
Migraines and headaches are no exception and should not be treated lightly.
They can be prevented, ask your doctor!
I suffered really badly from SAD and tried anti depressants and a host of other drugs the doctor offered me. in the end i bought a natural light alarm clock which helps enourmously.The SAD used to leave me with terrible migranes that totally wiped me out.