SIRAH NGELU

Headache is defined as pain or discomfort in the head that is located above the eyes or the ears, behind the head (occipital), or in the back of the upper neck.

Headaches are a very common medical problem and a common cause of disability among men and women. Headaches interfere with the ability to work and to perform daily tasks. Some people have frequent headaches; other people hardly ever have them.

Classification of headache are;

• Primary (idiopathic) headache, includes;
  

1. Tension-type of headache
   
2. Migraine (with or without aura)
   
3. Combination of headache
4. Cluster headache
   

• Secondary headache caused by underlying disease

Causes

• Although headaches can be painful and distressing, they rarely indicate a serious condition. Most headaches - tension type, migraine, and cluster headaches - are not caused by another identifiable disorder. Tension type headaches are the most common.
• Less commonly, headaches result from another disorder. Usually, the disorder is not serious. Disorders that cause headaches are often minor or temporary ones that affect the eyes, nose, throat, sinuses, teeth, jaws, ears, or neck.
• Rarely, headaches are caused by a serious disorder. Such disorder include a head injury, stroke, bulge in the wall of an artery supplying the brain (cerebral aneurysm), brain infection (brain abscess, meningitis, and encephalitis), and blood vessel (arteriovenous)malformation near the brain. Infections such as tuberculosis may affect the brain and cause headaches. Disorders that increase pressure within the skull can cause headaches by putting pressure on the brain. Examples area brain tumor, bleeding (hemorrhage), an accumulation of blood (hematoma), and pseudotumor cerebri, in which pressure within the skull increases but ni cause can be identified.
• Other serious diseases that may cause headache include very high blood pressure, which may produce a throbbing sensation in the head. (However, high BP does not usually cause headache.) Lung disorders (such as emphysema) that reduce the oxygen supply to the brain may cause headaches, as may sleep apnea, which temporarily increases levels of carbon dioxide in the blood. Inflammation of large arteries (temporal arteritis), usually in the neck and head, may cause headaches. Temporal arteritis affects older people primarily. Severe cases of influenza and high fever may cause headaches. Lyme disease in its early stages commonly causes headaches.
• Headaches commonly result from withdrawal of caffeine, withdrawal of analgesics after long-term use, and use of certain drugs that widen blood vessels (such as nitroglycerin).

Diagnosis

• Usually, doctors can determine the type or cause of headaches on the basis of the person's medical history, the characteristics of the headache, and results of a physical examinations.
• Characteristics of the headache include its frequency, duration, location, severity, and associated symptoms.
• The following characteristics may indicate that a serious disorder is the cause of headaches, and prompt medical attention is required.

1. Frequent headaches in a person who rarely has headaches,
2. Mild headaches that become severe,
3. headaches that awaken a person from sleep,
4. Any change in the pattern or nature of headaches,
5. Headaches associated with symptoms such as a fever and a stiff neck, changes in sensation, or vision, weakness, loss of coordination, or fainting.
   

• For example, a severe headache with a fever and a stiff neck suggests meningitis - a life threatening infection of the layers of tissue covering the brain and spinal cord (meninges). A headache that occurs suddenly and that is more severe that any others the person has experienced suggests a subarachnoid hemorrhage - often due to ruptured aneurysm.
• When doctors suspect a serious disorder, additional diagnostic procedures are usually performed. If meningitis is suspected, a spinal tap (lumbar puncture) is performed immediately. A spinal tap may also be performed if doctors suspect a ruptured aneurysm. Occasionally, blood tests are performed to check for a disorder such as Lyme disease. The erythrocyte sedimentation rate (ESR - the rate at which RBC settle down to the bottom of a test tube containing blood) may be determined to check for temporal arteritis. A high ESR suggests inflammation.
  
• If doctors suspect a tumor, stroke, hemorrhage, or another structural brain disorder, CT or MRI scan of the head is performed

A. Tension-Type Headaches
Tension type headache is usually mild to moderate, band-like pain that affects the whole head.

The cause of tension-type headaches is not well understood but may be related to a lower-than normal threshold for pain. Stress clearly understood, and it is not the only explanation for the symptoms.

There are two classification of tension type headache;

1. Episodic type headache - tension type headache that occur fewer than 15 days per month.
2. Chronic type headache - occurs more than 15 days per month for at least 6 months.
   

Symptoms and Diagnosis

• The pain is usually mild to moderate, although it may be severe.
  
• It feels like tightening of a band around the head, making whole head ache. The pain may last 30 minutes to 1 week.
  
• Unlike a migraine headache, a tension-type headache is not associated with nausea and vomiting and is not made worse by physical activity, light, sounds, or smells.
  
• Tension-type headaches typically start several hours after waking and rarely awaken a person from sleep.
• The diagnosis is based on the person's description of the headache and the results of a physical examination.
• No specific procedures can confirm the diagnosis.
• Rarely, CT or MRI scan of the head is performed to rule out other disorders that may be causing the headache, particularly if headaches have developed recently.

