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Posted by on Oct 16, 2015 in patient education | 0 comments

Headache

A headache is one of the commonest illness and reasons for visiting a doctor or clinic. Almost everyone experiences a headache at some point and most headaches will respond to simple painkillers , drinking extra water ,rest or other simple measures .

There are many different types of headache, most headaches are not caused by serious or sinister conditions .In certain circumstances however , a headache can be in fact a symptom of a serious or life threatening illness .

What are the different types of headache?
Headaches can be primary, or they can be secondary which means they are related to a separate illness.
Your doctor can generally tell the likely cause of your headache from talking to you and examining you. Once he or she has discovered the cause then you will be able to decide how to reduce or stop the headaches. This may involve taking medication only when you get the headaches, taking daily medication to prevent them or, sometimes, stopping medication you are already taking.

Very occasionally, headaches need further investigation to rule out more serious underlying causes.

Primary headaches
The most common types of headache are tension-type headaches and migraines.

Tension-type headaches
Tension-type headaches are usually felt as a band or across the forehead. They can last for several days. They can be uncomfortable and tiring, but they do not usually disturb sleep. Most people can carry on working with a tension-type headache..Tension-type headaches tend to worsen as the day goes on and are often mildest in the morning.
Tension-type headaches are thought to be caused by tightness in the muscles at the back of the neck and over the scalp. The underlying causes include anything which makes those muscles tense. This includes both physical and mental tension. Tiredness, stress, anxiety and an awkward sleeping position can make them worse. Working long hours bent over a computer may trigger them. Some people get tension-type headaches if they drink too much caffeine or alcohol, if they don’t drink enough water or if they go for a long time between meals and become tired and hungry. Occasionally, tension-type headaches can be caused by poor vision, particularly if reading in low light for long periods

What is the treatment for tension-type headaches?
Tension-type headaches usually respond to simple painkillers and extra water intake. However, the best approach is to treat the underlying cause ( if identifiable). Changes in lifestyle can help – such as having less caffeine, drinking more water and adequate sleep. So, too, can a sensible diet in which you eat regularly and have a good balance of slow-release energy foods rather than lots of sugars. Reducing the number of pillows you sleep on can sometimes help, particularly if you sleep on more than two pillows.

Migraines
A typical migraine is one-sided and throbbing. Indeed, headaches that are one-sided, headaches that throb and headaches that make you feel sick are more likely to be migraines than anything else. Migraines are often severe enough to be disabling.

Migraines can last a few hours to three days. They are often made worse by movement or sound. Patients often feel sick (nausea) or vomit, even if the pain is not severe. Often patients find bright light and even TV make the headache worse. Most people with migraines have 1-2 attacks a month.

people with migraine can have warning symptoms (aura) occur before the migraine, commonly consisting of flashing lights .Some people actually lose half of their vision completely. Others experience tingling or weakness on one side of the body, or slurring of speech. These warning symptoms can last for up to an hour, and are generally followed by a headache. Migraines can be triggered by stress, hunger, certain foods such as chocolate and red wine, tiredness, and lack of body fluid (dehydration). What is the treatment for migraines?

Migraines tend to improve with rest, sleep, darkness and quiet. Drinking water can help if you don’t feel sick, and simple painkillers such as paracetamol and ibuprofen can be effective. Many people find that they are not, and have special migraine medication prescribed by their doctor. These medications consist of tablets which you take when you have a migraine, and you take them as early as possible in the pain .

Cluster headaches
Cluster headaches are very severe headaches , sometimes called ‘suicide headaches’. They occur in clusters, often every day for a number of days or even weeks. Then they disappear for months on end. They are uncommon, and tend to occur particularly in adult male smokers. They are severe, one-sided headaches, which are really very disabling. Patients often have a red watery eye on the affected side, a stuffy runny nose and a droopy eyelid.
Cluster headaches usually require treatment from your doctor

Chronic daily headaches
Chronic daily headache or chronic tension-type headache is usually caused by muscle tension in the back of the neck and affects women more often than men. Chronic means that the condition is persistent and ongoing. These headaches can be started by neck injuries or tiredness and may be made worse by medication overuse . A headache that occurs almost every day for three months or more is called a chronic daily headache.

