A headache or cephalalgia refers to pain anywhere in the different areas of the head or neck. This includes the nine pain-sensitive structures, which include the cranium (the periosteum of the skull), muscles, nerves, arteries and veins, subcutaneous tissues, eyes, ears, sinus and mucous membranes.
A chronic daily headache (CDH) is commonly defined as a headache occurring for 15 or more days in a month or at least for three months. Chronic daily headache (CDH) is where a person experiences frequent headaches that are challenging to manage. A recent population-based survey shows that nearly 5% of the unselected population has daily headaches. Most of the patients with persistent headaches have a primary headache syndrome. Headache is the most common complaint which brings a patient to a neurologist. Although most headaches are benign in origin, some can have severe and sometimes life-threatening causes.
1) Primary Headaches: In this type, there are no underlying causes. It includes tension-type headache, migraine, cluster headache, etc.
Tension-type headaches present with tightness or heaviness in the head is usually mild to moderate in intensity and is either episodic or continuous.
Migraine is the most common cause of severe, throbbing, unilateral/bilateral headache lasting 4 to 72 hours with or without nausea, vomiting, dislike towards bright light and loud sounds.
2) Secondary Headaches: This type of headache is due to an underlying cause. It can be a brain stroke, haemorrhage, brain infection, or a brain tumour.
Sudden severe headaches should be immediately reported as they can indicate haemorrhage inside the brain or surface of the brain.
The most common causes of headaches are:
Staying in one position for a long time
Working in an awkward position for a long time
Clenching one’s jaw
Fever, neck stiffness, personality change or abnormal neurological symptoms, which demand prompt attention.
A sudden, new or different headache in someone over 50 years old
Headache that develops within minutes “thunderclap” headache
Headache associated with confusion may be indicative of encephalitis
Inability to move a limb or abnormalities on neurological examination, mental confusion, being woken by headache
Headache that worsens with changing posture, headache worsened by exertion, coughing, straining Visual loss or visual abnormalities and jaw claudication (jaw pain on chewing that resolves afterwards)
Signs of irritated brain surface, such as severely stiff neck(a sign of meningitis), or sudden spike of pain with quick movement of head
History of a known serious disease that can involve the head or brain, such as acquired immune deficiency disease (AIDS) or Cancer. A sudden change in headache pattern such as increased frequency, intensity, or duration
A headache that is associated with neurological symptoms such as weakness, dizziness, sudden loss of balance or falling, numbness or tingling, paralysis, speech difficulties, mental confusion, seizures, personality changes/inappropriate behavior, or vision changes (blurry vision, double vision, or blind spots)
Headache with unexplained fever, shortness of breath, weakness on one side of the body
Headache pain that awakens you at night (Cluster headache or alarm clock headache)
Headaches with severe nausea and vomiting (Migraine)
Headaches that occur after a head injury or accident
Nontrivial head trauma or convulsions
Relentlessly worsening headache over days or weeks
Blood pressure higher than 180/115
The following migraine or headache symptoms do not require urgent care, but you should contact your doctor if you, or your loved one, have any of these symptoms.
You feel so bad you cannot go to work or enjoy yourself
Non prescription drugs rarely provide relief
Have three or more headaches per week
Have headaches that keep getting worse and won't go away
Need to take a pain reliever every day or almost every day for your headaches
Need more than two to three doses of over-the-counter medications per week to relieve headache symptoms
Have a history of headaches, but have noticed a recent change in your headache symptoms
Max Institute of Neurosciences (MINS) provides world-class super speciality tertiary care for all kinds of headaches. Apart from an array of services like Advanced Brain Tumour Centre, Minimally Invasive Spine Surgery Centre, Stroke Centre, it has India's first Intraoperative MRI.
