Headaches

What causes a headache?

Headaches may be caused by a number of conditions, such as disorders of the neck, eyes, brain, jaw, or teeth. Headaches with an underlying medical condition are classified as secondary headaches because they are related to the condition. An example of this would be a headache due to neck injury or sinus infection. Consult your physician for diagnosis.

Other headaches are classified as primary because the headache itself is the main medical problem, although underlying non-medical causes, such as muscle tension or foods, may be identified. Other contributing factors may include medications, dehydration, or changing levels of hormones. These factors that influence headaches are sometimes called headache triggers.

Types of primary headaches:

Migraines

This type of headache is distinguished by the fact that symptoms other than pain occur as part of the headache. Nausea and vomiting, lightheadedness, sensitivity to light (photophobia), and other visual symptoms typically occur.

Migraines are also unique in that they have distinct phases. Not all individuals experience each phase, however. The phases of a migraine headache may include:

  • premonition phase - a change in mood or behavior that may occur hours or days before the headache.
  • aura phase - a group of visual, sensory, or motor symptoms that immediately precede the headache. Examples include hallucinations, numbness, changes in speech, and muscle weakness.
  • headache phase - period during the actual headache. Throbbing pain on one or both sides of the head. Sensitivity to light and motion are common, as are depression, fatigue, and anxiety.
  • headache resolution phase - pain lessens during this phase, but may be replaced with fatigue, irritability, and difficulty concentrating. Some individuals feel refreshed after an attack, while others do not.

Tension headaches

Tension headaches are the most common type of headache. Stress and muscle tension are often factors in tension-type headaches. While symptoms may differ, the following are common symptoms of a tension-type headache:

  • slow onset of the headache
  • head usually hurts on both sides
  • pain is dull or feels like a band or vice around the head
  • pain may involve the back (posterior) part of the head or neck
  • pain is mild to moderate, but not severe

Tension type headaches typically do not cause nausea, vomiting, or sensitivity to light (photophobia).

Cluster headaches

Cluster headaches usually occur in a series that may last weeks or months, and the headache series may return every year or two. While people often experience symptoms differently, the following are the most common symptoms of a cluster headache:

  • severe pain on one side of the head, usually behind one eye
  • the eye that is affected may have a droopy lid, small pupil, or redness and swelling of the eyelid
  • runny nose or congestion
  • swelling of the forehead

Diagnosis

If the history is consistent with migraine or tension-type headaches and the neurological exam is normal, no further diagnostic testing may be necessary. However, if it is not a primary type headache, then other tests may be needed to determine the cause.

Tests used to determine the cause of a headache may include:

  • blood tests - various blood chemistry and other laboratory tests may be run to check for underlying conditions.
  • sinus x-rays - a diagnostic imaging procedure to evaluate for congestion or other problems that may be corrected.
  • magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • computed tomography scan (Also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

 

 

Treatment for headaches:

The ultimate goal of treatment is to stop headaches from occurring. Adequate headache management depends on the accurate identification of the type of headache and may include:

  • avoiding known triggers, such as certain foods and beverages, lack of sleep, and fasting
  • changing eating habits
  • exercise
  • resting in a quiet, dark environment
  • medications, as recommended by your physician
  • stress management

Migraine headaches may require specific medication management including:

  • abortive medications - medications, prescribed by your physician, that act on specific receptors in nerves and blood vessels in the head to stop a headache in progress.
  • rescue medications - medications purchased over-the-counter, such as analgesics (pain relievers), to stop the headache.
  • preventive medications - medications, prescribed by your physician, that are taken daily to reduce the onset of severe migraine headaches.

Some headaches may require immediate medical attention including hospitalization for observation, diagnostic testing, or even surgery. Treatment is individualized depending on the underlying condition causing the headache. Full recovery depends on the type of headache and other medical problems that may be present.

 

Information courtesy of the  University of Miami Health System.

 

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