Headaches are one of the most common medical complaints that we see in family practice. Most people experience them at some point in their life. They can affect anyone regardless of age, race, and gender.
A headache can be a sign of stress or emotional distress, or it can result from a medical disorder, such as migraine or high blood pressure, anxiety, or depression. It can lead to other problems. People with chronic migraine headaches, for example, may find it hard to attend work or school regularly.
Primary headaches are stand-alone illnesses caused directly by the overactivity of, or problems with, structures in the head that are pain-sensitive. This includes the blood vessels, muscles, and nerves of the head and neck. They may also result from changes in chemical activity in the brain. Common primary headaches include migraines, cluster headaches, and tension headaches.
Secondary headaches are symptoms that happen when another condition stimulates the pain-sensitive nerves of the head. In other words, the headache symptoms can be attributed to another cause. A wide range of different factors can cause secondary headaches. These include:
· alcohol-induced hangover
· brain tumor
· blood clots
· bleeding in or around the brain
· "brain freeze," or ice-cream headaches
· carbon monoxide poisoning
· teeth-grinding at night
· overuse of pain medication, known as rebound headaches
· panic attacks
As headaches can be a symptom of a serious condition, it is important to seek medical advice if they become more severe, regular, or persistent. For example, if a headache is more painful and disruptive than previous headaches, worsens, or fails to improve with medication or is accompanied by other symptoms such as confusion, fever, sensory changes, and stiffness in the neck, a doctor should be contacted immediately.
Tension headaches are the most common form of primary headache. Such headaches normally begin slowly and gradually in the middle of the day. The person can feel:
· as if they have a tight band around the head
· a constant, dull ache on both sides
· pain spread to or from the neck
Tension-type headaches can be either episodic or chronic. Episodic attacks are usually a few hours in duration, but it can last for several days. Chronic headaches occur for 15 or more days a month for a period of at least 3 months.
A migraine headache may cause a pulsating, throbbing pain usually only on one side of the head. The aching may be accompanied by:
· blurred vision
· sensory disturbances known as auras
Migraine is the second most common form of primary headache and can have a significant impact on the life of an individual. According to the WHO, migraine is the sixth highest cause of days lost due to disability worldwide. A migraine can last from a few hours to between 2 and 3 days.
Rebound or medication-overuse headaches stem from an excessive use of medication to treat headache symptoms. They are the most common cause of secondary headaches. They usually begin early in the day and persist throughout the day. They may improve with pain medication, but worsen when its effects wear off. Along with the headache itself, rebound headaches can cause:
· neck pain
· a feeling of nasal congestion
· reduced sleep quality
Rebound headaches can cause a range of symptoms, and the pain can be different each day.
Cluster headaches usually last between 15 minutes and 3 hours, and they occur suddenly once per day up to eight times per day for a period of weeks to months. In between clusters, there may be no headache symptoms, and this headache-free period can last months to years. The pain caused by cluster headaches is:
· often described as sharp or burning
· typically located in or around one eye
The affected area may become red and swollen, the eyelid may droop, and the nasal passage on the affected side may become stuffy and runny.
These are sudden, severe headaches that are often described as the "worst headache of my life." They reach maximum intensity in less than one minute and last longer than 5 minutes. A thunderclap headache is often secondary to life-threatening conditions, such as intracerebral hemorrhage, cerebral venous thrombosis, ruptured or unruptured aneurysms, reversible cerebral vasoconstriction syndrome (RVS), meningitis, and pituitary apoplexy. who experience these sudden, severe headaches should seek medical evaluation immediately.
Headaches in children
Importantly, in children and adolescents, primary headaches are often co-morbid with psychiatric conditions. Awareness of, and enquiry about, sleep disorders, PTSD, school phobias, ADHD, conduct disorder, learning disorders, encopresis (soiling of underwear with stool past the age of toilet training), enuresis (bedwetting), depression and anxiety is important when assessing a child with headaches.
The most common ways of treating headaches are rest and pain relief medication. Generic pain relief medication is available over the counter (OTC), or doctors can prescribe preventative medication, such as tricyclic antidepressants, serotonin receptor agonists, anti-epilepticdrugs,andbeta-blockers.
It is important to follow the doctor's advice because overusing pain relief medication can lead to rebound headaches. The treatment of rebound headaches involves the reducing or stopping pain relief medication. In extreme cases, a short hospital stay may be needed to manage withdrawal safely and effectively.
Several alternative forms of treatment for headaches are available, but it is important to consult a doctor before making any major changes or beginning any alternative forms of treatment. Alternative approaches include:
· cognitive behavior therapy
Research has not provided evidence to confirm that all these methods work.
Sometimes, a headache may result from a deficiency of a particular nutrient or nutrients, especially magnesium and certain B vitamins. Nutrient deficiencies can be due to a poor quality diet, underlying malabsorption issues, or other medical conditions.
A number of steps can be taken to reduce the risk of headaches and to ease the pain if they do occur:
1. Apply a heat pack or ice pack to your head or neck, but avoid extreme temperatures.
2. Avoid stressors, where possible, and develop healthy coping strategies for unavoidable stress.
3. Eat regular meals, taking care to maintain stable blood sugar.
A hot shower can help, although in one rare condition hot water exposure can trigger headaches. Exercising regularly and getting enough rest and regular sleep contributes to overall health and stress reduction.
A doctor will usually be able to diagnose a particular type of headache through a description of the condition, the type of pain, and the timing and pattern of attacks. If the nature of the headache appears to be complex, tests may be carried out to eliminate more serious causes.
Further testing could include:
· blood tests
· brain scans, such as CT and MRI
The WHO points out that headaches are often not taken seriously because they are sporadic, most headaches do not lead to death, and they are not contagious.