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The Common Bane of Head Pain

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April 30, 2019 0 3 minutes, 12 seconds read
Dr. Rajshekher Reddy - Max Hospital
Director - Headache and Neuromuscular Disorders
Neurology, Neurosciences

Headache is one of the most common disorders seen to occur in all age groups but much more so in women. Broadly headaches can be classified as Primary and Secondary Headaches disorders. Primary Headache disorders have no apparent causative factor and are thought to be interplay between genetic predisposition and environmental provocative factors. The most common by far is Migraine. Secondary headaches are those that result from a cause e.g. Brain Tumor.

The Primary Headaches:

  • Migraine
  • Tension-type headache
  • Cluster headache and other trigeminal autonomic cephalalgias
  • Other primary headaches.

The Secondary Headaches:

  • Headache attributed to head and/or neck trauma
  • Headache attributed to cranial or cervical vascular disorder
  • Headache attributed to non vascular intracranial disorder
  • Headache attributed to a substance or its withdrawal
  • Headache attributed to infection
  • Headache attributed to disorder of homoeostasis
  • Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial structures.
  • Headache attributed to psychiatric disorder

Cranial Neuralgias, Central and primary facial pain and other headaches

  • Cranial neuralgias and central causes of facial pain
  • Other headache, cranial neuralgia, central or primary facial pain

For all practical purposes, most people suffering from headaches have primary headache disorders especially Migraine. Though most people worry that they may have a “Brain Tumor” or serious disease causing headache that is a rare and an unusual situation. Certain Red flags can help and decide if the headache cause could be of a dangerous origin.

Workisome Headache Red Flags “Snoop”

  • Systematic symptoms (Fever, weight loss) or secondary risk factors (HIV, Systematic cancer)
  • Neurologic symptoms or abnormal signs (confusion, impaired alertness or consciousness)
  • Onset: Sudden, abrupt or spilt second
  • Older : New onset and progressive headache, especially in middle –age > 50 (Giant cell arteritis)
  • Previous headache history  : First headache or different (change in attack frequency, severity or clinical features)

There is also an incorrect belief that the word migraine would always implies a very severe headache. That is incorrect and most headaches suffered by people in the world are Migraine. Migraine is a spectrum of headaches that could be mild and infrequent or severe, frequent and daily. Migraine with aura (usually visual symptoms) is also called Classic migraine and occurs in 15% patients. Migraine without aura (also called Common Migraine) occurs in 85% patients.

Common Symptoms of Migraine

  • Head pain (Pounding, pulsating, throbbing)
  • Nausea/Vomiting
  • Loss of appetite
  • Light or sound sensitivity (Sonophotophobia)
  • Scalp tenderness
  • Dizziness and lightheadedness 
  • Irritability

Common Aggravating Causes of Migraine are:

  • Sleep deprivation – Excess or lack
  • Irregularity of  meal times
  • Stress
  • Hormonal changes
  • Food triggers

The management of headaches begins by establishing the correct diagnosis clinically or with the help of tests ruling out the rare but dangerous secondary headache disorders.

Once it is established that underlying condition is migraine than the treatment has the following steps:

  • Lifestyle management - to recognize and eliminate aggravating factors.
  • Preventive therapy:  Daily medications of various types which are used to prevent/reduce the number of “attacks” of headache. These are not Rescue (immediate/SOS) pain relieving medicines and must be taken regularly for 3- 6 months or more.
  • Rescue therapy: To abort the “attack” of severe headache.

It is important to recognize and appropriately deal with these disabling headaches to prevent Medicine Overuse Headache (MOH) which occurs in many people who chose only to take “Acute/Abortive/Rescue” medications. Painkiller over use can also result in Ulcer disease and kidney dysfunction.   For patients in whom headaches have worsened to a point where they have incapacitating near daily headaches. Newer modalities of therapy like Botox are available.

Key points:

  • Recognize that most headache are Migraine and not “Gas”, “Weak eyes” or “Sinus”.
  • Migraine does not imply only severe debilitating headaches.  Practically most headaches is the world are Migraine.
  • Prevent MOH and side effects of rescue medications.
  • Recognize CDH (Chronic daily headache) and consider newer modalities of treatment such as Botox.

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