Headache; Causes, Symptoms, Diagnosis, Treatment

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 dehydration, fatigue, sleep deprivation, stress, the effects of medications, the effects of recreational drugs, viral infections, loud noises, common colds, head injury, rapid ingestion of very cold food or beverage, and dental or sinus issues.

  A headache

A 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.

In 2013, the International Headache Society released its latest classification system for headache. Because so many people suffer from headaches, and because treatment is difficult sometimes, it was hoped that the new classification system would help health-care professionals make a more specific diagnosis as to the type of headache a patient has, and allow better and more effective options for treatment.

The guidelines are extensive and the Headache Society recommends that health-care professionals consult the guidelines frequently to make certain of the diagnosis.

 A. There are three major categories of headache based upon the source of the pain

The different types of headaches depend upon the class they belong to. Some common types include

• Menstrual headaches
• Primary tension headaches that are episodic
• Primary tension headaches that are chronic
• Primary muscle contraction headaches
• Primary migraine headaches with aura
• Primary migraine headaches without aura
• Primary cluster headache
• Primary paroxysmal hemicrania (a type of cluster headache)
• A primary cough headache
• Primary stabbing headache
• A primary headache associated with sexual intercourse
• Primary thunderclap headache
• A hypnic headache (headaches that awaken a person from sleep)
• Hemicrania continua (headaches that are persistently on one side only. right or left [unilateral])
• New daily persistent headache (NDPH) (a type of a chronic headache)
• A headache from exertion
• Trigeminal neuralgia and other cranial nerve inflammation

2. Secondary headaches due to or causes

Secondary headaches are symptoms that happen when another condition stimulates the pain-sensitive nerves of the head. In other words, the headache symptoms can be attributed to another cause.

A wide range of different factors can cause secondary headaches.

These include:
Eating something very cold can lead to a “brain freeze

• Traumatic Disorder
• Infection
• Structural problems with the bones of the face, teeth, eyes, ears, nose, sinuses or other structure
• Substance abuse or withdrawal alcohol-induced hangover brain tumor blood clots bleeding in or around the brain”brain freeze,” or ice-cream headaches carbon monoxide poisoning concussion dehydration glaucoma teeth-grinding at night influenza overuse of pain medication, known as rebound headaches panic attacks stroke

3. Others Type of headache

• Pregnancy headaches
• Rebound headaches
• Sinus headaches
• Spinal headaches
• Caffeine headaches
• Menstrual headaches
• Cough headaches
• Exertion headaches
• Hangover headaches
• Hypertension headaches
• Tumor headaches
• Meningitis and encephalitis headaches
• Post-traumatic headaches
• Temporal arteritis
• cranial neuralgias, facial pain, and other headaches.

B. The symptoms of a headache can depend on the type.

Tension headaches

Tension headaches are the most common form of primary headache. Such headaches normally begin slowly and gradually in the middle of the day.

The person can feel:

• as if they have a tight band around the head
• a constant, dull ache on both sides
• pain spread to or from the neck

Tension-type headaches can be either episodic or chronic. Episodic attacks are usually a few hours in duration, but can last for several days. Chronic headaches occur for 15 or more days a month for a period of at least 3 months.

C.Migraines

A migraine headache may cause a pulsating, throbbing pain usually only on one side of the head. The aching may be accompanied by:

• Blurred vision
• Light-headedness
• Nausea
• Sensory disturbances known as auras

A migraine is the second most common form of a primary headache and can have a significant impact on the life of an individual. According to the WHO, migraine is the sixth highest cause of days lost due to disability worldwide. A migraine can last from a few hours to between 2 and 3 days.

D.Rebound headaches

Rebound or medication-overuse headaches stem from excessive use of medication to treat headache symptoms. They are the most common cause of secondary headaches. They usually begin early in the day and persist throughout the day. They may improve with pain medication, but worsen when its effects wear off.

Along with a headache itself, rebound headaches can cause:

• Neck pain
• Restlessness
• The feeling of nasal congestion
• Reduced sleep quality

Rebound headaches can cause a range of symptoms, and the pain can be different each day.

E.Cluster headaches

Cluster headaches usually last between 15 minutes and 3 hours, and they occur suddenly once per day up to eight times per day for a period of weeks to months. In between clusters, there may be no headache symptoms, and this headache-free period can last months to years.

