It’s a headache!

By Dr. Ruvini Abeygunaratne Karunaratne

You cannot go through life without having an occasional headache, but for some people the frequency of the attacks as well as the severity can affect their quality of life significantly. Although headaches are generally benign, they could also be a sign of a serious underlying health problem.

A headache can be described as aching or pain in the head, located above the eyes, ears and back of the head. They may be associated with a range of other symptoms such as feeling sick, photophobia (when the light hurts your eyes) and noises.

There are many causes for headaches and many treatments, but the main reason for an accurate diagnosis is to rule out a serious underlying medical condition.

Headaches can be categorised into primary and secondary headaches. Primary headaches are those, which are not caused by any disease conditions. Examples are migraines, tension headaches, and cluster headaches. Secondary headaches, on the other hand, are those, which have a disease process, which causes them.

Primary headaches

These account for approximately 90% of headaches.

Tension headaches

These are the most common of primary headaches and usually present in middle-aged adults. There is a higher incidence in females compared to males. These can be caused by a number of physical conditions, such as arthritis in the neck and spine, joint problems, dilation of blood vessels, coughing, blockage in the sinuses (sinusitis) sneezing and fever. Mental conditions are also associated with these headaches, such as stress, depression and anxiety.

• Symptoms: Patient describes mild to moderate pain on both sides of the head, with an associated feeling of tightness. There may also be tenderness in the scalp and neck. The attacks can be described as episodic in nature.

• Treatment: Usually with basic over the counter analgesics such as Paracetamol and non-steroidal anti-inflammatory drugs such as aspirin and Ibruprofen.

Migraines

Migraines affect around 15% of adults. Again females are affected more than males and there appears to be a higher incidence if there are other family members suffering from them. There are two main kinds of migraines, those that cause an aura (classic migraine) and those that do not (common migraines).

Sinus - Blocked sinuses pressure headaches

An aura can be described as a symptom that is experienced prior to the onset of the migraine. Auras can be numbness of face or limbs, vomiting, blindness, paralysis of limbs, fainting etc. These symptoms normally resolve within an hour or so.

Common migraines present with a sudden onset of headache. Recent studies have shown that the cause of migraines could be due to the change in activity (over activity) of the nerve cells in the brain called neurons, there is also evidence to suggest that a chemical messenger in the brain called serotonin is involved in precipitating them

There are many trigger factors identified which seem to precipitate a migraine. Hormonal changes in women, loud noises, lack of sleep, bright lights, certain foods such as chocolate and cheese and smoking have all been identified as possible triggering culprits.

• Symptoms: A severe attack can cause severe throbbing pain with sensitivity to light and movement. The pain could be on one side of the head or both. There may be associated symptoms as described above, as well as nausea, vomiting, diarrhoea or feeling tired. The attacks normally last for about 48 to 72 hours.

• Treatment: Mild migraines may be treated with simple analgesic medications, lying in a quiet, darkened room and resting. To avoid attacks you can cut down or refrain from trigger factors. If symptoms are worsening or not resolved by simple measures, you will need to be seen by a doctor, who may prescribe an analgesia which is stronger medication for sickness and also preventative medication. If your migraines are changing in character, lasting longer, associated with a weakness in your body, come on with exercise or you are generally worried about them, you need to seek medical advice. It is also advisable to seek medical advice if you are older than 50 years when you have your first migraine attack. The main reason is to rule out any other underlying serious medical condition.

Cluster headaches

These are rare primary headaches, they affect about 0.1% of the population. These are more common in males! The average age ranges from 28-35 years and such headaches normally begin at a young age. As the name suggests these headaches are a clustering of painful attacks, over many weeks or even months. The pain peaks at about 5 minutes and may last for about an hour.

There are two types. Episodic, which is the common type, where you may have two to three headaches a day for about two months and not experience another headache for a year, after which the pattern will repeat, and chronic cluster headaches, where unfortunately you get no period of untreated sustained relief.

• Symptoms: One-sided head pain, which comes on when you are asleep. Excruciating in nature, the headache may be associated with drooping of the eyelid on the affected side, pain behind the eye one-sided nasal stuffiness and runny nose and tearing in the eye on the affected side. There is also associated seasonal variation noted.

• Treatment: As these are sudden onset headaches which are severe in nature, till a diagnosis is established you should be seen by your family doctor. This is to rule out any underlying conditions. Simple analgesia is the first line treatment, as well as medications, which can be prescribed by your doctor for nerve pain such as Amytyptilline. As blood vessels in the brain which are in spasm are thought to be one of the reasons for these headaches, medications that decrease the spasms of vessels have also been used. As inflammations of the blood vessels have also been considered small doses of steroids have been used in treatment. All these options should be discussed with your family doctor.

Secondary headaches

Tension - Tightening band type pain around forehead

These are headaches that have an underlying medical cause. If a patient experiences a secondary headache, medical attention should be sought urgently.

Some features, which can be symptomatic of secondary headaches, are higher body temperature, rashes, swelling of glands, tenderness in the neck and stiffness of joints.

If you are elderly then underlying malignancies should be ruled out. If there is a history of brain haemorrhages in the family or the patient suffers from high blood pressure a bleed in the brain must be ruled out.

As described in the MediScene article last month, a sudden onset headache could also be due to a ruptured blood vessel in the brain, causing a subarachnoid haemorrhage. Seek medical attention!

Finally it is very important to stress a condition called medication-overuse headaches. People who have frequent headaches take regular painkillers, often in an attempt to prevent them coming on.

The over-use of analgesia decreases their effectiveness with time, requiring the sufferer to take stronger medication. The reduced effectiveness of the medication can cause further headaches, known as rebound or withdrawal headaches, or medication overuse headaches. About 2% of patients suffer from overuse headaches and again women are affected more than males.

So remember to use appropriate analgesia when suffering from a headache and if the frequencies of the headaches are changing such that you require to increase the dosage, seek medical advice.