Headaches have been classified according to their characteristics to provide a common language for people to use when talking about them. All headaches can be classified as either primary or secondary. The secondary headache disorders are those attributable to an underlying medical problem. Serious causes of secondary headache include brain tumors, bleeding in the brain, aneurysms (weakened blood vessel walls) and infections.
Less serious causes of secondary headache include dental problems, sinus infections and allergies. Although TV commercials focus on allergies and sinus problems as causes of headache, the most common types of headaches are primary headaches. These are headaches not attributable to some other medical problem. The primary headache disorders fall into three categories: (1) migraine, (2) tension-type headache and (3) cluster headache.
MIGRAINE
Migraine occurs more in women than men, often causes disability and affects about 15% of the world’s population. Most people with migraine have their first episode of headache between the ages of 6 and 25. The two major categories of migraine are migraine without aura (previously called common migraine) and migraine with aura (previously called classic migraine). Migraine is usually inherited. Parents with migraine whose children complain of headache should not assume that their children are imitating them. Headache may begin as early as age 2; children of migraine sufferers who complain of headaches should be believed and evaluated by a doctor.
Migraine without Aura
Attacks may last from 4 to 72 hours, but an average attack usually lasts from 12 to 48 hours.
The diagnosis of migraine without aura requires 4-5 attacks with aura.
Other symptoms of a migraine attack may include dizziness, frequent urination, diarrhoea, sweating and cold hands and feet. If a fever accompanies your headache, you must contact a doctor to rule out a serious infection, such as meningitis. You should, however note that high blood pressure during a migraine attack does not mean you have a persistent high blood pressure problem. To be on the safe side, have your blood pressure checked between headaches to make sure it has returned to normal levels (e.g. 110-120 / 70-80 mm Hg).
Many patients retreat to dark, quiet room and lie still during attacks; trying to sleep may break a migraine attack.
Migraine with Aura
The word aura refers to visual symptoms that occur before or at the same time as the headache. Approximately 15% of patients with migraine experience the warning phenomenon of aura. Some patients have aura without headache, which is known as a migraine equivalent. In this case, the headache that follows the aura is similar to that previously described, but less severe.
Aura usually lasts 20 to 30 minutes. The most common type of visual aura shows up as coloured spots, flashing bright lights, or multicolored, shimmering, zigzag lines in the shape of a crescent. Other visual disturbances include scotoma (a small growing black area in the visual field); photopsia (a bright flash of light); loss of vision on one or both sides; tunnel vision or inability to see words in a particular area when looking at a printed page. Other auras include neurological events that can resemble stroke symptoms, such as weakness or numbness in an arm and/or leg on one side or difficulty in speaking.
If aura symptoms persist for more than 1 hour, they could be related to a more serious abnormality. In migraine, headache follows the aura in 5 to 60 minutes.
MIGRAINE VARIANTS (OTHER HEADACHES)
Migraine variants are seen frequently in some patients. These are described here under :
Exertional Headache
An exertional headache is brought on by exertion of any type, including bending, coughing, sneezing, straining, or exercise. This type of headache should always be brought to a doctor’s attention.
Ice-Pick-Like Pains or ‘Jabs and Jolts’
Also known as ‘idiopathic (cause unknown) stabbing headache,’ these headaches are perceived as very sharp, brief, ice-pick-like pains at various locations of the head.
Sex Headache (Coital Headache)
These intense headaches occur primarily in men at the time of orgasm.
Chronic Paroxysmal Hemicrania
This is a rare type of headache disorder that resembles cluster headache. Unlike cluster headache, it occurs more commonly in women than in men and is characterized by 12 or more attacks per day. Always one sided, the pain lasts only 5 to 10 minutes.
All of the above types of headache respond to the non-steroidal anti-inflammatory medication.
‘Ice-Cream’ Headache
The official term for this type of headache is ‘cold stimulus’ headache because it occurs between the eyes after eating or drinking something very cold. It lasts for fewer than 5 minutes and may be prevented by eating ice cream slowly, in small amounts, and by letting it in the mouth before swallowing.