The pain caused by cluster headaches is:

• One-sided
• Severe
• Often described as sharp or burning
• Typically located in or around one eye

The affected area may become red and swollen, the eyelid may droop, and the nasal passage on the affected side may become stuffy and runny.

F.Thunderclap headaches

These are sudden, severe headaches that are often described as the “worst headache of my life.” They reach maximum intensity in less than one minute and last longer than 5 minutes.

A thunderclap headache is often secondary to life-threatening conditions, such as intracerebral hemorrhage, cerebral venous thrombosis, ruptured or unruptured aneurysms, reversible cerebral vasoconstriction syndrome (RVS), meningitis, and pituitary apoplexy.

• Type of pain -Many patients suffer from more than one type of headache. This may result from different etiologic factors or may represent a change in the character of a chronic headache disorder.
• Temporal profile of pain – Acute-onset headaches of severe intensity occurring in a patient without a previous history of similar headaches may suggest an organic etiology. The timing of onset and association with sleep or hormonal cycles may be helpful in diagnosis.
• Characteristics of pain – The location, duration, and quality of pain should be carefully evaluated. Location may be diffuse, either unilateral or bilateral, or localized to specific structures in the head and neck. Vascular headaches produce throbbing pain; constant pain results from myogenic or traction headaches. The intensity of pain is not a reliable indicator of the seriousness of underlying conditions causing the headache.
• Prodromes – Neurologic symptoms may precede a classic migraine headache. Visual symptoms such as scintillations, scotoma, or hemianopsia are most common; other symptoms, such as hemiplegia or ophthalmoplegia, occur rarely. Patients with a common migraine may report vague premonitory symptoms such as malaise or psychic disturbances.
• Precipitating factors –Association of a headache with environmental factors may be helpful in diagnosis. Foods such as alcohol or those containing tyramine or sodium nitrates may precipitate vascular headaches. Some patients report an association with menstruation. Medications, including nitrates and other vasodilators, indomethacin, and oral contraceptives can aggravate or induce a headache. Occupational factors can produce mechanical influences that aggravate a headache. A history of frequent neck movements, exposure to bright lights, or long periods of work at video terminals may be helpful.
• Associated symptoms –a Headache associated with progressive neurologic deficits or seizures can indicate an intracranial lesion. Meningeal signs occurring with an acute violent headache suggest subarachnoid hemorrhage. A migraine is commonly a “sick headache” associated with nausea, anorexia, photophobia, or sonophobia. Autonomic symptoms such as lacrimation, nasal congestion, facial flushing, or Horner’s syndrome accompany cluster headaches.
• Medical history – A headache with onset after head trauma may suggest subdural hematoma. The previous history of malignancy or systemic disease may suggest an etiology of a headache. Family history should be investigated because a migraine is commonly familial. Prior investigations into a patient’s headache, including attempted therapeutic interventions, should be carefully evaluated.

Causes of Headaches

• Headache pain results from signals interacting among the brain, blood vessels, and surrounding nerves. During a headache, specific nerves of the blood vessels are activated and send pain signals to the brain. It’s not clear, however, why these signals are activated in the first place.
• There is a migraine “pain center,” or generator, in the midbrain area. A migraine begins when overactive nerve cells send out impulses to the blood vessels. This causes the release of prostaglandins, serotonin, and other substances that cause swelling of the blood vessels in the vicinity of the nerve endings, resulting in pain.
• Headaches that occur suddenly (acute onset) are usually caused by illness, infection, cold, or fever. Other conditions that can cause an acute headache include sinusitis (inflammation of the sinuses), pharyngitis (inflammation or infection of the throat), or otitis (ear infection or inflammation).

In some cases, the headaches may be the result of a blow to the head (trauma) or, rarely, a sign of a more serious medical condition.

Common triggers of tension-type headaches or migraine headaches include

• Emotional stress related to family and friends, work, or school
• Alcohol use
• Skipping meals
• Changes in sleep patterns
• Excessive medication use
• Tension
• Depression

Other causes of headaches include eye strain and neck or back strain caused by poor posture.