Treatment

• For most mild to moderate tension-type headaches, almost any over-the counter analgesic, such as aspirin, acetaminophen, or ibuprofen can provide fast, temporarily relief.
• Massaging the affected area may help relieve the pain.
• Severe headaches may require stronger, prescription analgesics, some of which contains opioid (narcotics), such as codeine or oxycodone.
• For some people, caffeine, an ingredient of some headache preparations, enhances the effect of analgesics.
• However, overuse of analgesics or caffeine can lead to chronic daily headaches. Such headaches. called rebound headaches, occur when a dose of an analgesic is missed or late or when caffeine intake is reduced or stopped.

B. Migraine Headaches

A migraine headache is throbbing, moderate to severe pain, usually on one side of the head that is worsened by physical activity, light sounds, or smells and that is associated with nausea and vomiting.

• Although migraines can start at any age, they usually begin between the ages of 10 and 40.
• In most people, migraines recur periodically, but they usually become significantly less severe or resolve entirely after age 50 or 60.
• Migraines are 3 times more common among women that among men.
• Migraines tend to run in families; more than half of the people who have migraines have close relatives who also have them.
• The cause of migraines is not well understood. According to one theory, migraines occur when arteries to the brain become constrict and then dilate; dilation is thought to activate nearby pain receptors.
• However this theory is too simple to explain the complex changes in blood flow that occur in the brain during a migraine. Furthermore, a series of changes in the nerve cells of the brain occur before the changes in the blood flow.
• A rare subtype of migraine called familial hemiplegic migraine is associated with a genetic defect on chromosomes 1 and 19. The role of genes in the more common forms of migraine is under study.
• Estrogen, the main female hormone, appears to trigger migraines, a possibly explaining why migraines are more common among women.
• During puberty, migraines become much more commons among girls than among boys.
• Some women have migraines just before, during, or just after menstrual periods.
• As menopause approaches (when estrogen level fluctuating), migraines become particularly difficult to control. Oral contraceptives (which control estrogen) and estrogen replacement therapy often make migraines worse.
• Insomnia, changes in barometric pressure, and hunger may also trigger migraines.
• There are two types of migraine;

1. Migraine with aura (classic)
   
2. Migraine without aura (common)
   

Symptoms and Diagnosis

• In a migraine, throbbing pain is typically felt on one side of the head. The pain may be moderate but is often severe and incapacitating.
• Physical activity, light, sounds, or smells may make the headache worse.
• Headache is often accompanied by nausea, sometimes with vomiting.
• A migraine attack often involves more than a headache. It may include a prodrome, an aura, an a postdrome.
• The prodrome is a change in mood or behavior, which can precede the rest of the migraine by 24 hours.
• People may become depressed, elated, irritable, or restlessness.
• Nausea or loss of appetite may also occur.
• About 25% of people experience an aura. The aura involves temporary, reversible disturbances in vision, sensation, balance, movement, or speech.
• Commonly, people see jagged, shimmering, or flashing flashing lights.
• Less commonly, people experience tingling sensations, loss of balance, weakness in an arm or a leg, or difficulty talking.
• The aura occurs within the hour before the migraine and ends as the migraine begins.
• About 25% of people experience a postdrome, which involves changes in mood and behavior after the migraine.
• Migraines attacks may occur frequently for a long period of time but then may disappear for many weeks, month, or even years.
• Migraines are diagnosed on the basics of symptoms. No procedure can confirm the diagnosis.
  
• If headaches have developed recently or if the pattern of symptoms has changed, CT or MRI scan of the head is performed to exclude other disorder.

Prevention & Treatment

• Treatment of migraine headaches involves three types of drugs; drugs to prevent migraines, drug to stop (abort) a migraine as it beginning, and drugs to relive pain.
• People who have more than one migraine a week often benefit from taking drugs every day to prevent migraine attacks.
• Beta blockers, such as propanolol, are often given first.
• Calcium channel blockers, antidepressants, and some anticonvulsants, particularly divalproex, are also effective.
• The choice of a preventive drug is based on the side effects of the drug and another disorders present. For example, if weight gain could cause problems, divalproex is usually not prescribed. If the person is has depression, a tricyclic antidepressant such as nortriptyline may be prescribed.
• To abort a migraine as it is beginning, most doctors prefer a relatively new group of drugs called triptans (5-hydroxytryptophan [5-HT] agonist). Triptans specifically target the receptors that stimulate the nerves supplying the the cerebral blood vessels. Thus, triptans may reverse the dilatation of these blood vessels which contributes to a migraine.
• As soon as people sense a migraine attack is beginning, they take one of these drigs to stop the attack from the processing.
  
• Other drugs used to abort migraines, such as ergotamine, are sometimes used, but they are not as safe or as effective as triptans. Because triptans and ergotamine cause blood vessels to constrict, they are not recommended for people who have angina or other heart disease or for people who have prodromal symptoms that resemble those of stroke (because constriction of arteries may trigger a stroke).
• For less severe migraines, analgesics alone or analgesics that contain caffeine can be useful. They can be taken as needed during a migraine, with or instead of a triptan.
• As for tension-type headaches, overuse of analgesics or caffeine can make the migraine worse.
  
• For more severe migraines, opioids may be needed.