headache - Types, Diagnosis, Treatment

An aching sensation over the vault of the skull, temples, or back of the head, usually diffuse and poorly localized. In the majority of instances, the complaint is trivial and responds to simple analgesics, such as aspirin. Very occasionally, headaches herald serious intracranial disease such as haemorrhage, meningitis, or tumour. The brain itself is insensitive to touch, and headaches arise from the stretching or distortion of its covering membranes, from tension arising from the muscles overlying the skull, or from vascular dilatation with increased blood supply, as occurs in generalized fevers or over-indulgence in alcohol.

sometimes neck or upper back pain may also be interpreted as a headache.

Headaches have a wide variety of causes, ranging from eye strain, sinusitis and tension to life-threatening conditions such as encephalitis, meningitis, cerebral aneurysms and brain tumors (although up to 99% of headaches have a benign cause and do not warrant further treatment other than a painkiller). When the headache occurs in conjunction with a head injury the cause is usually quite evident; The most common type of headache is a tension headache.

Treatment of uncomplicated headache is usually symptomatic with over-the-counter painkillers such as aspirin, paracetamol (acetaminophen) or ibuprofen, although some specific forms of headaches (e.g. Headache often results from traction to or irritation of the meninges and blood vessels.

Types

There are five types of headache: vascular, myogenic (muscle tension), cervicogenic, traction, and inflammatory.

Vascular The most common type of vascular headache is migraine. Migraine headaches are usually characterized by severe pain on one or both sides of the head, an upset stomach, and, at times, disturbed vision. After migraine, the most common type of vascular headache is the "toxic" headache produced by fever. Other kinds of vascular headaches include cluster headaches, which cause repeated episodes of intense pain, and headaches resulting from high blood pressure (rare). Tension headache is the most common form of myogenic headache. Cervicogenic headaches originates from disorders of the neck, including the anatomical structures innervated by the cervical roots C1–C3. Cervical headache is often precipitated by neck movement and/or sustained awkward head positioning. Traction and inflammatory headaches are symptoms of other disorders, ranging from stroke to sinus infection.

Specific types of headaches include:

Ictal headache Ice cream headache Thunderclap headache Vascular headache Toxic headache Coital cephalalgia (also known as: sex headache) Sinus headache Hemicrania continua Rebound headache (also called medication overuse headache, abbreviated MOH) New daily persistent headache (NDPH)

Like other types of pain, headaches can serve as warning signals of more serious disorders. This is particularly true for headaches caused by inflammation, including those related to meningitis as well as those resulting from diseases of the sinuses, spine, neck, ears and teeth.

Diagnosis

While statistically headaches are most likely to be harmless and self-limiting, some specific headache syndromes may demand specific treatment or may be warning signals of more serious disorders. Some headache subtypes are characterized by a specific pattern of symptoms, and no further testing may be necessary, while others may prompt further diagnostic tests.

Headache associated with specific symptoms may warrant urgent medical attention, particularly sudden, severe headache or sudden headache associated with a stiff neck; headaches following a blow to the head, or associated with pain in the eye or ear; persistent headache in a person with no previous history of headaches;

The most important step in diagnosing a headache is for the physician to take a careful history and to examine the patient. In the majority of cases the diagnosis will be tension headache or migraine, both of which can be managed on the basis of a clear-cut clinical picture. Blood tests may help narrow down the differential diagnosis, but are rarely confirmatory of specific headache forms.

Treatment

Not all headaches require medical attention, and respond with simple analgesia (painkillers) such as paracetamol/acetaminophen or members of the NSAID class (such as aspirin/acetylsalicylic acid or ibuprofen). By far the most effective and rapid treatment protocol for the common tension headache is to lower body temperature.

In recurrent unexplained headaches, healthcare professionals may recommend keeping a "headache diary" with entries on type of headache, associated symptoms, precipitating and aggravating factors.

Prevention

Some forms of headache may be amenable to preventative treatment, such as migraine.

Manipulative therapy

A controversial approach to headache treatment is chiropractic care.

The most compelling study of chiropractic efficacy is Nelson's randomized trial, comparing chiropractic to medical care, which included the drug amitriptyline, for the treatment of Migraine Headache.

Independent (non-chiropractic) researchers reviewed research on many different types of behavioral and physical treatments for tension-type and cervicogenic headaches and found that cervical spinal manipulation was associated with improvement in cervicogenic headache outcomes (but not for tension-type headache), and was superior to soft-tissue therapies like massage.