When headaches become progressive and occur along with other neurological symptoms, they can be the sign of a disease process in the brain, such as:

• Hydrocephalus (abnormal buildup of fluid in the brain)
• Meningitis (an infection or inflammation of the membrane that covers the brain and spinal cord)
• Encephalitis (infection/inflammation of the brain)
• Hemorrhage (bleeding within the brain)
• Tumor
• Blood clots along the surface of the brain
• Head trauma
• Abscess
• Toxins (overexposure to chemicals, including certain medications)

The American Headache Society recommends using “SNOOP”,

A mnemonic to remember the red flags for identifying a secondary headache:

• Systemic symptoms (fever or weight loss)
• Systemic disease (HIV infection, malignancy)
• Neurologic symptoms or signs
• Onset sudden (a thunderclap headache)
• Onset after age 40 years
• Previous headache history (first, worst, or a different headache)

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Other red flag symptoms include

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• Tricyclic antidepressants – These are older antidepressant drugs that include amitriptyline (Elavil), doxepin (Silenor, Sinequan), nortriptyline (Pamelor), and protriptyline (Vivactil).
• Migraine drugs called triptans – Some examples are almotriptan (Axert), frovatriptan (Frova), sumatriptan (Imitrex), and zolmitriptan (Zomig).
• NSAIDs (nonsteroidal anti-inflammatory drugs) – These painkillers include aspirin, celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen, and naproxen.
• Amitriptyline – Tricyclic antidepressant amitriptyline has been most extensively studied and has been found to most effective for the treatment of CTTH.[rx] Way back in 1964, Lance et al. conducted the first controlled crossover trial and demonstrated the superiority of amitriptyline over placebo in patients with CTTH.[rx] Since then, a number of studies tested the various doses and compared amitriptyline with other antidepressants like citalopram.[rx–rx] By and large, doses up to 75 mg of amitriptyline were found to be useful. Mechanism of action of amitriptyline in CTTH is uncertain. Possible explanations include serotonin reuptake inhibition, potentiation of endogenous opioids, NMDA receptor antagonism and blockade of ion channels.[rx]Amitriptyline should be started on a low dose (10 mg to 25 mg per day) and titrated by 10-25 mg weekly till the therapeutic effect or the side effects appear. Significant clinical effect of Amitriptyline is usually seen by the end of one week and should be apparent by 3-4 weeks.[rx]
• Other antidepressants – like SSRIs and tetracyclic have been found to be not so useful. Although studies have found a modest effect on prevention of CTTH by drugs like citalopram,[rx] sertraline, mianserin,[rx] fluvoxamine,[rx] paroxetine,[rx] venlafaxine (extended release)[rx] and a D2 antagonist sulpiride,[rx] there are no robust data for recommending these agents yet. A new drug, mirtazapine,[rx] a noradrenergic and serotonergic antidepressant however has been found to be efficacious and can be given in situations where amitriptyline is either ineffective or contraindicated. At a dose of 30 mg/day, it reduced headache index by 34% more than placebo in difficult-to-treat patients, including patients who had not responded to amitriptyline.

Muscle Relaxants

• The role of muscle relaxants in the prevention of CTTH is debatable. Centrally acting muscle relaxant like tizanidine may have some benefit but is not recommended routinely. Peripherally acting muscle relaxants have no role. At least 3 studies have tested tizanidine in CTTH and while two studies[rx,rx] showed modest benefit, one failed to show any.[rx]

Botulinum toxin type A

• Following an open-labeled study in which Botulinum Toxin Type A injection was shown to be efficacious in CTTH patients,[rx] few controlled studies have been undertaken.[rx–rx] The results have been conflicting and largely negative. Hence, Botulinum Toxin Type A is not recommended for CTTH prevention.

Nonpharmacologic therapy

Non-pharmacologic management includes physical therapy and psychologic treatment. Ideally, these should be tried in all patients as adjuncts to pharmacotherapy. These may, however, be more attractive to patients reluctant to use drugs.

• Physical therapy – It is the most commonly used non-pharmacologic treatment of TTH. Its components include improvement of posture, relaxation, exercise programs, hot and cold packs, ultrasound, and electrical stimulation.[rx] Active treatment strategies generally are recommended. A controlled study combining various techniques, such as massage, relaxation, and home-based exercises found a modest effect.[rx] Adding craniocervical training to classical physiotherapy may be better than physiotherapy alone.[rx]
• Psychologic therapy – This includes relaxation training, EMG biofeedback, and cognitive-behavioral therapy.[rx] During relaxation training, the patients consciously reduce muscle tension and autonomic arousal that can precipitate and result from headaches. Thus, it is a strategy for training in self-regulation. EMG biofeedback helps the patients to develop control over pericranial muscle tension. The patients use the feedbacks that are presented with an auditory or visual display of the electrical activity of the muscles in the face, neck, or shoulders. It is uncertain whether reductions in muscle tension or cognitive changes of self-efficacy account for improvement. The latter is more likely. In cognitive-behavioral therapy, patients are taught to identify thoughts and beliefs that generate stress and aggravate headaches. Although the treatment outcome of psychologic therapies is difficult to measure, there seems to be reasonable scientific support for their effectiveness.
• Miscellaneous treatments – Oromandibular treatment with occlusal splints is an attractive option but lack scientific data and hence not recommended for routine use.[rx] Similarly, for acupuncture, there are conflicting results regarding its efficacy for the treatment of TTH.[rx–rx] Spinal manipulation has shown no effect on the treatment of episodic TTH.[rx]

