Headache is a common complaint in Medical Practice. A vast spectrum of disorders are behind the causes of headaches.
First of all, the causes of headache are:
I. Common Causes:
- Tension Headache
- Migraine Headache
- Cluster Headache
II. Less Common Causes are:
- Subarachnoid hemorrhage
- Meningitis and Encephalitis
- Brain tumor
- Acute narrow angle glaucoma
- Temporal arteritis
III. Other Causes Are:
- Benign Intracranial Hypertension
I’d like to elaborate on Tension headache and Migraine:
A. Tension Headache:
- Most common cause of headache. Patient complains of ’Bandlike’ tightness :” Like a tight band being applied around the head”
- This type of headache aggravates at the end-of the day ‘ Office Headache’.
- It is usually related to Stress.
- Headache occurs posteriorly, or temporally . This type of headache is related to muscle spasm. It may continue for days to week.
- All the Laboratory Studies and investigations are normal.
- Relaxation therapy is helpful along with analgesics.
B. Migraine Headache:
- It is a form of Vascular headache and ranges from mild headaches to severe disabling headache.
- It results due to cerebral vasospasm followed by dilation.
- Food ( nuts, alcohol, chocolate etc), Stress, Weather Change, Hormonal changes in the body in female have been Implicated as the precipitants
- Coffee once thought to precipitate migraine is now known to be quite helpful in Migraine and is used therapeutically combined with analgesics.
Migraine consists of Vasospastic and Dilatory phase:
Several Neurological defect like temporary loss of vision, deafness can occur in Spastic phase. Headache occurs when vasodilation occurs.
Usually Unilateral headaches- may be severe and throbbing .
Reccurence on the same side
Prodrome symptoms are: Nausea, Vomiting, and Aura ( feature of classical migraine)- flashes of light, Zig zag lines , halos, Scotomas .
Photophobia is quite common.
Diagnosis: Migraine is a clinical diagnosis. Tests aren’t much of help except to exclude other pathology.
- Prophylaxis : Calcium channel blocker: Flunarazine is choice drug lately.
- Treatment: Non-steroidal anti-inflammatory drugs (“NSAIDs”) can effectively alleviate migraines.Trials have consistently found that a 1000 mg dose of Aspirin (also called ASA) could relieve moderate to severe migraine pain, with similar effectiveness to sumatriptan.
- Paracetamol/acetaminophen benefited over half of patients with mild or moderate migraines.
- Simple analgesics combined with caffeine may help.
- Analgesics combined with antiemetics
- Serotonin agonists- Sumatriptan
- Antidepressants: Amytriptylline
- Ergot alkaloids: Dihydroergotamine
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