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A Headache is defined as a pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes.
Tension headaches are the most common type of primary headache. Up to 90% of adults have had or will have tension headaches. Tension headaches occur more commonly among women than men. Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience a migraine headache. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. It is estimated that 6% of men and up to 18% of women will experience a migraine headache in their lifetime.
Cluster headaches are a rare type of primary headache affecting 0.1% of the population (1 in a 1,000 people). It more commonly affects men in their late 20s though women and children can also suffer these types of headache. Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly while others are debilitated. While these headaches are not life-threatening, they may be associated with symptoms that can mimic strokes or intracerebral bleeding.
The pain begins in the back of the head and upper neck and is described as a band-like tightness or pressure. Often is described as pressure encircling the head with the most intense pressure over the eyebrows. The pain usually is mild (not disabling) and bilateral (affecting both sides of the head). The pain is not associated with an aura (see below), nausea, vomiting, or sensitivity to light and sound. The pain occurs sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people. The pain allows most people to function normally, despite the headache.
Most people successfully treat themselves with over-thecounter (OTC) pain medications to control tension headaches. The following work well for most people:
If these fail, other supportive treatments are available. Recurrent headaches should be a signal to seek medical help. Massage, biofeedback, and stress management can all be used as adjuncts to help with control of tension headaches. It is important to remember that OTC medications, while safe, are medications and may have side effects and potential interactions with prescription medications. It always is wise to ask your health care practitioner or pharmacist if you have questions about OTC medications and their use. This is especially important with OTC pain medications, because patients use them so frequently. It is important to read the listing of ingredients in OTC pain medications. Often an OTC medication is a combination of ingredients, and the second or third ingredient may have the potential for drug interaction or contraindication with medications a patient is currently taking. For example:
Some OTC medications include caffeine, which may trigger rapid heartbeats in some patients. In night time preparations, diphenhydramine (Benadryl) may be added. This may cause drowsiness, and driving or using heavy machinery may not be appropriate when taking the medication.
Aspirin should not be used in children and teenagers because of the risk of Reye's Syndrome, a disease where coma, brain damage, and death can occur if there is a viral like illness when the and aspirin is used. Aspirin and ibuprofen are irritating to the stomach and may cause bleeding. They should be used with caution in patients who have peptic ulcer disease or
who take blood thinners like warfarin (Coumadin) andclopidogrel bisulfate (Plavix).
Acetaminophen, if used in large amounts, can cause liver damage or failure. It should be used with caution in patients who drink significant amounts of alcohol or who have liver disease. One cause of chronic tension headaches is overuse of medications for pain. When pain medications are used for a prolonged period of time, headaches can recur as the effects of the medication wear off. Thus, the headache becomes a symptom of the withdrawal of medication (rebound headache).
tend to run in families and this suggests that there may be a genetic role; may be triggered by changes in sleeppatterns; may be triggered by medications (for example, nitroglycerin, used for heart disease).
If an individual is in a susceptible period for cluster headache, cigarette smoking, alcohol, and some foods (for example, chocolate) also can be potential causes for headache.
During the period in which the cluster headaches occur, pain typically occurs once or twice daily, but some patients may experience pain more than twice daily. Each episode of pain lasts from 30 to 90 minutes. Attacks tend to occur at about the same time every day and often awaken the patient at night from a sound sleep. The pain typically is excruciating and located around or behind one eye. Some patients describe the pain as feeling like a hot poker in the eye. The affected eye may become red, inflamed, and watery. The nose on the affected side may become congested and runny.
Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall, and can be driven to desperate measures. Cluster headaches are much more common in men than women.
inhalation of high concentrations of oxygen (though this will not work if the headache is well established); injection of tryptan medications, for example, sumatriptan (Imitrex),zolmitriptan (Zomig), and rizatriptan(Maxalt) which are commonly used for migraine treatments as well; injection of lidocaine, a local anesthetic, into the nostril; dihydroergotamine (DHE, Migranal), a medication that causes blood vessels to constrict; caffeine
calcium channel blockers [for example,verapamil (Calan, Verelan, Verelan PM, Isoptin, Covera-HS), diltiazem(Cardizem, Dilacor, Tiazac)] prednisone (Deltasone, Liquid Pred) antidepressant medications lithium (Eskalith, Lithobid) valproic acid, divalproex (Depakote, Depakote ER, Depakene, Depacon), and topiramate (Topamax) (often used for seizure control)
considered to diagnose the underlying disease. Some of the causes of secondary headache may be potentially life-threatening and deadly. Early diagnosis and treatment is essential if damage is to be limited. The International Headache Society lists eight categories of secondary headache. A few examples in each category are noted. (This is not a complete list). Head and neck trauma Injuries to the head may cause bleeding in the spaces between the layers of tissue that surround the brain (subdural, epidural and subarachnoid spaces) or within the brain tissue itself.
