Headaches

Headaches are a very common symptom associated with a wide variety of conditions but not all headaches are the same. Here are some of the most common types of headaches:

Tension Headaches

Thought to be the cause of the majority of chronic daily headaches, tension headaches result from neurovascular irritation referred to the muscles of the scalp and upper neck. They are often brought on by stress, worry, concentrated visual effort and inhalation of fumes. There is also a link to depression and cervical spondylosis (degeneration of bones of the neck). Sustained use of analgesics can actually exaccerbate these headaches.

Presentation

  • tight band sensations
  • pressure behind the eyes
  • throbbing pain

Treatment

  • avoid causing factors
  • cessation of analgesics
  • physical treatment e.g. massage, osteopathy, ice packs
  • specialised drugs for depression (if deemed a cause)

Migraine

Migraines are recurrent headaches associated with visual and gastrointestinal disturbance. Over 20% of the world’s population are said to suffer from migrainous symptoms with 90% of these originating before 40 years of age. The cause of migraine is different from individual to individual but common causes include:

  • relaxation (weekend migraine)
  • chocolate
  • cheese
  • noise / light
  • premenstrual symptoms

Migraine is common around puberty and at menopause and increase in severity and frequency with hormonal contraceptives, pregnancy and occasionally with hypertension or following minor head trauma.

Types of Migraine

  • Migraine with Aura
    Prodromal symptoms are visual, including flashes and the appearance of jagged lines, often accompanied by transient aphasia (disrupted speech) with tingling, numbness, vague weakness and nausea. This lasts from a few minutes to an hour, followed by headache, increased nausea and sometimes vomiting. After several hours the migraine will settle and deep sleep will follow.
  • Migraine without Aura (common migraine)
    This is the most common type, with only vague visual symptoms followed by headache and nausea.
  • Basilar Migraine
    Prodromal symptoms include tingling of the tongue and around the mouth (circumoral), vertigo, diplopia (double vision), transient visual disturbance/blindness, syncope (loss of consciousness), dysarthria (poor articulation of words) and ataxia (lack of coordination).
  • Hemiparetic Migraine
    These are rare and resemble a stroke, recovering within 24 hours.
  • Opthalmoplegic and Facioplegic Migraine
    Again, rare, these are a palsy of the Cranial Nerves III (occulomotor), V (trigeminal) and VII (facial).

Presentation

Migraines can be separated into phases:

  • wellbeing before an attack
  • prodromal symptoms
  • the main attack – headache, nausea, vomiting
  • sleep and feeling drained post-attack

Treatment

  • Avoidance of causing factors e.g. diet, occupational
  • Change of medication e.g. contraception
  • Paracetamol/analgesics at start of an attack with an antiemetic (to combat nausea)
  • Specialist drugs called Triptans such as Sumaltriptan, Almotriptan, Eliptriptan etc at the start of an attack or Prophylaxis such as Pizotifen, Propanolol or Amitriptyline for frequent attacks

Cluster Headaches

These are recurrent bouts of excrutiating unilateral pain around one eye. They typically affect adults, in particularly males between 30 and 40 with alcohol a common trigger. Bouts consist of recurrent daily attacks in clusters over one or two months.

Presentation

  • Severe pain around one eye
  • Builds over a few minutes and lasts for a few hours
  • Vomiting can occur
  • Corresponding cheek and nostril become congested
  • Transient ipsilateral Horner’s Syndrome: ptosis (eyelid drop), miosis (constriction of pupil) & andhydrosis (decreased sweating on one side)
  • Bouts occur in clusters daily for a few days repeatedly over a number of months

Treatment

  • Analgesics and migraine drugs are unhelpful
  • Subcutaneous sumatriptan is effective
  • Oxygen inhalation can sometimes abort an attack
  • Verapramil, topiramate, lithium carbonate or a short course of steroids can help to end a bout of cluster headaches

Other Types of Headache

  • Ice Cream Headaches
    Intense retropharangeal pain following eating very cold food
  • Primary Cough Headaches
    Sudden sharp head pain on coughing. Often resolves spontaneously.
  • Primary Low CSF Volume Headaches
    Seen typically on standing up. Can be spontaneous or following vigarous valsalva, straining or orgasm. Secondary low CSF volume headache can follow lumbar puncture.
  • Primary Sex Headaches
    Typically arise in men at orgasm and resolve spontaneously. Can rarely occur with an unruptured intracranial aneurysm.

If you are suffering from headaches and are concerned about their cause, seek professional advice by visiting your GP who will be able to talk through the causes and possible treatments.

Ref: Kumar, P & Clark, M (2009). Clinical Medicine. 7th ed. Edinburgh: Saunders Elsevier. p1136-1139.

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