Headaches: things to remember

Headache, an almost universal human experience is one of the common complaints encountered in medical practice. About 90% of the population experience at least one episode of headache over the course of one year, of which about 1% result from a serious condition.

Take a close look at your headache and note down when it occurs, your symptoms and if there are any specific triggers, for example certain foods, lack of sleep, stress, wine or weather. Keeping a head ache diary may help determine your headache type and identify the best treatment.

There are many types of headaches, some are chronic and some appear all of a sudden. Chronic headaches are usually referred to as headaches which occur 15 days or more a month. Some types of chronic headaches include:

• Primary exertional headaches, which appear after exercising
• Rebound headaches, can occur from overusing pain medications for headaches for several days every week in the past months. These headaches can appear almost daily and can be associated with nausea and vomiting. They may stop when you stop taking medication, but it can take a couple of weeks. If there is no result, Amitriptyline can work.
• Cluster headaches, can cause severe grinding pain, lasting less than 3 hours, on one side of the head and occur off and on for weeks, sometimes lasting for several months. Cluster headaches can appear together with one or more of the following, tearing, red eye, nasal congestion and nasal discharge, usually at the same side as the pain.
• Arnold`s neuralgia: is an unilateral occipital pain, occurring when occipital major nerve is damaged. Treatment consist of an infiltration of the nerve.

The most common types of headaches are tension headaches and migraines; they can appear as chronic headaches or only occur occasionally.

Tension- type headache (TTH):

Tension- type headache, is the most common headache as about 80% of the general population suffer from TTH. The pain intensity is mild to moderate and is often described as having a pressing or tightening (non pulsating) quality that is not aggravated by routine physical activity, such as walking or climbing stairs. The pain lasts for at least several hours to days and is predominantly felt bilaterally.

Treatment

Simple analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in treating acute headache. Tricyclic antidepressants (especially amitryptiline) should be the primary choice of preventive medication for patients with frequent or chronic TTH. If you need any of these drugs multiple days during a week, ask your doctor for advice. Be careful with taking Aspirin, living in a Dengue Endemic area, Aspirin can make Dengue infection worse. Do not give Aspirin to your kids as it can cause a serious condition called Reye's syndrome.

Alternative treatment options such as massage therapy; acupuncture may also help to relieve your symptoms.

Migraines

Migraines are another common type of headache. They typically affect more women than men. Migraine headaches can last from 4 hours to 3 days and usually happen one to four times a month. Migraine comes usually with a moderate to severe throbbing pain which has a pulsating quality to it. They can be on one side of the head but can also spread to the entire head. Migraines are often associated with nausea and vomiting and many people have what is called photophobia, meaning they are very sensitive to light and also sounds. In severe forms there can be neurological symptoms associated with a migraine attack, and the affected person may have warning symptoms known as aura occurring before the headache onset. These can include flashes of light, blind spots, or tingling on one side of the face or in your arm or leg. Migraines tend to get worse with exercise, which raises blood pressure. In children, benign paroxysmal vertigo and abdominal pain are considered as migraine equivalents. They usually stop after a good night sleep.

Migraine treatment is aimed at relieving symptoms and preventing further attacks. If you know what triggers your migraines, for example histamine rich foods such as chocolate and cheese, try to avoid them to prevent an attack or at least make the attack less severe.

If you already have a migraine it is best to rest in a quiet, cool and darkened room and take some pain killers such as, paracetamol or ibuprofen. Your doctor may prescribe some specific mediation for your which have been very effective for migraines and which include sumatriptan and zolmitriptant. In some cases, your doctor may prescribe preventative medications such as beta blockers, amytriptiline, topiramate, and others. Acupuncture and a massage may help relieve your symptoms together with the medicine.

What are headache emergency signs?

If your experience one of the following, you should consider it a medical emergency and seek medical assistance immediately:

• A sudden, very intense headache
• A headache with fever and stiff neck or a rash
• A headache with fever, seizure, confusion, or loss of consciousness.
• Persistent headache or worsening of headache in patients despite treatment.
• Persistent headache in children.
• Headache after a head injury or fall
• Headache accompanied by other symptoms such as numbness in limbs, blurred vision, difficulty to speak, double vision or fainting.

These symptoms suggest a more serious condition, you should seek immediate medical attention to get a prompt diagnosis and treatment which may save your life.

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