Concussions, where head injury occurs without bleeding A symptom of whiplash and neck injury
Blood vessel problems in the head and neck Stroke or transient ischemic attack(TIA)
Arteriovenous malformations (AVM) may cause headache before they leak Carotid artery inflammation Temporal arteritis (inflammation of the temporal artery)
Non-blood vessel problems of the brain Brain tumors, either primary, originating in the brain, or metastatic from a cancer that began in another organ
Seizures Idiopathic intracranial hypertension, once named pseudotumor cerebri, where the pressure is too high in the cerebrospinal fluid within the spinal canal.
Medications and drugs (including withdrawal from those drugs) Infection Meningitis
Problems with the eyes, ears, nose throat, teeth and neck Psychiatric disorders
blood tests, computerized tomography (CT Scan), magnetic resonance imaging (MRI) scans of the head, and lumbar puncture.
Specific tests will depend upon what potential issues the health care practitioner and patient want to address. Blood tests Blood tests provide helpful information in association with the history and physical examination in pursuing a diagnosis. For example, an infection or inflammation in the body may cause a rise in the white blood cell count, the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). These two tests are very non-specific, that is, they may be abnormal with anyinfection or inflammation, and abnormalities do not point to a specific diagnosis of the cause of the infection or inflammation. Blood tests can also assess electrolyte disturbances, and a variety of organ functions like liver, kidney, and thyroid. Computerized tomography of the head Computerized tomography (CT scan) is able to detect bleeding, swelling, and tumors. It can also show evidence of previous stroke. With intravenous contrast injection, it can also be used to look at the arteries of the brain. Magnetic resonance imaging (MRI) of the head MRI is able to better look at the anatomy of the brain, meninges (the layers that cover the brain and the spinal cord). While it is more precise, the time to perform the scan is significantly longer than for computerized tomography. This type of scan is not available at all hospitals. Moreover, it takes much longer to perform, requires the patient to cooperate by holding still, and requires that the patient have no metal in their body (for example, a heart pacemaker or metal foreign objects in the eye). Lumbar puncture Cerebro-spinal fluid, the fluid that surrounds the brain and spinal cord, can be obtained with a needle that is inserted into the spine in the lower back. Examination of the fluid can reveal infection (such as meningitis due to bacteria, a virus, or tuberculosis) or blood from hemorrhage. In almost all cases, computerized tomography is done prior to lumbar puncture to make certain there is no bleeding, swelling, or tumor in the brain. Pressure within the space can be measured when the lumbar puncture needle is inserted. Elevated pressures may make the diagnosis of idiopathic intracranial hypertension in combination with the appropriate circumstances.
The "worst headache of your life." This is the wording often used in textbooks as a cue for medical practitioners to consider the diagnosis of a subarachnoid hemorrhage due to aruptured cerebral aneurysm. The amount of pain will often be taken in context with the appearance of the patient and other associated signs and symptoms.
Different than your usual headaches Starts suddenly or is aggravated by exertion, coughing, bending over, or sexual activity Associated with persistent nausea and vomiting Associated with fever or stiff neck Associated with seizures Associated with recent head trauma or a fall Associated with changes in vision, speech, or behavior Associated with weakness or change in sensation Not responding to treatment and is getting worse Requires more than the recommended dose of over-the-counter medications for pain Disabling and interfering with work and quality of life
Headache At A Glance
The head is one of the most common sites of pain in the body. The most common types of headache can be classified as 1) primary, 2) secondary, and 3) cranial neuralgias, facial pain, and other headaches.
The most common types of primary headaches are 1) tension, 2) migraine, and 3) cluster.
Tension headaches are the most common type of primary headache and usually are treated with over-the-counter medications for pain
Patients should seek medical care for new onset headaches, fever, stiff neck, change in behavior, vomiting, weakness or change in sensation.
Medical Author: Benjamin Wedro, MD, FACEP, FAAEM Medical Editor: Jay W. Marks, MD
http://www.medicinenet.com/headache/