Headache
What is a headache?
A headache is
pain or discomfort in the head or face area. Headaches vary greatly in terms of
pain location, pain intensity, and how frequently they occur. This results in
several categories of headaches. While the actual brain tissue doesn’t have
pain-sensitive nerve fibers and doesn’t feel pain, other parts of the head can
be responsible for a headache including:
·
A network of nerves that extends over
the scalp
·
Certain nerves in the face, mouth, and
throat
·
Muscles of the head, neck, and shoulders
·
Blood vessels found along the surface
and at the base of the brain (these contain delicate nerve fibers)
Different types
of headaches include:
Migraine
This type of
headache is distinguished by the fact that symptoms other than pain occur as
part of the headache. Nausea and vomiting, lightheadedness, sensitivity to
light (photophobia), and other visual symptoms typically occur with migraine.
Migraines are also unique in that they have distinct phases. Not all people
have each phase, however. The phases of a migraine headache may include:
·
Premonition phase. A change in mood
or behavior that may occur hours or days before the headache.
·
Aura phase. A group of visual,
sensory, or motor symptoms that immediately precede the headache. Examples
include vision changes, hallucinations, numbness, changes in speech, and muscle
weakness.
·
Headache phase. Period during the
actual headache with throbbing pain on one or both sides of the head.
Sensitivity to light and motion are common, as are depression, fatigue, and
anxiety.
·
Headache resolution phase. Pain lessens
during this phase, but may be replaced with fatigue, irritability, and
difficulty concentrating. Some individuals feel refreshed after an attack,
while others do not.
Tension
headaches
Tension
headaches are the most common type of headache. Stress and muscle tension are
often factors in tension-type headaches. While symptoms may differ, the
following are common symptoms of a tension-type headache:
·
Slow onset of the headache
·
Head usually hurts on both sides
·
Pain is dull or feels like a band or
vice around the head
·
Pain may involve the back (posterior)
part of the head or neck
·
Pain is mild to moderate, but not severe
·
Tension type headaches typically do not
cause nausea, vomiting, or sensitivity to light (photophobia).
Cluster
headaches
Cluster
headaches usually occur in a series that may last weeks or months, and the
headache series may return every year or two.
While people
often experience symptoms differently, the following are the most common
symptoms of a cluster headache:
·
Severe pain on one side of
the head, usually behind one eye
·
The eye that is affected may
be red and watery with a droopy lid and small pupil
·
Swelling of the eyelid
·
Runny nose or congestion
·
Swelling of the forehead
What causes a headache?
Headaches are
classified as primary or secondary.
·
A primary headache means the headache itself is the main medical problem,
although other factors, such as muscle tension or exposure to certain foods,
may be identified. Other contributing factors include medications, dehydration,
or hormone changes.
·
A secondary headache is related to an underlying medical condition. An example of
this would be a headache due to neck injury, eye problems, jaw, teeth or sinus
infection.
What are the symptoms of a headache?
Headache
symptoms depend on the type of headache. The frequency of headaches and the
intensity of the symptoms may vary as well. Typical headache symptoms include:
·
Slow onset of the headache
·
Head usually hurts on both
sides
·
Pain is dull or feels like a
band or vice around the head
·
Pain may involve the back (posterior)
part of the head or neck
·
Pain is mild to moderate, but
not severe
Tension type
headaches typically do not cause nausea, vomiting, or sensitivity to light
(photophobia).
The symptoms
of a headache may resemble other conditions or medical problems. Always consult
your health care provider for a diagnosis.
How is a headache diagnosed?
The full
extent of the problem may not be understood immediately, but may be revealed
with a comprehensive medical evaluation and diagnostic testing. The diagnosis
of a headache is made with a careful history, physical examination and
diagnostic tests.
Questions
commonly asked during the exam may include, but are not limited to, the
following:
·
When do headaches occur?
·
What is the location of the
headache?
·
What do the headaches feel
like?
·
How long do the headaches
last?
·
Have there been changes in
behavior or personality?
·
Do changes in position or
sitting up cause the headache?
·
Do you have trouble sleeping?
·
Do you have a history of
stress?
·
Is there a history of head
injury?
If the history
is consistent with migraine or tension-type headaches and the neurological exam
is normal, no further diagnostic testing may be necessary. However, if it is
not a primary type headache, then other tests may be needed to determine the
cause.
Tests used to
determine the cause of a headache may include:
·
Blood tests. Various blood chemistry and other lab tests may be run to
check for underlying conditions.
·
Sinus x-rays. A diagnostic imaging procedure to evaluate for congestion
or other problems that may be corrected.
·
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of
large magnets, radiofrequencies, and a computer to produce detailed images of
organs and structures within the body.
·
Computed tomography scan (also called a CT or CAT
scan). A diagnostic imaging procedure that uses a combination of
X-rays and computer technology to produce horizontal, or
axial, images (often called slices) of the body. A CT scan shows
detailed images of any part of the body, including the bones, muscles, fat, and
organs. CT scans are more detailed than general X-rays.
How are headaches treated?
Specific
treatment for headaches will be determined by your health care provider
based on:
·
Your age, overall health, and
medical history
·
Type of headaches
·
Severity and frequency of the
headaches
·
Your tolerance for specific
medications, procedures, or therapies
·
Your opinion or preference
The ultimate
goal of treatment is to stop headaches from occurring. Adequate headache
management depends on the accurate identification of the type of headache and
may include:
·
Avoiding known triggers, such
as certain foods and beverages, lack of sleep, and fasting
·
Changing eating habits
·
Exercise
·
Resting in a quiet, dark
environment
·
Medications, as recommended
by your health care provider
·
Stress management
Migraine
headaches may require specific medication management including:
·
Abortive medications. Medications, prescribed by your health care provider, that
act on specific receptors in nerves and blood vessels in the head to stop a
headache in progress.
·
Rescue medications. Medications purchased over-the-counter, such as analgesics
(pain relievers), to stop the headache.
·
Preventive medications. Medications, prescribed by your health care provider, that
are taken daily to reduce the onset of severe migraine headaches.
Some headaches
may require immediate medical attention including hospitalization for
observation, diagnostic testing, or even surgery. Treatment is individualized
depending on the underlying condition causing the headache. Full recovery
depends on the type of headache and other medical problems that may be present.
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