There is no one in this earth who did not suffer from any type of headache in his lifetime. Fortunately most kinds of headache are of benign or harmless in nature. There are only a few kinds of headaches, which are serious. Thanks god, they are really very rare. Probably you are not suffering from such.
If you notice any of the following symptoms, it may be serious. Consult your doctor.
With these symptoms CT-scan or MRI- scan is required.
Migraine is commonest type of headache that needs a visit to a doctor. It is also the commonest cause of severe headache. Migraine headaches are different from other types of headaches and can be diagnosed by its characteristics. Family history of migraines, age when the first attack occurred, and frequency and duration of headaches will also help to determine whether an individual is suffering from migraines or not.
The International Headache Society has laid down the guidelines to diagnose the two forms of migraine headaches:
At least five attacks per year that last 4 to 72 hours:
At least two of the following headache symptoms:
At least one of the following associated symptoms:
No evidence of any other diseases that may cause these symptoms
At least two attacks per year
At least three of the following symptoms:
Gradual development of at least one aura symptom over more than four minutes or two or more symptoms that occur at the same time
No evidence of any other diseases that may cause these symptoms
Migraine Phases: Researchers believe that migraine attacks have four distinct phases. These phases are:
Researchers believe that migraine attacks have four distinct phases. These phases are:
1st phase or prodrome It is experienced by 60% of migraineurs. It starts hours or days before a migraine attack. Many physical and psychological symptoms are seen in this phase. These symptoms vary between the individuals, but remain consistent for a particular individual. The symptoms include:
2nd phase or aura Aura is experienced by 20% of migraineurs suffering from classic migraine just before the migraine attack. It develops 5 to 20 minutes before a migraine attack and lasts less than an hour.
Aura symptoms include:
3rd phase or phase of migraine headache
Symptoms of migraine headache are different from other headaches. Symptoms that distinguish migraines from other headaches:
4th phase or postdrome
Some individuals may experience the following symptoms after a migraine attack: Fatigue /Irritability /Impaired concentration /Scalp tenderness /Mood changes.
Preventive: It is indicated in following situations: -
Drugs commonly used are Flunarizine, Propranolol, Methysergide, Amitriptyline, Carbamazepine, Divalproex sodium etc.
Interventional Pain Management: Injections of Botulinum Toxin in the scalp prevent migraine attack for prolonged period.
Avoidance of triggers: Researchers have found that trigger factors often provoke migraine attacks. Studies have shown that avoiding these trigger factors could reduce the frequency of migraine attacks by half. They are as follows:
Foods Aged cheese, Alcohol, MSG, Chocolate, Caffeine, Hot dogs, Bacon, Luncheon meats, Avocado, Fermented or pickled foods, Yeast or protein extracts, Onions Nuts, Aspartame.
Medications Antibiotics, Antihypertensives, H2 blockers, Vasodilators.
Hormonal Factors Menstruation, Oral contraceptives, Hormone replacement therapy
Lifestyle Factors Delaying or skipping meals, Changes in sleep patterns, Stress
Environmental Changes Weather changes, High altitude, Time zone changes like jet lag.
Abortive: There are certain drugs used to abort the attacks of migraine headaches:
Cerebral vasoconstrictors: ergotamine tartrate, dihydroergotamine, sumatriptan, zolmitriptan etc.
Non-vasoconstrictors: Butorphanol and other narcotic analgesics.
Interventional Pain Management: Spheno-palatine Ganglion block abort acute attack of migraine.
General pain management Simple analgesics like Paracetamol, Aspirin to other NSAIDs and opioids like codeine, tramadol etc.
Headaches are one of the most common physical problem people experience. When headaches are severe, they often control the life of their victim by disrupting job performance, daily activities and sleep. Common types of headaches are: tension, migraine, cluster and sinus. One more type of headache which is responsible for about 15-20% headache is Cervicogenic headache
Many a time's pain arising from upper neck structures (like C1-2, 2-3 joints/ nerves) might travel in the head as a referred pain. It is vital to differentiate and treat the condition accordingly. We differentiate & treat complex types of headache effectively.
The intractable headache which is not responding to above measures requires minimally invasive approach like-
If there is a herniated disk, or other significant structural abnormality, surgery may be recommended. In order to determine if a destructive procedure is indicated (such as RDTC) a diagnostic ganglion block may be required.
Episodic tension-type headache is best treated with analgesics such as aspirin, acetominophen, and other NSAIDS. Abortive therapy is most successful, and patients should be instructed to take medications at the onset of symptoms.
Chronic recurrent tension-type headaches are more difficult to manage.
Preventive medications: anxiolytics, SSRIs, andidepressants.
