Head ache

What is a headache?

A Headache is defined as a pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes.

How are headaches classified?

Headaches have numerous causes, and in 2007 the International Headache Society agreed upon an updated classification system for headache. Because so many people suffer from headaches and because treatment sometimes is difficult, it is hoped that the new classification system will allow health care practitioners come to a specific diagnosis as to the type of headache and to provide better and more effective treatment.

There are three major categories of headaches:

• Primary headaches
• Secondary headaches and
• Cranial neuralgias, facial pain, and other headache.

What are primary headaches?

Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache

Tension headaches

The most common type of primary headache. Up to 90% of adults have had or will have tension headaches. Tension headaches occur more commonly among women than men. commonly among women than men.

Migraine headaches

The second most common type of primary headache. people about 12% of the population will experience a migraine headache. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. It is estimated that 6% of men and up to 18% of women will experience a migraine headache in their lifetime.

Cluster headaches

These are rare type of primary headache affecting 0.1% of the population (1 in a 1,000 people). It more commonly affects men in their late 20s though women and children can also suffer these types of headache.

Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly while others are debilitated. While these headaches are not life-threatening, they may be associated with symptoms that can mimic strokes or intracerebral bleeding.

What are secondary headaches?

Secondary headaches are those that are due to an underlying structural problem in the head or neck. There are numerous causes of this type of headache ranging from bleeding in the brain, tumor, or meningitis and encephalitis. What are cranial neuralgias, facial pain, and other headaches

Neuralgia means nerve pain (neur= nerve + algia=pain). Cranial neuralgia describes a group of headaches that occur because the nerves in the head and upper neck become inflamed and become the source of the pain in the head. Facial pain and a variety of other causes for headache are included in this category

What causes tension headaches?

While tension headaches are the most frequently occurring type of headache, their cause is not known. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may spasm and cause pain. Common sites include the base of the skull where the trapezius muscles of the neck inserts, the temple where muscles that move the jaw are located, and the forehead.

There is little research to confirm the exact cause of tension headaches. Tension headaches occur because of physical or emotional stress placed on the body. These stressors can cause the muscles surrounding the skull to clench the teeth and go into spasm. Physical stressors include difficult and prolonged manual labor, or sitting at a desk or computer for long periods of time concentrating. Emotional stress may also cause tension headaches by causing the muscles surrounding the skull to contract.

What are the symptoms of tension headaches?

The pain symptoms of a tension headache are:

• The pain begins in the back of the head and upper neck and is described as a band-like tightness or pressure.
• Often is described as pressure encircling the head with the most intense pressure over the eyebrows.
• The pain usually is mild (not disabling) and bilateral (affecting both sides of the head).
• The pain is not associated with an aura (see below), nausea, vomiting, or sensitivity to light and sound.
• The pain occurs sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people. The pain allows most people to function normally, despite the headache.

What diseases cause secondary headaches?

Headache is a symptom associated with many illnesses. While head pain itself is the issue with primary headaches, secondary headaches are due to an underlying disease or injury that needs to be diagnosed and treated. Controlling the headache symptom will need to occur at the same time that diagnostic tests are being considered to diagnose the underlying disease. Some of the causes of secondary headache may be potentially life-threatening and deadly. Early diagnosis and treatment is essential if damage is to be limited.

The International Headache Society lists eight categories of secondary headache. A few examples in each category are noted.

Head and neck trauma

• Injuries to the head may cause bleeding in the spaces between the layers of tissue that surround the brain (subdural, epidural and subarachnoid spaces) or within the brain tissue itself.
• Concussions, where head injury occurs without bleeding
• A symptom of whiplash and neck injury

Blood vessel problems in the head and neck

• Stroke or transient ischemic attack (TIA)
• Arteriovenous malformations (AVM) may cause headache before they leak
• Carotid artery inflammation
• Temporal arteritis (inflammation of the temporal artery)

Non-blood vessel problems of the brain

• Brain tumors, either primary, originating in the brain, or metastatic from a cancer that began in another organ
• Seizures
• Idiopathic intracranial hypertension, once named pseudotumor cerebri, where the pressure is too high in the cerebrospinal fluid within the spinal canal.

Infection

• Meningitis
• Encephalitis
• HIV/AIDS
• Systemic infections (for example, pneumonia or influenza)

Changes in the body's environment

• High blood pressure (hypertension)
• Dehydration
• Hypothyroidism
• Renal dialysis

Problems with the eyes, ears, nose throat, teeth and neck

• Psychiatric disorders

What are the exams and tests for secondary headaches?

The patient history and physical examination provide the initial direction for determining the cause of secondary headaches. Therefore, it is extremely important that patients with severe headaches seek medical care and give their health care practitioner an opportunity to assess their condition. Tests that may be useful in making the diagnosis of the underlying disease causing headaches include:

• blood tests
• computerized tomography (CT Scan)
• magnetic resonance imaging (MRI) scans of the head, and

• lumbar puncture

Specific tests will depend upon what potential issues the health care practitioner and patient want to address.

Blood tests

Blood tests provide helpful information in association with the history and physical examination in pursuing a diagnosis. For example, an infection or inflammation in the body may cause a rise in the white blood cell count, the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). These two tests are very non-specific, that is, they may be abnormal with any infection or inflammation, and abnormalities do not point to a specific diagnosis of the cause of the infection or inflammation.

Blood tests can also assess electrolyte disturbances, and a variety of organ functions like liver, kidney, and thyroid.

Computerized tomography of the head

Computerized tomography (CT scan) is able to detect bleeding, swelling, and tumors. It can also show evidence of previous stroke. With intravenous contrast injection, it can also be used to look at the arteries of the brain.

Magnetic resonance imaging (MRI) of the head

MRI is able to better look at the anatomy of the brain, meninges (the layers that cover the brain and the spinal cord). While it is more precise, the time to perform the scan is significantly longer than for computerized tomography. This type of scan is not available at all hospitals. Moreover, it takes much longer to perform, requires the patient to cooperate by holding still, and requires that the patient have no metal in their body (for example, a heart pacemaker or metal foreign objects in the eye).

Lumbar puncture

Cerebro-spinal fluid, the fluid that surrounds the brain and spinal cord, can be obtained with a needle that is inserted into the spine in the lower back. Examination of the fluid can reveal infection (such as meningitis due to bacteria, a virus, or tuberculosis) or blood from hemorrhage. In almost all cases, computerized tomography is done prior to lumbar puncture to make certain there is no bleeding, swelling, or tumor in the brain. Pressure within the space can be measured when the lumbar puncture needle is inserted. Elevated pressures may make the diagnosis of idiopathic intracranial hypertension in combination with the appropriate circumstances.

Source: Portal Content Team