Nearly everyone has had headache pain, and most of us have had it many times. A minor headache is little more than a nuisance that’s relieved by an over-the-counter pain reliever, some food or coffee, or a short rest. But if your headache is severe or unusual, you might worry about stroke, a tumor, or a blood clot. Fortunately, such problems are rare. Still, you should know when a headache needs urgent care and how to control the vast majority of headaches that are not threatening to your health. Headache is defined as a pain arising from the head or upper neck of the body. The pain originates from the tissues and structures that surround the skull or the brain because the brain itself has no nerves that give rise to the sensation of pain (pain fibers). The thin layer of tissue (periosteum) that surrounds bones, muscles that encase the skull, sinuses, eyes, and ears, as well as thin tissues that cover the surface of the brain and spinal cord (meninges), arteries, veins, and nerves, all can become inflamed or irritated and cause headache. The pain may be a dull ache, sharp, throbbing, constant, intermittent, mild, or intense. Headaches can be more complicated than most people realize. Different kinds can have their own set of symptoms, happen for unique reasons, and need different kinds of treatment. Once you know the type of headache you have, you and your doctor can find the treatment that’s most likely to help and even try to prevent them.
Headache is the symptom of pain anywhere in the region of the head or neck. It occurs in migraines (sharp, or throbbing pains), tension-type headaches, and cluster headaches.Frequent headaches can affect relationships and employment. There is also an increased risk of depression in those with severe headaches. Headaches can occur as a result of many conditions whether serious or not. There are a number of different classification systems for headaches. The most well-recognized is that of the International Headache Society. Causes of headaches may include fatigue, sleep deprivation, stress, the effects of medications, the effects of recreational drugs, viral infections, loud noises, common colds, head injury, rapid ingestion of a very cold food or beverage, and dental or sinus issues.The pain you feel during a headache comes from a mix of signals between your brain, blood vessels, and nearby nerves. Specific nerves of the blood vessels and head muscles switch on and send pain signals to your brain. But it’s not clear why these signals turn on in the first place. People often get headaches because of:
Illness: such as an infection, cold, or fever. They’re also common with conditions like sinusitis (inflammation of the sinuses), a throat infection, or an ear infection. In some cases, the headaches may be the result of a blow to the head or rarely, a sign of a more serious medical problem. Stress: Emotional stress and depression as well as alcohol use, skipping meals, changes in sleep patterns, and taking too much medication. Other causes include eyestrain and neck or back strain due to poor posture. Your environment, including secondhand tobacco smoke, strong smells from household chemicals or perfumes, allergens, and certain foods. Stress, pollution, noise, lighting, and weather changes are other possible triggers. Headaches, especially migraine headaches, tend to run in families. Most children and teens (90%) who have migraines have other family members who get them. When both parents have a history of migraines, there is a 70% chance that their child will also have them. If only one parent has a history of these headaches, the risk drops to 25%-50%.
Doctors don’t know exactly what causes migraines. A popular theory is that triggers cause unusual brain activity, which causes changes in the blood vessels there. Some forms of migraines are linked to genetic problems in certain parts of the brain. Too much physical activity can also trigger a migraine in adults. Treatment of a headache depends on the underlying cause, but commonly involves pain medication. Some form of headache is one of the most commonly experienced of all physical discomforts. About half of adults have a headache in a given year. Tension headaches are the most common, affecting about 1.6 billion people (21.8% of the population) followed by migraine headaches which affect about 848 million (11.7%)
There are more than two hundred types of headaches. Some are harmless and some are life-threatening. The description of the headache and findings on neurological examination, determine whether additional tests are needed and what treatment is best. Once you get your headaches diagnosed correctly, you can start the right treatment plan for your symptoms. The first step is to talk to your doctor about your headaches. She’ll give you a physical exam and ask you about the symptoms you have and how often they happen. It’s important to be as complete as possible with these descriptions. Give your doctor a list of things that cause your headaches, make them worse, and what helps you feel better. You can track details in a headache diary to help your doctor diagnose your problem. Most people don’t need special diagnostic tests. But sometimes, doctors suggest a CT scan or MRI to look for problems inside your brain that might cause your headaches. Skull X-rays are not helpful. An EEG (electroencephalogram) is also unnecessary unless you have passed out when you had a headache. If your headache symptoms get worse or happen more often despite treatment, ask your doctor to refer you to a headache specialist. If you need more information, contact one of the organizations in the resource list for a list of member doctors in your state.
Your doctor may recommend different types of treatment to try. She also might recommend more testing or refer you to a headache specialist. The treatment you need will depend on a lot of things, including the type of headache you get, how often, and its cause. Some people don’t need medical help at all. But those who do might get medications, counseling, stress management, and biofeedback. Your doctor will make a treatment plan to meet your specific needs. Once you start a treatment program, keep track of how well it’s working. A headache diary can help you note any patterns or changes in how you feel. Know that it may take some time for you and your doctor to find the best treatment plan, so try to be patient. Be honest with her about what is and isn’t working for you. Even though you’re getting treatment, you should still steer clear of the things you know can trigger your problem, like foods or smells. And it’s important to stick to healthy habits that will keep you feeling good, like regular exercise, enough sleep, and a healthy diet. Also, make your scheduled follow-up appointments so your doctor can see how you’re doing and make changes in the treatment program if you need them.
