Headache

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What are the causes of headache?

Headaches, medically termed cephalalgia, may be primary or secondary. Primary headache includes migraine, cluster or tension headache. Secondary headaches are caused by extracranial (outside of the skull) disorders of the eyes, nose, teeth, throat, temporo-mandibular joint, ears and cervical (neck spine) vertebrae, or more seriously, by such conditions as head injuries, acute systemic, or intracranial (inside the skull) infection, stroke, bleeding, intracranial tumor, severe hypertension (high blood pressure) and cerebral hypoxia (lack of oxygen to the brain). There are systemic causes also, like fever, anemia, hypoxia, viremia, caffeine withdrawal, hypercapnia, hypertension, vasoactive chemicals or drugs. The most common cause of headache is extracranial (outside of the skull), and therefore, not life threatening.

What is the commonest eye problem causing headache?

Error of refraction is a very common cause of headache. Correction with prescription eyeglasses usually relieve and prevent vision-related headaches.

What is tension headache?

When all other possibilities have been ruled out, and considering the stress factor in the diagnostic equation, tension headache becomes the prime suspect. This tends to be chronic or continuous and usually starts from the back of the head or the front of the skull, just above the eyes, then spreads to the entire head. It is felt as a vice-like pressure sensation "constricting" the skull. This lasts from 30 minutes to one week, and is non-pulsating, bilateral, mild to moderate in intensity, and not affected by exertion, and not associated with nausea, vomiting or sensitivity to sound, light or smell, like migraine is. On the other hand, headaches due to high blood pressure or febrile illnesses usually cause throbbing pain that involves any part of the head.

How is headache managed?

Majority of common headaches are brief in duration and requires no medical consultation or treatment other than analgesics (pain medications, like acetaminophen, aspirin) and, perhaps, rest. Alternative strategies, like biofeedback, acupuncture, dietary manipulations and other less conventional methods have been used for this, with no clear-cut results and of doubtful benefits, according to scientific studies on them. But since this alternative approaches pose little risk by way of complications, they are being tried, even for their psychological benefits. The treatment for "secondary" headaches (and "systemic" headaches) are aimed at treating the underlying illness that is causing them. Example, for meningitis, prompt appropriate antibiotic treatment, analgesics, etc. For bleeding in the brain or brain tumors, surgery is the treatment.

How about tension headaches?

Tension headaches can be regarded as cranial hyperalgesia (hypersensitive head, with reduced endogenous pain modulation and increased pain potentiation) caused by mood disorders, sleep disorder and anxiety states. Treatment is directed to treating the mood, sleep and anxiety disorders, and the use or common household analgesics. For recurrent or chronic ones, doctors have been adding tricyclic antidepressants, but with caution, since these drugs could be habit forming. Diagnosis of other contributing illness is important in the treatment. For those who have severe tension headaches, a multidimensional approach is needed, which, in a few cases, may require psychiatric involvement.

And cluster headaches?

Cluster headaches are unilateral, severe, and last about 15 minutes to an hour and a half. They are periorbital (pains around the eyes) and temporal (temple pains), occurring about 8 times a day, associated with one of the following: facial sweating, red eye, tearing, stuffy nose, ptosis (droopy eyelids) and miosis (constricted pupils). Cluster headaches affect men more than women, and are triggered by barometric pressure changes, lack of sleep, and alcohol. Treatment includes the use of medications like indomethacin, which is uniquely effective against cluster headaches. The main goal here is prophylactic (prevention), using verapamil, a calcium channel blocker, and serotonin antagonist methysergide. Sumatropin and ergots are used for abortive (to stop an ongoing cluster headache) treatment.

What is the treatment for migraine?

Migraine is more severe and debilitating. Some patients with severe attacks bang their head against concrete walls in desperation. A brief period (prodromal symptoms) of depression, restlessness, irritability or anorexia (lack of appetite) often precedes migraine headaches. In about 10 to 20% of cases, individuals with migraine have an aura (premonition) when the migraine is to occur. The pain is throbbing, moderate to severe, affects one side of the head, aggravated by exertion and associated with nausea and vomiting. Patients with migraine are overly sensitive to sound (noise or even loud music), light and odor. About 24 million Americans have migraine headaches, which are more common among women, and usually starts between the ages 10 and 40. More than 50% have a family history of migraine. After the age 50, migraine headaches oftentimes go into partial or complete remission after the age 50. The treatment hinges on the frequency of the attacks and the presence of other comorbidities (diseases). As a rule, the management strategy is classified as prophylactic, abortive or analgesic. There are a host medications available today for each of these three phases of treatments. For prophylaxis, beta blockers, calcium channel blockers, tricyclic antidepressants or anticonvulsants are employed. For abortive, serotonin receptor activators have been found to be effective in about 70% of patients. The newer generation of the drug (5-HT 1B/1D agonists) has increased effectiveness and reduced adverse side effects of the older ones. Dopamine agonists and ergot alkaloids have also been found to be effective. Analgesics cause rebound headaches and should be used only if medically recommended. The use of addicting drugs, like demerol, morphine, other opioids, is strongly discouraged, except under very special medical circumstances and only under strict physician guidelines and supervision.

©2003Raoul R. Diez, M.A.O.D.