TENSION-TYPE HEADACHE
Tension-type headache is the most common type of headache. Probably 90% or more of the world’s population has experienced one from time to time. Many of these headaches are associated with tension in muscles, although in some patients this may not be the case. There is much speculation as to whether tension-type headache and nilgame headache are separate disorders. Many headache specialists believe they are caused by similar mechanisms in the brain. Tension-type headaches may be episodic or chronic.
Episodic Tension-Type Headache
Occurring occasionally—once or twice per week, or once per month—these headaches are described as pressing, aching, stitching or as of a band-like feeling that does not throb. It is usually felt on both sides of the head. Unlike migraine, the pain is usually moderate, does not interfere with normal function, and is not aggravated by activity. These headaches are rarely associated with nausea; however, light or sound sensitivity may be present, but not both.
Chronic Tension-Type Headache
Symptoms are identical to those of episodic tension-type headache, but they occur more than 15 days per month, often daily.These patients often develop chronic daily headache.
Chronic Daily Headache
At present, there is no official classification for this daily (often constant) headache. Patients say they have pain all the time. Often they add that it waxes and wanes throughout the day. It wears them down. Occasionally, the pain becomes sufficiently severe that it interferes with their ability to function. This type of headache clearly resembles migraine. Some experts believe these patients have transformed migraine, which starts in the teens with occasional migraine, and transforms to daily, dull-to-moderate pain (tension-type headache) by the time they are in their 30s and 40s. Eighty percent of people with chronic daily headache take pain relievers or other acute care medications on a daily basis. As a result, this can lead to rebound headache, which is worse and more constant.
CLUSTER HEADACHE
Cluster headache is probably the most dramatic of all the headache types. The pain occurs exclusively on one side of the head, in and around the eye and temple. In contrast to typical throbbing migraine pain, cluster pain is more steady, boring and relentless.
Patients describe pain as intense pressure behind the eye that feels as though it is pushing the eye forward. Some patients describe the feeling as one which makes them want to pluck out the painful eye. Others describe it as a red-hot poker being thrust into the eye with immense force and then twirled. Drooping of the eyelid, constriction of the pupil, redness and tearing of the eye, followed by a stuffed then running nostril, may accompany the headache, occurring on the same side of the head as the pain. It may last anywhere from 20 minutes to 3 hours, with a average duration of 45 to 90 minutes.
Attacks may occur several times per day with an average of one to three attacks in a 24-hour period. Cluster headaches often occur at the same time of the day or night, usually after work. Most characteristically, these headaches awaken the sufferer 90 minutes after falling asleep.
In contrast to migraine; which affects one in five women and occur three times more frequently in women than in men, cluster headaches occur five times as often in men and affect only 0. 1% of the population. A family history of cluster headache is much less common than migraine. The typical male sufferer is 35 years, a little tall than average, and may have hazel-coloured hair, along with deep lines around the forehead, mouth, and chin.
Cluster pain is so excruciating that it brings even the strongest of men literally to their knees. It is no wonder that cluster headache has been termed ‘suicide headache’ Rather than retreating to a dark, quiet room is do migraine sufferer cluster patients cannot sit or he still. Rather, they pace, rock, and drive their fists into the painful eye. Some patients may even show unusual behaviour, such as hitting themselves in the head, banging their heads against the wall, or engaging in intense physical activity such as push-ups or running.
The word ‘cluster’ describes the time pattern of these headaches, which occur in cluster periods of about 6 to 8 weeks per year. Patients are free of headache between cluster periods. Alcohol is the most common trigger, but only during the cluster period. Actively drinking alcoholics may stop drinking completely until the cluster period has passed. Cluster headache occur, in two patterns: episodic and chronic.
Episodic Cluster Headache
In the more common episodic variety of cluster headache, patients experience a 6 week cluster period once per year. Cluster periods may occur every 1 to 2 years, or only once in a lifetime. Symptoms may mislead doctors to incorrect diagnoses and treatments such as sinus headaches which may be inappropriately treated with a variety of sinus indications and surgery. They may also be mistaken for dental problems.
Chronic Cluster Headache
About 10% of all patients suffering from cluster headaches have them on a daily, or almost daily basis for years. Fortunately, now there are effective treatments for cluster headaches.