Headaches are broadly classified as "primary" or "secondary". Primary headaches are benign, recurrent headaches not caused by underlying disease or structural problems. For example, migraine is a type of primary headache. While primary headaches may cause significant daily pain and disability, they are not dangerous. Secondary headaches are caused by an underlying disease, like an infection, head injury, vascular disorders, brain bleed or tumors. Secondary headaches can be harmless or dangerous. Certain "red flags" or warning signs indicate a secondary headache may be dangerous.Occurring in about three of every four adults, tension headaches are the most common of all headaches. In most cases, they are mild to moderate in severity and occur infrequently. But a few people get severe tension headaches, and some are troubled by them for three or four times a week. The typical tension headache produces a dull, squeezing pain on both sides of the head. People with strong tension headaches may feel like their head is in a vise. The shoulders and neck can also ache. Some tension headaches are triggered by fatigue, emotional stress, or problems involving the muscles or joints of the neck or jaw. Most last for 20 minutes to two hours.If you get occasional tension-type headaches, you can take care of them yourself. Over-the-counter pain relievers such as acetaminophen (Tylenol, other brands) and nonsteroidal anti-inflammatories (NSAIDs) such as aspirin, naproxen (Aleve, other brands), or ibuprofen (Motrin, Advil, other brands) often do the trick, but follow the directions on the label, and never take more than you should. A heating pad or warm shower may help; some people feel better with a short nap or light snack. If you get frequent tension-type headaches, try to identify triggers so you can avoid them. Don’t get overtired or skip meals. Learn relaxation techniques; yoga is particularly helpful because it can relax both your mind and your neck muscles. If you clench your jaw or grind your teeth at night, a bite plate may help. If you need more help, your doctor may prescribe a stronger pain medication or a muscle relaxant to control headache pain. Many people with recurrent tension-type headaches can prevent attacks by taking a tricyclic antidepressant such as amitriptyline (Elavil, generic). Fortunately, most people with tension-type headaches will do very well with simpler programs. 90% of all headaches are primary headaches. Primary headaches usually first start when people are between 20 and 40 years old. The most common types of primary headaches are migraines and tension-type headaches. They have different characteristics. Migraines typically present with pulsing head pain, nausea, photophobia (sensitivity to light) and phonophobia (sensitivity to sound). Tension-type headaches usually present with non-pulsing "bandlike" pressure on both sides of the head, not accompanied by other symptoms. Other very rare types of primary headaches include: cluster headaches: This type is intense and feels like a burning or piercing pain behind or around one eye, either throbbing or constant. It’s the least common but the most severe type of headache. The pain can be so bad that most people with cluster headaches can’t sit still and will often pace during an attack. On the side of the pain, the eyelid droops, the eye reddens, pupil gets smaller or the eye tears. The nostril on that side runs or stuffs
They’re called “cluster headaches” because they tend to happen in groups. You might get them one to three times per day during a cluster period, which may last 2 weeks to 3 months. Each headache attack last 15 mins to 3 hours and often wakens the patient from sleep. The headaches may disappear completely (go into "remission") for months or years, only to come back again. Cluster headaches affect men 3-4 times more often than women.short episodes (15–180 minutes) of severe pain, usually around one eye, with autonomic symptoms (tearing, red eye, nasal congestion) which occur at the same time every day. Cluster headaches can be treated with triptans and prevented with prednisone, ergotamine or lithium. trigeminal neuralgia or occipital neuralgia: shooting face pain hemicrania continua: continuous unilateral pain with episodes of severe pain. Hemicrania continua can be relieved by the medication indomethacin.
primary stabbing headache: recurrent episodes of stabbing "ice pick pain" or "jabs and jolts" for 1 second to several minutes without autonomic symptoms (tearing, red eye, nasal congestion). These headaches can be treated with indomethacin. primary cough headache: starts suddenly and lasts for several minutes after coughing, sneezing or straining (anything that may increase pressure in the head). Serious causes (see secondary headaches red flag section) must be ruled out before a diagnosis of "benign" primary cough headache can be made. primary exertional headache: throbbing, pulsatile pain which starts during or after exercising, lasting for 5 minutes to 24 hours. The mechanism behind these headaches is unclear, possibly due to straining causing veins in the head to dilate, causing pain. These headaches can be prevented by not exercising too strenuously and can be treated with medications such as indomethacin. primary sex headache: dull, bilateral headache that starts during sexual activity and becomes much worse during orgasm. These headaches are thought to be due to lower pressure in the head during sex. It is important to realize that headaches that begin during orgasm may be due to a subarachnoid hemorrhage, so serious causes must be ruled out first. These headaches are treated by advising the person to stop sex if they develop a headache. Medications such as propranolol and diltiazem can also be helpful.
hypnic headache: moderate-severe headache that starts a few hours after falling asleep and lasts 15–30 minutes. The headache may recur several times during night. Hypnic headaches are usually in older women. They may be treated with lithium.
Headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as cervicogenic headache (pain arising from the neck muscles). Medication overuse headache may occur in those using excessive painkillers for headaches, paradoxically causing worsening headaches.More serious causes of secondary headaches include: meningitis: inflammation of the meninges which presents with fever and meningismus, or stiff neck
bleeding inside the brain (intracranial hemorrhage)
subarachnoid hemorrhage (acute, severe headache, stiff neck WITHOUT fever) ruptured aneurysm, arteriovenous malformation, intraparenchymal hemorrhage (headache only)
brain tumor: dull headache, worse with exertion and change in position, accompanied by nausea and vomiting. Often, the person will have nausea and vomiting for weeks before the headache starts. temporal arteritis: inflammatory disease of arteries common in the elderly (average age 70) with fever, headache, weight loss, jaw claudication, tender vessels by the temples, polymyalgia rheumatica acute closed angle glaucoma (increased pressure in the eyeball): headache that starts with eye pain, blurry vision, associated with nausea and vomiting. On physical exam, the person will have a red eye and a fixed, mid dilated pupil. Post-ictal headaches: Headaches that happen after a convulsion or other type of seizure, as part of the period after the seizure (the post-ictal state) Gastrointestinal disorders may cause headaches, including Helicobacter pylori infection, celiac disease, non-celiac gluten sensitivity, irritable bowel syndrome, inflammatory bowel disease, gastroparesis, and hepatobiliary disorders. The treatment of the gastrointestinal disorders may lead to a remission or improvement of headaches.
The brain itself is not sensitive to pain, because it lacks pain receptors. However, several areas of the head and neck do have pain receptors and can thus sense pain. These include the extracranial arteries, middle meningeal artery, large veins, venous sinuses, cranial and spinal nerves, head and neck muscles, the meninges, falx cerebri, parts of the brainstem, eyes, ears, teeth and lining of the mouth.Pial arteries, rather than pial veins are responsible for pain production. Headaches often result from traction to or irritation of the meninges and blood vessels. The nociceptors may be stimulated by head trauma or tumors and cause headaches. Blood vessel spasms, dilated blood vessels, inflammation or infection of meninges and muscular tension can also stimulate nociceptors and cause pain. Once stimulated, a nociceptor sends a message up the length of the nerve fiber to the nerve cells in the brain, signaling that a part of the body hurts.
Primary headaches are more difficult to understand than secondary headaches. The exact mechanisms which cause migraines, tension headaches and cluster headaches are not known. There have been different theories over time which attempt to explain what happens in the brain to cause these headaches.
Migraines are currently thought to be caused by dysfunction of the nerves in the brain. This condition is accompanied by intense headaches. These headaches are often described as pounding, throbbing pain. They can last from 4 hours to 3 days and usually happen one to four times per month. Along with the pain, people have other symptoms, such as sensitivity to light, noise, or smells; nausea or vomiting; loss of appetite; and upset stomach or belly pain. When a child has a migraine, she may look pale, feel dizzy, and have blurry vision, fever, and an upset stomach.Migraines occur less often than tension-type headaches, but they are usually much more severe. They are two to three times more common in women than men, but that’s small consolation if you are among the 6% to 8% of all men who have migraines. And since a Harvard study of 20,084 men age 40 to 84 reported that having migraines boosts the risk of heart attacks by 42%, men with migraines should take their headaches to heart. Neurologists believe that migraines are caused by changes in the brain’s blood flow and nerve cell activity. Genetics play a role since 70% of migraine victims have at least one close relative with the problem. Migraine triggers. Although a migraine can come on without warning, it is often set off by a trigger. The things that set off a migraine vary from person to person, but a migraine sufferer usually remains sensitive to the same triggers. A small percentage of children’s migraines include digestive symptoms, like vomiting, that happen about once a month. Previously, migraines were thought to be caused by a primary problem with the blood vessels in the brain.This vascular theory, which was developed in the 20th century by Wolff, suggested that the aura in migraines is caused by constriction of intracranial vessels (vessels inside the brain), and the headache itself is caused by rebound dilation of extracranial vessels (vessels just outside the brain). Dilation of these extracranial blood vessels activates the pain receptors in the surrounding nerves, causing a headache. The vascular theory is no longer accepted. Studies have shown migraine head pain is not accompanied by extracranial vasodilation, but rather only has some mild intracranial vasodilation.
Currently, most specialists think migraines are due to a primary problem with the nerves in the brain. Auras are thought to be caused by a wave of increased activity of neurons in the cerebral cortex (a part of the brain) known as cortical spreading depression followed by a period of depressed activity. Some people think headaches are caused by the activation of sensory nerves which release peptides or serotonin, causing inflammation in arteries, dura and meninges and also cause some vasodilation. Triptans, medications which treat migraines, block serotonin receptors and constrict blood vessels. People who are more susceptible to experience migraines without headache are those who have a family history of migraines, women, and women who are experiencing hormonal changes or are taking birth control pills or are prescribed hormone replacement therapy. Tension headaches are thought to be caused by activation of peripheral nerves in the head and neck muscles Cluster headaches involve overactivation of the trigeminal nerve and hypothalamus in the brain, but the exact cause is unknown.
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