Headache in Adults

Well we all must have experienced headache at least once in our life. Headache one of the most common condition and sometimes it can be quite incapacitating. There are many causes of headache and according to a comprehensive headache classification guide, established by the International Headache Society, there are more than 150 headache categories.

But, a practical headache classification divides headaches into two main categories, primary and secondary headaches.

Primary headaches are those that are not the caused by another medical condition. The category includes causes like tension-type, migraine, and cluster headaches etc.

Secondary headaches are those that are caused by another underlying medical or neurological conditions like tumour, brain stroke, trauma, infections of brain, medication overuse, or headaches cause by sinus infection etc.

So if you are having headache, you should give due importance to it if any one of following is associated with it:-

1. If it is first or worst headache of life?

2. If it headache started suddenly without any warning or build-up?

3. If there is any fundamental change in the pattern of recurrent headaches

4. If you are you more than 50 years?

5. If you are also having associated condition like presence of cancer, HIV, pregnancy?

6. If you are also having symptoms other than headache?

Though there is sometimes underlying serious cause of the headache but most headaches are not caused by life-threatening disorders and usually the cause is one of the primary headaches, most commonly one of the four syndromes:

1. Tension-type headache

2. Migraine headache

3. Chronic daily headache

4. Cluster headache

TENSION TYPE HEADACHES

Tension-type headaches are the most common type of headache. People with TTH often feel stress or tension before their headache. Tension-type headaches tend to be mild to moderate and occur on both sides of the head. Unlike migraine, tension headaches occur without other associated symptoms such as nausea, vomiting, sensitivity to lights and sounds. They usually do not get worse during routine activities (bending over, walking stairs, etc.)

Symptoms of tension type headaches include:

• Pressure or tightness around both sides of the head or neck with mild tenderness in the muscles of the head, neck, or shoulders

• Mild to moderate pain that is usually continues with much change in intensity and does not throb

• Pain is not worsened by activity like bending over, walking stairs, etc.

• Pain can increase or decrease in severity over the course of the headache

MIGRAINE HEADACHE

Migraines are the second most common type of primary headaches. Migraine pain is moderate to severe, and that is worsened by sneezing, straining, constant motion, head movement, or physical activity. Headache is often described as pounding or throbbing type when severe, and in 60-70 percent people it occurs only on one side of the head. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.

Migraine symptoms also include sensitivity to light, noise or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain. Few people with migraines also experience nasal stuffiness and runny nose, or teary eyes.

In some people, a warning symptom known as an aura occurs before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as difficulty speaking, abnormal sensation on one side of the face or in an arm or leg.

Migraines can be triggered by many factors like lack of sleep, hunger, bright light, stress and anxiety, physical exertion, fatigue, head trauma, and certain foods or drinks.

CLUSTER HEADACHES

Cluster headaches are relatively uncommon, but most severe, type of primary headache. The cluster headache is so severe that most patients become very restless and agitated. The pain is located behind one eye or around the eye, without changing sides. The pain is burning or stabbing type that is throbbing or constant.

It is termed as “cluster headache” because its tendency to occur in multiple episodes, or cluster. Cluster headaches occur one to eight times per day during a cluster period, which may last 2 weeks to 3 months. The headaches may disappear completely for months or years, but they can come back without any warning

CHRONIC DAILY HEADACHE

Daily headaches present for more than 15 days per month for at least three months, is described as a chronic daily headache. Chronic daily headache is not a type of headache but a category that includes frequent headaches of various kinds. Most people with chronic daily headache have migraine or tension-type headache as the underlying type of headache. They often start out having an occasional migraine or tension-type headache, but the headaches became more frequent over months or years. Some people with frequent headache use headache medications too often, which can lead to "medication-overuse headaches".

To make the correct diagnosis your doctor will ask certain questions which you should know about your headache like:-

• What is the location of headache?

• How did the headache start (e.g. suddenly or slowing becoming worse)

• What is the quality of headache (e.g. throbbing, pounding, splitting, stabbing, blinding or pressure-like).

• How severe is your headache?

• Do you also have symptoms other than headache?

If you are having recurrent headache you doctor will also ask about:

• At what age you started having headache?

• What is frequency of headaches, ( daily or many times in weeks or months)

• Is there any specific pattern of headache (including any relationship to phase of menstrual cycle)

• Which factors increase your headache (e.g. head position, time of day, sleep, light, sounds, physical activity, odors, chewing, change in temperature or altitude, noise, smoke, stress, oversleeping

• What is the usual duration of headache?

• What symptoms precede your headache?

• Do you suffer from more than one type of headache?

• What is response to the previous treatment if taken?

If you are having frequent headaches like migraine, you can keep a headache diary. In you can keep the record of each headache and also the information about the preceding events before each headache and also the response to treatment. It can also help to diagnose and monitor response of particular treatment.