Non-pharmacologic therapies such as biofeedback, physical therapy, relaxation therapy, stress management training, and psychotherapy have also been shown to be helpful.
The intractable headache which is not responding to above measures requires minimally invasive approach like-
If there is a herniated disk, or other significant structural abnormality, surgery may be recommended. In order to determine if a destructive procedure is indicated (such as RDTC) a diagnostic ganglion block may be required.
Episodic tension-type headache is best treated with analgesics such as aspirin, acetominophen, and other NSAIDS. Abortive therapy is most successful, and patients should be instructed to take medications at the onset of symptoms.
Chronic recurrent tension-type headaches are more difficult to manage.
Preventive medications: anxiolytics, SSRIs, andidepressants.
Non-pharmacologic therapies such as biofeedback, physical therapy, relaxation therapy, stress management training, and psychotherapy have also been shown to be helpful.
The intractable headache which is not responding to above measures requires minimally invasive approach like-
Preventive measures: Maintain regular sleep pattern, maintain regular meal pattern, low tyramine & low caffeine diet, coping stratergies,Moderate amount of exercise, Drink plenty of water, Limit alcohol and other drugs
Prophylactic therapy: Drugs commonly used are CCB (Flunarizine), β-blockers (Propranolol etc.), Antidepressants( Amitriptyline), Anticonvulsants(Carbamazepine, Divalproex sodium etc.) In addition to above physical therapy, stress management therapy, relaxation training etc can also help.
Abortive agents: The most potent abortive agents are the Triptans(5-HT) agonist which are Cerebral vasoconstrictors (e.g. : sumatriptan, zolmitriptan etc.) Another highly effective group of antimigraine medications are ergotamine-containing drugs-ergotamine tartrate & dihydroergotamine.
Interventional Pain Management: Injections of Botulinum Toxin in the scalp prevent migraine attack for prolonged period.
Abortive therapy: Subcutaneous sumatriptan ,High dose/high flowrate oxygen
Preventive therapy: Verapamil, Lithium,methylsergide
Transitional treatments: High dose corticosteroids
Interventional pain management: For intractable cluster headache we can do different
Overview
(From the Greek words hemi, meaning half, and kranion, meaning skull) is a chronic neurological disorder characterized by moderate to severe headaches, and nausea(vomiting like sensation).
It is about three times more common in women than in men.
The typical migraine headache is unilateral (affecting one half of the head) and pulsating in nature and lasting from 4 to 72 hours;
symptoms include nausea, vomiting, photophobia (increased sensitivity to light) and phonophobia (increased sensitivity to sound); the symptoms are generally aggravated by routine activity.
The International Headache Society (IHS) offers guidelines for the classification and diagnosis of migraine headaches, in a document called "The International Classification of Headache Disorders, 2nd edition" (ICHD-2). These guidelines constitute arbitrary definitions, and are not supported by scientific data.
Migraines typically present with recurrent severe headache associated with autonomic symptoms. An aura only occurs in a small percentage of people. The severity of the pain, duration of the headache, and frequency of attacks is variable. A migraine lasting 72 hours is termed status migrainosus and can be treated with intravenous prochlorperazine.
The four possible phases to a migraine attack are listed below — not all the phases are necessarily experienced. Additionally, the phases experienced and the symptoms experienced during them can vary from one migraine attack to another in the same person
For the 20–30% of migraine sufferers who experience migraine with aura, this aura comprises focal neurological phenomena that precede or accompany the attack. They appear gradually over five to 20 minutes and generally last fewer than 60 minutes. The headache phase of the migraine attack usually begins within 60 minutes of the end of the aura phase, but it is sometimes delayed up to several hours, and it can be missing entirely . The pain may also begin before the aura has completely subsided. Symptoms of migraine aura can be sensory or motor in nature.
Visual aura is the most common of the neurological events, and can occur without any headache. There is a disturbance of vision consisting often of unformed flashes of white and/or black or rarely of multicolored lights (photopsia) or formations of dazzling zigzag lines (scintillating scotoma, often arranged like the battlements of a castle, hence the alternative terms "fortification spectra" or "teichopsia"). Some patients complain of blurred or shimmering or cloudy vision, as though they were looking at an area above a heated surface, looking through thick or smoked glass, or, in some cases, tunnel vision and hemianopsia.
The somatosensory aura of migraine may consist of digitolingual or cheiro-oral paresthesias, a feeling of pins-and-needles experienced in the hand and arm, as well as in the nose-mouth area on the same side. The paresthesia may migrate up the arm and then extend to involve the face, lips and tongue.
Other symptoms of the aura phase can include auditory, gustatory or olfactory hallucinations, temporary dysphasia, vertigo, tingling or numbness of the face and extremities, and hypersensitivity to touch.
