Headaches

Headaches are one of the most common medical complaints. The number of headache sufferers is high- between 80 to 90 percent of the general population has experienced a headache.  Although headaches can be a sign of a medical emergency or serious neurological disease, most headaches do not indicate such conditions. Frequent, recurring, or prolonged headaches, however, should be initially viewed with concern, and every effort should be made to determine the cause of a headache. Treatment is most likely to be effective and appropriate following an accurate diagnosis.

There are two major types of headaches:

Muscle or Tension Headache

and

Episodic Vascular

Headache

Tension Headaches

Tension headaches are the most common type of headache. Approximately 60 to 80 percent of people who experience frequent headaches suffer from tension headaches.

  The pain with this type of headache is usually dull, persistent, occurs on both sides of the head to the shoulders, and varies in intensity. It is typically described as feeling as though there is a tight band around the head. Tension headaches have a gradual onset and termination, can last for hours or days, and affect people of all ages.

  There are many possible causes of tension headaches. Repressed anger, frustration, or anxiety can cause them, as can chronic depression or muscle injury. People who often deal with conflicting deadlines and pressure may experience tension headaches. This type of headache can also result from habitually tensing head and neck muscles in acts of concentration, such as driving or studying.

  There are four main approaches to the treatment of tension headaches: medication, physical therapy, psychotherapy, and stress management/ relaxation. Relaxation training and biofeedback may be helpful in relieving the pain of tension headaches. The most frequently used medication for tension headaches is a simple analgesic such as aspirin or acetaminophen (aspirin substitute). The physical therapy treatment may include the use of warm packs on the head and neck, warm baths and massage. The psychotherapy approach may include reassurance that the pain is treatable and simply due to a tension headache and eliminating the possible underlying causes of the problem.

Classical/Migraine Headaches

Classical/Migraine headaches result from contraction and rapid expansion of blood vessels in the skull, which stretch the artery walls and produce painful throbbing with each heart beat. The pain of migraine is usually concentrated on one side of the head, but may be generalized throughout the head. The pain is often associated with nausea, vomiting, and loss of appetite; thus, the term sick headache is often used when referring to migraines. People sometimes experience blurred vision with migraine headaches, which can last for hours or days.

  Affecting ten percent of the people who suffer with headaches, migraines are more common in women than in men and tend to run in families.  Approximately 70 percent of people who suffer with migraines have a family history of migraine headaches.

  The occurrences of migraines can often be reduced or eliminated by recognizing the individual causes and then avoiding or learning to overcome the source of the problem.  A headache diary, in which the person records precipitating events, circumstances and environmental conditions, for example, can be helpful in pinpointing the cause.

  Possible causes include allergy or sensitivity to particular foods, odors, alcoholic beverages (especially red wines), or caffeine. Other possible triggers include premenstrual status, oral contraceptive pills, bright lights, motion, noise and stress.

  Once a migraine headache has developed, the key is to treat it early, before the headache becomes more severe. A simple analgesic (acetaminophen or aspirin) is often the initial treatment to relieve symptoms. If this over-the-counter analgesic is not effective, prescription medication may be helpful.  An ice pack and rest may also help. Biofeedback has also proved to be helpful in teaching people to effectively reduce the amount of muscular activity in the neck and forehead.

Cluster Headaches

Cluster headaches have a sudden onset and termination and occur repeatedly over a period of time. The average length of a cluster headache is 45 minutes. They may occur between one and three times a day, and the cluster period may last from 6 to 12 weeks. The cluster headache period may cease for 6 to 12 months before recurring.

  Cluster headaches often occur at night, waking you from sleep. The pain is constant, excruciating, burning, and usually on one side of the head.

  Cluster headaches, although very rare, are five to nine times more common in men than in women. They can happen at any age, but most commonly occur between the ages of 20 and 40. There is not usually a family history of cluster headaches.

  Treatment for cluster headaches may require prescription medication. Once a cluster period has started, the person may be able to prevent the actual headache by taking certain medication prophylactically. Other therapies include avoiding afternoon naps and alcoholic beverages. Sunglasses are recommended to be worn in glaringly bright light.

Determining the type and cause of headache

Since the major types of headaches have some distinct characteristics and may benefit from different types of treatment, for someone with frequent, intense, or prolonged headaches should be evaluated by a health care provider.  Be prepared to provide some specific information regarding the headaches experienced. The following information may be helpful in establishing a diagnosis:

ONSET: The time of life when headaches began. The time of day of each episode.

FREQUENCY: How often and the pattern in which the headaches occur.

PRODROMES: Significant warning signs before the headache begins (visual/auditory/olfactory disturbances, changes in mood, etc.)

QUALITY OF PAIN: sharp stabbing, pounding, dull, aching, constricting

LOCATION OF PAIN:

DURATION:

SEVERITY:

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