Headache

Description of Headache

Definition
 
A headache is a pain in the head or neck.
 
Causes and Risk Factors
 
A headache may occur due to many conditions that may be minor or serious. A headache may occur due to:
1. Cold or flu
2. Stress
3. Lack of sleep
4. Hunger
5. Tiredness
6. Eye strain
7. Neck pain
8. Sinus
9. Dental problems
10. Alcohol intake or withdrawal
11. Migraine

The causes that may require immediate medical attention include:
1. High blood pressure
2. Stroke
3. Bleeding in the brain
4. Increase in cerebrospinal fluid in the skull
5. Tumor in the brain
6. Carbon monoxide (CO) poisoning
7. Infection
8. Inadequate blood supply to the head and the brain
9. Problems with the artery that supplies blood to the brain
 
Signs and symptoms
 
The kind of pain, its location, severity, and duration depend on the type of a headache you have. It may be of the following types:
1. Migraine headache
2. Tension headache
3. Cluster headache
4. Paroxysmal hemicranias
5. Hemicrania continua

Migraine headaches usually run in the family and are more common in women. They may last for several hours or even days and have the following symptoms:
1. Throbbing pain on one or both sides of the head
2. Discomfort on exposure to bright light or loud sound
3. Nausea
4. Vomiting

Migraine headaches worsen with activity. Tension headaches are caused due to muscular contractions and may last for several hours or days. These usually have a family history. The symptoms include:
1. Dull pain
2. Pressure around the forehead on both the sides

Tension-type headaches get better with activity. Cluster headaches are more common in men. They may last for a few minutes to a few hours. Paroxysmal hemicranias and hemicranias occur more commonly in women. Hemicrania continua cause continuous stabbing pain on one side. Symptoms for these kinds of headaches are:
1. Pain usually on the same side of the face
2. Swollen eyes
3. Drooping eyelids
4. Runny nose
5. Watery eyes

If any of these headaches stay for at least 15 days in a month, it is called a chronic headache. Risk factors for a chronic headache include:
1. Being a female
2. Migraine
3. Obesity
4. Overuse of medicines
5. Stress
 
Investigations
 
The doctor will take a medical history that will include questions on:
1. Injury or trauma to the head recently or in the past
2. Pattern of a headache
3. Severity of a headache
4. Frequency of a headache
5. Activity that usually begins a headache
6. Exact area in the head and neck region where the pain occurs
7. Other symptoms that come with the headache

Tests that may be done include:
1. Complete blood count to check anemia
2. Erythrocyte sedimentation rate (ESR): It may be raised if there is damage to the artery that supplies blood to the head and the brain
3. CT scan to look for signs of bleeding in the brain, changes in size of specific areas of the brain, blood flow, presence of any lesion, or tumors
4. Lumbar puncture: A needle will be inserted into the spine at the lower back to collect the fluid inside (cerebrospinal fluid)
5. Cerebrospinal fluid analysis to check for infections, tumor or buildup of fluid inside
 
Treatment
 
Treatment of a headache will be directed at treating the underlying condition that is causing it. The doctor may prescribe the following to reduce the pain:
1. Paracetamol
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen
3. Opioids such as hydrocodone, fentanyl, and hydromorphone
 
Home remedies for a headache
 
Several home remedies can be helpful in headaches:
 
1. Massage with peppermint oil or rosemary oil.
2. Keep yourself hydrated and stay away from caffeine and high sugar drinks.
3. Have a handful of almonds every day.
4. Use a cold compress or a hot compress depending on what works for you.
5. Chew a piece of ginger or boil it in some water and sip on it.
6. Drink a tablespoon of fish oil every day. You can also use fish oil capsules.
7. Inhale lavender oil by adding two drops of it in boiling water.
8. Apply a paste of cinnamon powder in the water on your forehead.
9. Chew a few basil leaves or prepare a decoction in water and sip it regularly. You can also inhale the steam by adding it in boiling water.
10. Keep yourself active by exercising preferably in the fresh air. Do yoga regularly.
 
Complications and When Should You See a Doctor
 
The complications depend on the underlying cause of a headache. These may become chronic. See a doctor if your headache:
1. Is severe
2. Interferes with your daily activities
3. Is accompanied by fever, nausea, and vomiting
4. Causes vision problems such as double vision or loss of vision in one eye
5. Causes mental confusion, loss of memory, and vertigo
 
Prognosis and Prevention
 
A headache is a symptom and an indication of other conditions. The prognosis will depend on what is causing it. Minor causes of a headache may or may not require treatment and usually do not occur once the underlying cause is taken care of.
Migraines get better with age and when triggers factors are avoided. Acupuncture and biofeedback also help in migraine type headaches. Follow these tips for relief from a migraine:
1. Get sufficient sleep
2. Avoid food triggers such as alcohol
3. Avoid bright light, loud sound, or strong odors

The doctor may prescribe medicines for frequent and severe headaches. These will depend on the cause of a headache. Preventive medicine for migraine headaches include:
1. Beta-blockers such as propranolol and nadolol
2. NSAIDs such as ibuprofen
3. Tricyclic antidepressants such as amitriptyline and nortriptyline
4. Anticonvulsants such as valproate and topiramate

Preventive medicine for cluster headaches includes:
1. Calcium-channel blockers such as amlodipine
2. Anticonvulsants such as valproate and topiramate
Indomethacin may be prescribed for paroxysmal hemicrania and hemicrania continua.
 
References
 
Russi CS, Walker L. Headache. In: Walls M, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap17.
Digre KB. Headaches and other head pain. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 398.
 

Frequently Asked Questions about Headache

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