Max Institute of Neurosciences offers the following facilities:
Advanced Brain Tumour Centre
Minimally Invasive Spine Surgery Centre
Stroke Centre ·
Special Clinics for Epileptic, Neuromuscular and Movement Disorders ·
Neuro Immunology ·
Max Headache Clinic is a facility dedicated to treating headache and related conditions, via a variety of options. The clinic is dedicated to quality diagnosis and comprehensive, individualised management of headaches and works in close cooperation with the patient's personal physician. Close communication with referring physicians is a strong goal of this clinic, as it is understood that headache is a chronic disease which requires ongoing treatment.
At Max Institute of Neurosciences, as part of planning treatment a detailed discussion is done with the patient to have better understanding in terms of medical history, symptoms etc. Below are few detailed points which are discussed as a part of this discussion: ·
History of headache episodes: This is to record the response to recent onset of headaches to ensure that the pattern hasn’t changed (became more frequent or more severe, or both) even if the patient has always been somewhat ‘headachey’. ·
Frequency of headaches: This may lead to many varied responses. Still, the key is how many days are affected and on how many days does the patient have a significant disability. The patient can be advised to maintain a diary to record his pain pattern, frequency and list the medications taken to counter the pain. ·
Describing the worst attacks: Understanding the pattern of severe attacks help in guiding the therapy. Severe attacks will have some migrainous features which can lead to a proper diagnosis. ·
Triggers and family history: Migraine genes seem to confer a set of sensitivities to various triggers. The migraine brain has a variation which explains why triggers work on some days and not on others. This variability is perfectly compatible with the current view of migraine as a channelopathy. A well-maintained headache diary would address issues of medication overuse, confirm the number of days of headaches and migraine and may help in identifying the triggers. ·
Analgesic overuse: Patients with daily headaches might often consume large quantities of analgesics. Consuming an acute attack medicine more than twice a week is probably its overuse. Usually, such patients have headaches that are improved by acute attack medicines, only to return (rebound headache) as the drug effect wears off. At Max Institute of Neurosciences, they help reduce and slowly eliminate the overuse of analgesics with proper discussion and counselling. Patients can reduce their use either by 10% every week or two, depending on their circumstances, or if they wish and there is no contraindication, by immediate cessation of use. Either approach can be facilitated by keeping a record of analgesic use and pain pattern.
Post the discussion, the experts recommend various diagnostic tests; and after the entire diagnosis report is studied, the treatment plan is prepared.
Excluding treatable secondary causes, getting a clear analgesic history, and making a diagnosis of the primary headache type involved helps in efficient Chronic Headache management. The recent advances in technology and medications at Max Institute of Neurosciences have greatly helped countless headache patients. There are two types of treatment for chronic headaches; Acute abortive treatment and Preventive treatment. The first is aimed to relieve the symptoms immediately and the latter is focused on controlling the headaches that are chronic. For this reason, acute treatment is commonly and effectively used in treating migraines and preventive treatment is the usual approach in managing chronic headaches. The primary goal of preventive treatment is to reduce the frequency, severity, and duration of headaches. This type of treatment involves taking medication on a daily basis for at least 3 months and in some cases, for over 6 months. The medication used in preventive treatment is normally chosen based on the other conditions that the patient is suffering from. Generally, medication in preventive treatment starts at the minimum dosage which increases gradually until the pain is relieved and the goal achieved or until side effects appear. Psychological treatments are usually considered in co-morbid patients or in those who are unresponsive to the medication.
A) Preventive medication: A small dose of a non-steroidal anti-inflammatory drug (NSAID) will take the edge off the pain as the analgesic use is reduced. Preventative medication is introduced when the patient has reduced their analgesic use substantially. Sometimes, blood count and liver enzymes are checked at baseline.
B) Psychological treatments: This option is generally considered in comorbid patients or in those who are unresponsive to the medication.
C) Acupuncture Therapy: This treatment has been found to be beneficial in chronic headaches; both tension-type and migraine type.
D) Lifestyle changes: Your doctor will guide you in bringing important changes to your lifestyle. Doing plenty of exercises, stretching the neck and back muscles often help the patient feel better.
E) Head Massage: This may help relieve headache symptoms.