According to the National Center for Complementary and Integrative Health

(NCCIH), the following supplements may help prevent tension headaches:

• Butterbur
• Coenzyme Q10
• Feverfew
• Magnesium
• Riboflavin (vitamin B-2)

Other ways to ease a tension headache include

• Applying a heating pad or ice pack to your head for five to 10 minutes several times a day
• Taking a hot bath or shower to relax tense muscles
• Improving your posture
• Taking frequent computer breaks to prevent eye strain

Sometimes the overuse of analgesic medicines causes a condition called medication overuse headache, or rebound a headache.

• Headache education – includes identifying and recording what triggers your headache, such as lack of sleep, not eating at regular times, eating certain foods or additives, caffeine, environment, or stress. Avoiding headache triggers is an important step in successfully treating the headaches.
• Counseling  – in the form of one-on-one sessions, group therapy, or support groups can help you identify your headache triggers and teach you useful coping techniques.
• Stress management – To successfully treat headaches, it is important for you to identify what causes or triggers the headaches. Then you can learn ways to cope with or remove the stressful activities or events. Relaxation techniques are helpful in managing stress and include deep breathing exercises, progressive muscle relaxation, mental imagery relaxation, or relaxation to music. Ask your health care provider for more information about these techniques.
• Biofeedback – Biofeedback equipment includes sensors connected to your body to examine your involuntary physical responses to headaches, such as breathing, pulse, heart rate, temperature, muscle tension, and brain activity. By learning to recognize these physical reactions and how the body responds in stressful situations, biofeedback can help you learn how to release and control tension that causes headaches
• Chiropractic Care – Chiropractors don’t merely treat symptoms, instead, they look for causes, ” says a busy chiropractor in Dupage County, IL. “Many people have been taught to be skeptical of chiropractors because they really don’t understand what we do.”These Chicago chiropractors want to help. How can they eliminate your headache symptoms without drugs? Chiropractors are trained to use gentle and safe spinal adjustment techniques that can relieve any nerve interference that is causing your headache

Home Remedies for Headaches

Natural home remedies for headaches that really work

There comes a point when the world of deadlines, irksome bosses, late nights, skimpy sleep schedules and traffic jams takes a toll on us. It is then when our quintessential cup of coffee surrenders to splitting headaches. So, what do you do when you’re bad day culminates to a severe migraine?

The easy way out is, of course, to pop a painkiller, maybe even indulge in acupressure, sip on some chamomile tea. And we’re willing to do just about anything to get rid of that pounding headache. Lucky for you, we’ve compiled a list of 10 natural home remedies that will zap the pain from your debilitating headache.

Managing Your Headaches

• “Headaches are characterized by a feeling of tenseness in the neck, shoulder, and scalp whereas migraines are basically pulsating headaches, often on one side of the head.

• It is essential that you avoid headache-inducing substances like MSG (monosodium glutamate), excessive caffeine, alcohol, phenylethylamine found in chocolate and cheese, tyramine found in nuts and fermented meats and soy, and aspartame present in many artificially sweetened foods.
• If you start getting a headache, steer clear of all devices including your phone, laptop and TV. Eat healthily, and at regular intervals since a drop in blood sugar can set the stage for headaches. At least thrice a week, if not more, spend 30 minutes exercising

• Touted as an elixir for headaches, ginger is a home remedy for instant relief. It helps reduce inflammation of the blood vessels in the head, hence easing the pain. And since it stimulates digestion, it also helps quell the nausea which occurs during migraines.
• Wondering how to use this miracle ingredient? Steep ginger root for tea, or mix equal parts of ginger juice and lemon juice and drink up. You can consume this once or twice a day. You can also apply a paste of ginger powder and 2 tablespoons water on your forehead for a few minutes to provide quicker relief.