Oliver Sacks's book Migraine describes "migrainous deliria" as a result of such intense migraine aura that it is indistinguishable from "free-wheeling states of hallucinosis, illusion, or dreaming."
The underlying cause of migraines is unknown. There are, however, many biological events that have been clinically associated with migraine.
Migraines are underdiagnosed, and often are misdiagnosed. The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the "5, 4, 3, 2, 1 criteria":
5 or more attacks - for migraine with aura, two attacks are sufficient for diagnosis.
4 hours to 3 days in duration
2 or more of the following:
1 or more of the following:
The mnemonic POUNDing (Pulsating, duration of 4–72 hOurs, Unilateral, Nausea, Disabling) can help diagnose migraine. If four of the five criteria are met, then the positive likelihood ratio for diagnosing migraine is 24
A migraine diary allows the assessment of headache characteristics, to differentiate between migraine and tension-type headache and to record the use and efficacy of acute medication. A diary also helps to analyse the relationship between migraine and menstruation. Finally, the diary can help to identify trigger factors. A trigger may occur up to 24 hours prior to the onset of symptoms; the majority of migraines, though, are not caused by identifiable triggers.
There are three main aspects of treatment
Medications are more effectiveif used earlier in an attack. The frequent use of medications may, however, result in medication overuse headache, in which the headaches become more severe and more frequent. These may occur with triptans, ergotamines, and analgesics, especially narcotic analgesics.
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors
Cluster headache, nicknamed "suicide headache", is a neurological disease.
Cluster headaches occur- periodically: spontaneous remissions interrupt active periods of pain. The cause of the disease is currently unknown. It affects approximately 0.1% of the population, and men are more commonly affected than women
Cluster headaches are excruciating unilateralheadaches of extreme intensity. The duration of the common attack ranges from as short as 15 minutes to three hours or more.
The onset of an attack is-- rapid, and most often without the preliminary signs( that are characteristic of a migraine).
However, some sufferers report preliminary sensations of pain in the general area of attack, often referred to as "shadows", that may warn them an attack is lurking or imminent.
Though the headaches are almost exclusively unilateral, there are some documented as cases of "side-shifting" between cluster periods, or, even rarer, simultaneously (within the same cluster period) bilateral headach
A wide variety of prophylactic medicines are in use, and patient response to these is highly variable. Current European guidelines suggest the use of the calcium channel blockerverapamil at a dose of at least 240 mg daily. Steroids, such as prednisolone/prednisone, are also effective, with a high dose given for the first five days or longer (in some cases up to 6 months) before tapering down. Methysergide, lithium and the anticonvulsanttopiramate are recommended as alternative treatments. In Australia, Neurologist John Watson has also reported success with Epilim and Tegretol in some chronic, treatment-refractory cases.
Intravenous magnesiumsulfate relieves cluster headaches in about 40% of patients with low serum ionized magnesium levels. ]Melatonin has also been demonstrated to bring significant improvement in approximately half of episodic patients
Over-the-counter pain medications (such as aspirin, paracetamol, and ibuprofen) typically have no effect on the pain from a cluster headache.
Medications to treat cluster headaches are classified as either abortives or prophylactics (preventatives).
In addition, short-term transitional medications (such as steroids) may be used while prophylactic treatment is instituted and adjusted. With abortive treatments often only decreasing the duration of the headache and preventing it from reaching its peak rather than eliminating it entirely, preventive treatment is always indicated for cluster headaches, to be started at the first sign of a new cluster cycle.
Interventional pain procedure:
Sphenopalatine ganglion block. This is usually done under fluoroscopy( mobile X- ray mechine) guided in procedure room
During the onset of a cluster headache, many people respond to inhalation of 100% oxygen (12-15 litres per minute in a non-re-breathing mask. There is also a study (commenced 2011) using an "on-demand" valve that can deliver up to 160 litres per minute. When oxygen is used at the onset this can abort the attack in as little as 1 minute or as long as 10 minutes. Once an attack is at its peak, oxygen therapy appears to have little effect so many people keep an oxygen tank close at hand to use at the very first sign of an attack. An alternative first-line treatment is subcutaneous or intranasal administration of sumatriptan.[20]Hyperbaric oxygen therapy has been used successfully in treating cluster headaches though it was not shown to be more successful than surface oxygen
See your doctor if you've just started to experience cluster headaches to rule out other disorders and to find the most effective treatment. Headache pain, even when severe, usually isn't the result of an underlying disease, but headaches may occasionally indicate a serious underlying medical condition, such as a brain tumor or rupture of a weakened blood vessel (aneurysm). Additionally, if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.
if you have any of these signs and symptoms: