We are going to talk about Headache, its different types, headache treatment and how one can manage it effectively.
Brief introduction to headache:
Pain in the head is called headache. It also includes the face, teeth and the neck. There can be innumerable causes of headache. From simple trauma to dental issues to largely unknown factors headache can present in variety of forms. It is very important for a physician to ask patient different questions about headache. Its associated features to accurately diagnose a headache and subsequently treat it effectively. In fact, there is a separate one year fellowship for headache offered as a sub-specialty of neurology or pain medicine.
The different types of headaches have different characteristics. Some can present with headache on one side of the head. And some can present with headache predominantly in the front of the head. Also some predominantly at the back of the head. Some patients have associated sensitivity to different environmental stimuli during a headache. It should also be understood that prevention of a headache is by far the best treatment. Unfortunately majority of patient population do not recognize their headache triggers.
What are the different types of headache?
There are various types of headache. However the two types of it seen in majority of patients. 1 Migraine. and 2 Tension-type. There are specific diagnostic criteria for each type of headache and therefore they are treated differently. Few other examples include cluster, trigeminal neuralgia, Short-lasting unilateral neuralgiform with conjunctival injection and tearing (SUNCT syndrome), giant cell arteritis etc to name a few. Why it is important to ask so many questions about a headache. It is because a doctor wants to localize where in brain or head could be the source of the headache.
For example, a patient may have pain in the eye but may refer to it as a headache when in fact it could be increased pressure inside the eye (Glaucoma). Similarly a dental or ear pain may be referred to has a headache. And certainly it is the duty of a neuro physician to diagnose it for proper management.
Types of Headaches
- Very popularly known that high blood pressure causes headache. This is in fact a myth and is not true. High blood pressure does not cause headache. Most people would have high blood pressure without knowing. High blood however can cause a pulse-like pressure feeling at the back of the head.
- Brain tumor causes headache? Not commonly! On a rare circumstance if a brain tumor invades the head bone. It can cause a headache but usually brain tumors do not present with headache. They can present with weakness or loss of sensation on one side of the body. The most common tumor presenting with headache is of pituitary gland only when it is big enough.
What triggers a headache?
Most patients cannot identify simple things that they are doing in their routine that plays a major part in the headache genesis. The most common triggers of headache include
- Lack of sleep
- Dehydration or lack of enough water intakes
- Skipping or delaying meals
Besides the ones mentioned, there are many other triggers including stress (work related or family issues), caﬀeine intake, chocolate intake, cheese, Chinese salt (Mono-sodium glutamate), red wine and smoking to name some.
It is important to be vigilant and try to track your headache triggers. If no cause can be identified, one should at least try to sleep on time, eat on time and try to keep hydrated. Of course a visit to Neurologist is mandated to have oneself examined to rule out potentially dangerous conditions.
Red flags for a potentially dangerous headache
1- Worst headache of life never experienced before. Headaches can also be life threatening especially if there is a bleed in the head. This condition is called sub-arachnoids hemorrhage. It usually presents as sudden onset severe headache that patient has never experienced before. If this is the case, immediate presentation to the emergency room (ER) is a must.
2- Fever with new headache and neck stiffness
Headaches can also be because of meningitis which can present with neck stiffness besides extreme headache. This is also potentially life threatening condition. An immediate attention should be sought at ER.
3- Headache with one sided weakness, numbness or with seizures
Potentially this signifies a tumor or a bleeding inside the brain (also known as brain hemorrhage)
Prevention of headache
Headache prevention starts with identifying potential triggers. Once a trigger or more than one trigger is identified, prevention becomes very easy. Avoid the triggers! Some people do their best and avoid triggers but still get a headache every so often. This is a time to go to the Neurologist. Avoidance of triggers is essentially in the form of changes in lifestyle. If these do not work, then comes the time for medicines. The medicine for headache prevention is taken on a daily basis whether you have a headache or not. Usually these medicines take up to 8 weeks to start working so one has to be patient when expecting the results. One important thing that one should also bear in mind is that one medicine does not work for every kind of patient. Your doctor may try different medicines before the right match for you is found.
Headache treatment starts with prevention of headache with lifestyle changes and then comes medicines. For acute treatment, usually Non-Steroidal anti-inflammatory drugs (NSAIDs) are used. These include Brufen (Ibuprofen), Disprin (Acetylsalicylic acid), Ponstan (Mefanemic acid) to name a few. If one has a headache, one should not delay taking medicines to treat headache. Of course these are general rules and this article should not be used as a guideline to treat headache. One should always consult a physician and preferably Neurophysician (Neurologist) for headache treatment.
What should not be done for headache treatment?
Patients should not take abortive medicines (like brufen, Disprin etc) on a daily basis. As it increases the chances of getting a headache from the medicine itself. Which is known as analgesic overuse headache.