Soothe with Scent

• Peppermint Oil – With its refreshing scent, peppermint helps open up clogged blood vessels which cause a headache. It contains menthol which helps regulate blood flow in the body. Quietly breathe in the aroma in a cool, dark room. You can also mix 3 drops of peppermint oil in one tablespoon of almond oil, or just add a little water and massage the temples or the back of your neck with it. Alternatively, can apply crushed peppermint leaves on your forehead. Make an herbal tea by adding 1 teaspoon of dried peppermint to a cup of boiling water. Cover and let it steep for 10 minutes. Strain and add some honey to sweeten it. Sip the tea slowly.

Lavender Oil

• Not only does lavender have a beautiful fragrance – it’s also a great remedy for alleviating headaches. Simply smelling the soothing scent of lavender essential oil helps, so you can just put a few drops on a tissue and inhale it. You can also add 2 drops of lavender oil to two cups of boiling water and inhale the steam. Another option is to mix two or three drops in one tablespoon of almond oil or olive oil and massage your forehead with it.

Cinnamon Please

• Cinnamon is a miracle spice that can effectively treat headaches. Wondering how to use it? Here’s help: Grind some cinnamon sticks into a powder, and add some water to make a thick paste. Apply it on your forehead and temples and lie down for 30 minutes. Then wash it off with lukewarm water.

Make Time for Thyme

• To relieve headache pain, dab a drop or two of thyme or rosemary essential oil on each temple and on your forehead. Rub gently into the skin, then sit quietly for several minutes to let this home remedy work.
• Basic Stretches – A few simple exercises to stretch your head and neck can help reduce the intensity of a headache. Move your chin upwards and downwards, left and right, and bend your neck sideways toward each shoulder. You can also try to slowly rotate the neck in clockwise and anticlockwise directions to help the shoulder and neck muscles relax. So when a headache looms, you know what to do.

Heat Up or Cool Down

• Applying an ice pack to the back of your neck can give relief from a migraine since the cold from the ice helps to reduce inflammation that contributes to headaches. Plus, it has a numbing effect on the pain. And believe it or not, just soaking your feet in hot water also helps get rid of a headache. For a severe headache, add a bit of hot mustard powder to the water.

Crazy for Cloves

• Cloves can be used to ease a throbbing headache due to its cooling and pain-relieving properties. Crush a few cloves gently and put them in a sachet or a clean handkerchief. Inhale the smell of the crushed cloves whenever you have a headache until you get some relief from the pain. You can also put 2 drops of clove oil in a tablespoon of coconut oil plus sea salt and gently massage your forehead and temples with it.

Basil is the Best

• A strong-scented herb which is used for natural headache treatment, it has many analgesic benefits. The oil works as a muscle relaxant and helps get rid of headaches caused by tension and tight muscles. You can put 3 or 4 fresh basil leaves in a cup of boiling water and let it simmer. Add a little honey and sip the tea slowly. You can also chew some fresh basil leaves, or inhale the steam after boiling basil in a pot of water.

Apple a Day Keeps The Doctor Away

• Both apples and apple cider vinegar can be used to fight off a headache. They help restore the acid-alkaline balance in the body. “Mix a half cup of apple cider vinegar with half cup of water and boil the mixture in a covered saucepan. Remove from heat, hold a towel over your head and slowly inhale the steam.
• If you wake up with a headache, just eat a piece of apple sprinkled with salt, and drink some warm water after. Or add 2 teaspoons of apple cider vinegar to a glass of water, with honey and a splash of lemon juice. Drink it 2 or 3 times a day.

The Power of Prevention

• Could striking a camel pose ease your aching head? Yes, yoga combines physical postures, breathing exercises and meditation to boost relaxation. It will get your mind focused, stretch out your muscles, and get you moving in ways that can help you drop the tension. Regularly practicing yoga is the best thing to do, after all prevention is better than cure.

Tip: Make a conscious effort to take deep, full breaths that start in your diaphragm and fill up your lungs. This will get plenty of fresh oxygen circulating through your blood and will also help relax your mind and body.

References

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590146/
• https://www.ncbi.nlm.nih.gov/books/NBK377/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416971/
• https://www.ncbi.nlm.nih.gov/books/NBK279373/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416971/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444216/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444224/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722827/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992086/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190284/

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