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A headache involves pain in the head which can arise from many disorders or may be a disorder in and of itself.
There are three types of primary headaches: tension-type (muscular contraction headache), migraine (vascular headaches), and cluster. Virtually everyone experiences a tension-type headacheat some point. An estimated 18% of American women suffer migraines,compared to 6% of men. Cluster headaches affect fewer than 0.5% of thepopulation, and men account for approximately 80% of all cases.Headaches caused by illness are secondary headaches and are notincluded in these numbers.
Approximately 40-45 million people inthe United States suffer chronic headaches. Headaches have an enormousimpact on society due to missed workdays and productivity losses.
Causes and symptoms
Traditionaltheories about headaches link tension-type headaches to musclecontraction, and migraine and cluster headaches to blood vesseldilation (swelling). Pain-sensitive structures in the head includeblood vessel walls, membranous coverings of the brain, and scalp andneck muscles. Brain tissue itself has no sensitivity to pain.Therefore, headaches may result from contraction of the muscles of thescalp, face or neck; dilation of the blood vessels in the head; orbrain swelling that stretches the brain's coverings. Involvement ofspecific nerves of the face and head may also cause characteristicheadaches. Sinus inflammation is a common cause of headache. Keeping a headache diary may help link headaches to stressful occurrences, menstrual phases, food triggers, or medication.
Tension-typeheadaches are often brought on by stress, overexertion, loud noise, andother external factors. The typical tension-type headache is described as a tightening around the head and neck, and an accompanying dull ache.
Migrainesare intense throbbing headaches occurring on one or both sides of thehead, usually on one side. The pain is accompanied by other symptomssuch as nausea, vomiting, blurred vision, and aversion to light, sound,and movement. Migraines often are triggered by food items, such as redwine, chocolate, and aged cheeses. For women, a hormonal connection islikely, since headaches occur at specific points in the menstrualcycle, with use of oral contraceptives, or the use of hormonereplacement therapy after menopause. Research shows that a complexinteraction of nerves and neurotransmitters in the brain act to causemigraine headaches.
Cluster headaches cause excruciating pain.The severe, stabbing pain centers around one eye, and eye tearing andnasal congestion occur on the same side. The headachelasts from 15 minutes to four hours and may recur several times in aday. Heavy smokers are more likely to suffer cluster headaches, whichalso are associated with alcohol consumption.
Since headaches arise from many causes,a physical exam assesses general health and a neurologic exam evaluatesthe possibility of neurologic disease as a cause for the headache. If the headache is the primary illness, the doctor asks for a thorough history of the headache.Questions revolve around its frequency and duration, when it occurs,pain intensity and location, possible triggers, and any prior symptoms.This information aids in classifying the headache.
Warning signs that should point out the need for prompt medical intervention include:
- "Worst headacheof my life." This may indicate subarachnoid hemorrhage from a rupturedaneurysm (swollen blood vessel) in the head or other neurologicalemergency.
- Headacheaccompanied by one-sided weakness, numbness, visual loss, speechdifficulty, or other signs. This may indicate a stroke. Migraines mayinclude neurological symptoms.
- Headachethat becomes worse over a period of 6 months, especially if mostprominent in the morning or if accompanied by neurological symptoms.This may indicate a brain tumor.
- Sudden onset of headache. If accompanied by fever and stiff neck, this can indicate meningitis.
Headachediagnosis may include neurological imaging tests such as computedtomography scan (CT scan) or magnetic resonance imaging (MRI).
Headache treatment is divided into two forms: abortive and prophylactic. Abortive treatment addresses a headache in progress, and prophylactic treatment prevents headache occurrence.
Tension-typeheadaches can be treated with aspirin, acetaminophen, ibuprofen, ornaproxen. In early 1998, the FDA approved extra-strength Excedrin,which includes caffeine, for mild migraines. Physicians continue toinvestigate and monitor the best treatment for migraines and generallyprefer a stepped approach, depending on headacheseverity, frequency and impact on the patient's quality of life. Agroup of drugs called triptans are usually preferred for abortivetreatment. About seven triptans are available in the United States andthe pill forms are considered most effective. They should be taken asearly as possible during the typical migraine attack. The most commonprophylactic therapies include antidepressants, beta blockers, calciumchannel blockers and antiseizure medications. Antiseizure medicationshave proven particularly effective at blocking the actions ofneurotransmitters that start migraine attacks. Topiramate (Topamax) wasshown effective in several combined clinical trials in 2004 at 50 to200 mg per day.
In 2004, a new, large study added evidence to show the effectiveness of botulinum toxin type A (Botox) treatment to prevent headachepain for those with frequent, untreatable tension and migraineheadaches. Patients were treated every three months, with two to fiveinjections each time. They typically received relief within two tothree weeks.
Cluster headaches may also be treated withergotamine and sumatriptan, as well as by inhaling pure oxygen.Prophylactic treatments include prednisone, calcium channel blockers,and methysergide.
Alternative headache treatments include:
- acupuncture or acupressure
- herbal remedies using feverfew (Chrysanthemum parthenium ), valerian (Valeriana officinalis ), white willow (Salix alba ), or skullcap (Scutellaria lateriflora ), among others
- homeopathic remedies chosen specifically for the individual and his/her type of headache
- magnesium supplements
- regular physical exercise
- relaxation techniques, such as meditation and yoga
- transcutaneouselectrical nerve stimulation (TENS) (A procedure that electricallystimulates nerves and blocks the signals of pain transmission.)
Posted By: adminThursday, June 17, 2010 Total views: 3964