Headache: A Common Medical Problem

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
• Sinusitis

II. Less Common Causes are:

• Subarachnoid hemorrhage
• Meningitis and Encephalitis
• Brain tumor
• Acute narrow angle glaucoma
• Stroke
• Temporal arteritis
• Tetanus

III. Other Causes Are:

• Benign Intracranial Hypertension
• Uveitis
• Hypoglycemia

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.

History:
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.

Treatment:

1. Prophylaxis : Calcium channel blocker: Flunarazine is choice drug lately.
2. 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.
3. Paracetamol/acetaminophen benefited over half of patients with mild or moderate migraines.
4. Simple analgesics combined with caffeine may help.
5. Analgesics combined with antiemetics
6. Serotonin agonists- Sumatriptan
7. Antidepressants: Amytriptylline
8. Ergot alkaloids: Dihydroergotamine

About The Author

Sulav Shrestha blogs from KIST Medical College, Nepal
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