Headache Management

Headaches / Migraines

A headache is pain or discomfort anywhere in the region of the head or neck. Headaches are the most common health complaints experienced by every person at some point during their life. Most headaches are not serious and can be treated with medications and lifestyle changes. There are many different types of headaches and it is important to know the particular type of headache you have and also methods to treat the same.

Types

Depending upon the cause, headaches can be divided into three major categories:

Primary Headaches, Secondary Headaches and Cranial neuralgias, facial pain, and other headaches

Primary headaches: Primary headaches are those headaches that are not associated with other medical conditions. The most common types of primary headaches include:

  • Tension headaches: Tension headaches are the most common type of headaches that occur when the head and neck muscles contract. Tension headaches may occur at any age, but are most common in adults and adolescents. The muscle contractions may be caused by stress, poor posture, fatigue, eyestrain, alcohol and tobacco use, and even hormonal changes in women before and after a menstrual period.
  • Migraine Headache: A migraine is a common type of headache usually felt as a throbbing pain on one side of the head. The exact cause of migraine is unknown, but may occur from a series of changes in brain activity. Migraines occur more often in women than men and may run in families. Migraine attacks may be associated with alcohol use, smoking, lack of sleep, prolonged muscle tension and stress, changes in hormone levels during a woman’s menstrual periods or with the use of oral contraceptives and certain foods especially chocolate, cheese, nuts, alcohol, and foods containing preservatives and artificial sweeteners.
  • Cluster headaches: Cluster headache is a less common type of primary headache. Cluster headaches can occur at any age but are most common in men in their late 20s. The cause of cluster headaches is unknown, but abnormalities in an area of the brain called the hypothalamus may be involved. They also tend to run in families. Cluster headaches are triggered by certain factors such as changes in sleep patterns and use of medications such as nitroglycerin, a drug used to treat heart disease.

Secondary headaches: Secondary headaches are those that are caused by other underlying diseases. Some medical conditions that can cause secondary headaches include bleeding in the brain, brain tumors, meningitis and encephalitis.

Cranial neuralgias, facial pain, and other headaches: Cranial neuralgia (pain coming from a nerve) is pain or discomfort in the head or neck caused by inflammation of the nerves located in the head and upper neck. Facial pain can be caused from a nerve disorder, an injury, or an infection in a structure of the face or it may occur for no known reason.

Symptoms

People with tension headaches have generalized pain in the head and neck described as a band-like tightness or pressure.

Migraine headaches often cause a throbbing or pulsating sensation usually on one side of the head. Pain often starts as a dull ache and can worsen within minutes or hours. This type of headache may occur with symptoms such as nausea, vomiting, visual disturbances, and sensitivity to light and sound. The pain can last a few hours or even up to one or two days. Some people with migraines experience prodromal symptoms, including repeated yawning, food cravings, mood changes, and altered perception of heat and cold. These symptoms occur several hours before the headache begins.

Cluster headaches have a characteristic grouping or clustering of attacks. People with cluster headaches usually get pain once or twice daily, which may last for weeks or months. This is followed by a pain free period lasting for months or years, before the headache attacks start again. Each cluster headache lasts from 30 to 90 minutes. Attacks tend to occur at the same time each day and often wake the person from sleep. The pain is extremely painful and may occur behind and around one eye. Other symptoms include stuffy nose, excessive tearing, redness in the eye, and restlessness. For some people the pain feels like a hot poker being stuck right in the eye. People with cluster headache often pace the floor, bang their heads against a wall, and can be driven to take desperate measures to relieve the pain.

Diagnosis

Your doctor can diagnose headache by asking questions about your symptoms, family history, medical history, diet, and lifestyle. Diagnosis depends on your description about the headache, its location, length, duration, causative factors and associated symptoms. Your doctor may order the following diagnostic procedures:

An MRI or CT scan of the head may be needed to rule out other causes of the headaches.

An X-ray of the sinuses may be taken to evaluate sinus problems.

Lumbar puncture: A spinal tap, also called lumbar puncture, is removal of cerebrospinal fluid, or CSF (fluid surrounding the spinal cord and the brain) from the spinal canal to diagnose disorders affecting the brain and spinal cord. This procedure may be performed to look for signs of infection and to check for bleeding around the brain.

Temporal artery biopsy: A sample of blood vessel is taken from your temple and studied to check for signs of inflammation.

Treatment

Non-medicinal treatments are used together with medicinal treatments as part of a combined therapy program.

Physical Therapy

Physical therapists perform an initial evaluation of the chronic headache patient including assessment of posture, range of motion, muscle tightness and presence of myofascial trigger points. The goal is to determine the underlying structural cause of the headaches and then focus their treatment in this area. Treatment involves educating the patient regarding posture while standing, proper positioning while working at a desk, therapeutic exercises and stretching along with manual physical therapy. Physiotherapy can help diminish the frequency, intensity and duration of the chronic headache sufferers and has proven effective in the treatment of migraines.

Change in lifestyle (diet, trigger avoidance)

Alteration in meal timings and triggering factors (like caffeine and mobile phone signals) are often responsible for migraines. Try to avoid triggers that may bring on a headache by eating regular meals, avoiding alcohol and caffeine, getting plenty of rest and exercising regularly.

Relaxation (sleep, stress management and meditation)

Changes in sleep patterns, such as disturbed sleep or sleeping longer are some of the confounding factors associated with migraines. Effective stress management, good sleep and meditation has found to improve the conditions of chronic headaches.

Cryotherapy and Thermotherapy

This is the use of cold and heat to relieve headache symptoms. This type of therapy can provide great relief to patients suffering from chronic headaches.

Psychological Therapy

Mood disorders are commonly considered as a comorbid condition with headaches. Cognitive behavioral therapy is a widely recommended psychological intervention for the treatment of people with chronic headaches.

Biofeedback

This evaluates the effectiveness of relaxation training. It provides feedback information of the “body’s (biological) current state” to the patient with chronic headaches. Electromyograph (EMG) and Electroencephalograph (EEG) are used to evaluate electrical activity.

Everyone gets an occasional headache and they are usually harmless. You should be concerned if you have headaches almost every day and if pain limits your ability to get on with life’s activities. Some headaches may be a sign of a more severe illness and therefore one should get medical attention immediately.

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