Other Ttypes of Headache
Beside above mentioned headaches, their are so many other types of headaches which tease the mankind.
Post-Traumatic Headache
Post-traumatic headaches sometimes follow injury to the head or neck and may even develop after what seems to be only a minor injury. These headaches usually occur on both sides of the head; they are constant and mild to moderate in intensity; and they can continue for months. Sometimes, they become severe or even incapacitating and resemble migraine. Patients with post-traumatic headache may be thought to be exaggerating their pain or malingering, but in our experience, these patients have a debilitating disorder that may destroy the fabric of their lives which may seriously impair their ability to function.
Some patients with post-traumatic headache also develop the post-head trauma syndrome and experience impaired concentration, memory and sleep, as well as irritability, decreased energy and interests, personality changes and increased ability to handle even simple tasks.
Although scans of the brain or the cervical spine fail to reveal abnormalities, the injury may have caused microscopic tearing and damage to nerve fibers in the brain and brain stem. The damage may disrupt the delicate balance of the chemical messengers that control pain. Many patients develop post-traumatic headache as a result of a ‘whiplash’ (or neck injury) after a car accident. The degree of head trauma does not necessarily correlate with the degree of pain intensity or disability. Pre-existing migraine or tension-type headache may worsen after this kind of injury.
Sinus Headache
Sinus problems rarely cause chronic headaches. Sinus headaches are due to inflammation of the mucous membranes lining the sinuses in the head. Blockage of the sinus drainage system may cause infection and these infections are classified as acute or chronic. Headache caused by acute sinusitis may be felt in the cheeks, below, above, or behind the eyes or it may be referred to other areas such as the teeth or the top of the head.
Acute sinusitis is generally associated with fever, red, hot skin over the sinus and a yellow-green discharge from the nostrils and back of the throat. Any headache associated with fever or infection must be treated immediately.
Chronic, low-grade inflammation of any of the sinuses in the head may cause headache. The pain patterns are similar to those in acute sinusitis but of lesser intensity and not usually associated with fever. Depending on the sinuses involved, pain may be increased by shaking the head or by lying in certain positions that decrease the ability of the sinuses to drain. A severe sinus problem may trigger a migraine attack.
Allergy Headache
Commercials and advertisements to the contrary, most headaches are not due to allergies. Allergy to pollen and grasses and hay fever can, however cause sinus pain and headache.
Eye-Related Headache
Eye strain is not a common cause of chronic or recurrent headache. Headaches that are due to eye strain are generally mild and are felt in the forehead or in the eyes themselves. The pain is absent on awakening worsens when the eyes are used for prolonged periods.
Glaucoma (increased pressure within the eye) may cause a headache that mimics a bad migraine or tension-type headache or it may cause severe pain, in and around the eye or in the forehead. If you notice changes in your vision accompanied by pain and other symptoms, consult an eye doctor at once.
Temporomandibular Joint Dysfunction
The temporomandibular joint (TMJ) is located just in front of the ear, where the jaw meets the skull. TMJ problems may cause ear or jaw pain, ringing in the ears or pain (headache) in the area where the hinges and the jaw meet the upper face.
Many patients have been misdiagnosed as having TMJ problems and have undergone major surgical reconstruction of the joint without experiencing any relief of their pain. Most TMJ headaches are actually migraine or tension-type headaches.
Trigeminal Neuralgia
Trigeminal neuralgia is a piercing, sudden, severe pain lasting 1 to 4 minutes, confined to the cheek or jaw of one side. This type of pain is triggered by talking, chewing, exposure to wind or even by touching the face.
Spinal Tap Headache
Spinal tap headache occurs 12 to 48 hours after a diagnostic spinal tap in which fluid is removed in the spinal column. It is a diffuse, steady pain accompanied by nausea. It gets worse on standing and disappears on lying down. The headache occurs because fluid leaks from the spinal column at the spot where the needle made its puncture. The treatment is to drink sufficient fluids and to lie absolutely flat for 2 days. This type of headache disappears slowly. In severe cases, a minor procedure called an epidural blood patch is performed to seal the hole and prevent further leakage of spinal fluid.