What is the treatment for chronic daily headaches?
This type of headache is best treated by physiotherapy, avoiding painkillers and occasionally by certain antidepressant medications . Using painkillers regularly for chronic daily headache is likely to make things worse, as you may also develop a medication-induced headache

What are the different types of secondary headache?
Sometimes headaches have underlying causes, and treatment of the headache involves treating the cause. People often worry that headaches are caused by serious disease, or by high blood pressure. Both of these are extremely uncommon causes of headache – indeed high blood pressure usually causes no symptoms at all.

Headaches due to referred pain
Some headaches can be caused by pain in some other part of the head, such as tooth or ear pain, pain in the jaw joint and pains in the neck.

Sinusitis is a common cause. The headache of sinusitis is often felt at the front of the head and also in the face or teeth. Often the face feels tender to pressure, particularly just below the eyes and beside the nose. You may have a stuffy nose and the pain is often worse when you bend forwards. Acute sinusitis is the type that comes on quickly in association with a cold or sudden allergy. You may have a temperature and be producing a lot of mucus.
Acute glaucoma can cause severe headache . In this condition the pressure inside the eyes goes up suddenly and this causes a sudden very severe headache behind the eye. The eyeball can feel very hard to touch, the eye is red, the front of the eye (cornea) can look cloudy and the vision is usually blurred.
What types of headache are serious or dangerous?
All headaches are unpleasant , however a few headaches are signs of serious underlying problems.
Dangerous headaches tend to occur suddenly, and to become progressively worse over time. They include the following:

Bleeding around the brain (subarachnoid hemorrhage)
Subarachnoid hemorrhage is a very serious condition which occurs when a small blood vessel bursts on the surface of the brain. Patients develop a severe ‘thunderclap’ headache and stiff neck and may become unconscious. This headache is usually described as “ the worst headache of my life” .A person who suffers such a headache should be rushed to a hospital urgently .

Meningitis and brain infections
Meningitis is infection of the tissues around and on the surface of the brain . . Brain infections can be caused by germs called bacteria, viruses or fungi . They cause a severe, disabling headache. Usually patients are sick and cannot bear bright light . Often they have a stiff painful neck .brain infections are serious and life threatening illnesses.

Brain tumours
Brain tumour is a very uncommon cause of headaches. Usually the headache of brain tumours is present on waking in the morning, is worse on sitting up, and gets steadily worse from day to day, never easing and never disappearing. It can sometimes be worse on coughing and sneezing (as can sinus headaches and migraines).such a headache should be investigated early .

When should I be worried about a headache?
Most headaches don’t have a serious underlying cause. However, healthcare professionals are trained to ask you about the signs and symptoms that might suggest your headache needs further investigation, just to make sure it’s nothing serious.

The things which would suggest to your doctor and nurse that your headache might need further investigation include the following. They do not mean that your headache is serious or sinister, but they mean that the doctor or nurse might wish to do some further checks to be sure:

You have had a significant head injury in the previous three months.
Your headaches are worsening and accompanied by high temperature (fever).
Your headaches start extremely suddenly.
You have developed problems with speech and balance as well as headache.
You have developed problems with your memory or changes in your behavior or personality as well as headache.
You are confused or muddled with your headache.
Your headache started when you coughed, sneezed or strained.
Your headache is worse when you sit or stand.
Your headache is associated with red or painful eyes.
Your headaches are not like anything you have ever experienced before.
You have unexplained vomiting with the headache.
You have low immunity – for example, if you have HIV, or are on oral steroid medication or immune suppressing drugs.
You have or have had a type of cancer that can spread through the body.

Summary
Most headaches, whilst unpleasant, are harmless and respond to simple measures. Migraine, tension headache and medication-induced headache are all very common. Headaches are, very rarely, a sign of a serious or sinister underlying condition .

If you have a headache which is unusual for you then you should discuss it with your doctor. You should also talk to your doctor about headaches which are particularly severe or that stop your regular activities, those which are associated with other symptoms like weakness or tingling. Finally, always talk to your doctor if you have an unremitting morning headache which is present for more than three days or is getting gradually worse.

Remember that headaches are less likely to occur in those who:
Manage their stress levels well.
Eat a balanced, regular diet.
Take balanced regular exercise.
Pay attention to posture and core muscles.
Sleep on two pillows or fewer.
Drink plenty of water.
Have plenty of sleep.

Anything that you can do to improve any of these areas of your life will improve your health and well-being and reduce the number of headaches you experience.