P1 Types of Headache

Based on the etiology, Headache is classified in to primary and secondary headache. Depending on
the frequency and area of occurrence they are again subdivided and each type calls for different
medication and therapies.

Primary HeadacheThere are two major types of primary headache, which include: Vascular,
Myogenic (muscle tension),

Vascular Headaches: A highly common vascular headache is Migraine. Migraine is French in origin
and taken from the Greek hemicrania, which means "only half the head."

Migraines are a frequent recurring headache, which are highly common in women and worsens
before the onset of menstruation. Its onset is always gradual. Migraine is characterized by severe
pain on, one or both sides of the head, which last for minimum 12 hours. This kind of headache is
accompanied by loss of appetite, nausea and vomiting. This condition is further complicated by
bright light (photophobia) and loud noises (phonophobia). Therefore, it is always advisable to seek a
quiet and cool room.

Next to Migraine, a common vascular headache is “toxic” headache. This mostly occurs in high
fever.

Other kind of vascular headaches are cluster headaches. Cluster headaches occur repeatedly every
day at the same time for several weeks and then subside. It mainly occurs in the male population.
The ratio between male and female varies from 4:1 to 20:1. They occur in cluster of several days to
several weeks. After this the headaches may disappear for a few weeks months or even years if the
suffer is fairly lucky.

In chronic conditions, it might occur many times in a year. The pain is generally brief, slowly builds
up and becomes explosive over as little as five minutes, and last one to three hours. More than one
headache may occur in a single day. High blood pressure may also be a trigger for cluster
headaches.

The pain with a cluster headache develops in the region of one eye and spreads to the rest of the
face. The eye which is affected by this headache usually becomes red and wet and the nostril on the
same side of the face often becomes runny and blocked. One of the main differences between a
cluster and a migraine headache is the cluster sufferer usually feels better if they are moving about.

Unlike migraine sufferers, those with cluster headache often feel better if they keep moving during
the headache.

Muscular/ Myogenic headache: This headache results from tightening or tensing of facial and
neck muscles resulting in radiation of pain to the forehead. The most common type of muscular
headache is Tension headache. It is characterized by tenderness in the muscles of the scalp, neck
and shoulders. This kind of headache may occur on a daily basis. It is very easy to cure with
medication and a tension free surrounding. Chronic tension headaches can lead to frustration and
are often difficult to treat.

Secondary Headaches: Headaches caused by medical problems are known as secondary

headaches.

The underlying condition can be due to a Stroke, any type of head injury, a virus, brain tumor or
some type of metabolic disorder (e.g., diabetes, thyroid disease). They can also be due to simple
problems in the eyes, ears, neck, teeth, or sinuses. But what ever the problem is that is causing the
headache, the underlying condition must be diagnosed and treated.
A blow to the may result in a relentless, unexpected, and incapacitating secondary headache which
interferes with normal activities of daily living. The sufferer may also develop symptoms such as
convulsions, disorientation, and dizziness, loss of consciousness, fever and pain in the eye or ear.
Immediate medical intervention is required in such cases. Other less common types of headaches
include
 Ictal headaches (occur with seizure),
 Ice cream headache (occur while eating ice cream),

 Thunderclap headache (Occur when there is brain damage),

 Coital cephalalgia (sex headache),

 Sinus headache,

 Medication overuse headaches

P2 treating of headache

Over 40 million Americans experience chronic headaches. For at least half of

these people, the problem is severe and sometimes disabling. It can also be
costly: headache sufferers make over 8 million visits a year to doctor's offices.
Migraine victims alone lose over 65 million workdays because of headache pain.

Several areas of the head can hurt, including a network of nerves which extends
over the scalp and certain nerves in the face, mouth, and throat. Also sensitive to
pain, because they contain delicate nerve fibers, are the muscles of the head and
blood vessels found along the surface and at the base of the brain.

The bones of the skull and tissues of the brain itself, however, never hurt,
because they lack pain-sensitive nerve fibers.

The ends of these pain-sensitive nerves, called nociceptors, can be stimulated by

stress, muscular tension, dilated blood vessels, and other triggers of headache.
Once stimulated, a nociceptor sends a message up the length of the nerve fiber
to the nerve cells in the brain, signaling that a part of the body hurts. The
message is determined by the location of the nociceptor.

A number of chemicals help transmit pain-related information to the brain. Some

of these chemicals are natural painkilling proteins called endorphins, Greek for
"the morphine within." One theory suggests that people who suffer from severe
headache and other types of chronic pain have lower levels of endorphins than
people who are generally pain free.

Not all headaches require medical attention. Some result from missed meals or
occasional muscle tension and are easily remedied. But some types of headache
are signals of more serious disorders such as head injury and call for prompt
medical care.
 A test called an electroencephalogram (EEG) may be given to measure brain
activity. EEG's can indicate a malfunction in the brain, but they cannot usually
pinpoint a problem that might be causing a headache. A physician may suggest
that a patient with unusual headaches undergo a computed tomographic (CT)
scan. The CT scan produces images of the brain that show variations in the
density of different types of tissue. The scan enables the physician to distinguish,
for example, between a bleeding blood vessel in the brain and a brain tumor. The
CT scan is an important diagnostic tool in cases of headache associated with
brain lesions or other serious disease. Experts generally agree, however, that
this sophisticated and expensive technology is not required to diagnose simple or
periodic headache.

An eye exam is usually performed to check for weakness in the eye muscle or
unequal pupil size. Both of these symptoms are evidence of an aneurysm--an
abnormal ballooning of a blood vessel. A physician who suspects that a
headache patient has an aneurysm may also order an angiogram. In this test, a
special fluid which can be seen on an X ray is injected into the patient and
carried in the bloodstream to the brain to reveal any abnormalities in the blood
vessels there.

Headaches are diagnosed as:

 Vascular
 Muscle contraction
 Traction
 Inflammatory
Vascular headaches are a group that includes the well-known migraine - are so
named because they are thought to involve abnormal function of the brain's
blood vessels or vascular system.

Muscle contraction headaches appear to involve the tightening or tensing of

facial and neck muscles.
Traction and inflammatory headaches are symptoms of other disorders, ranging
from stroke to sinus infection. Some people have more than one type of
headache.

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. Sensitivity to light is a
standard symptom of the two most prevalent types of migraine-caused
headache: classic and common.
The major difference between the two types is the appearance of neurological
symptoms 10 to 30 minutes before a classic migraine attack. These symptoms
are called an aura. The person may see flashing lights or zigzag lines, or may
temporarily lose vision. Other classic symptoms include speech difficulty,
weakness of an arm or leg, tingling of the face or hands, and confusion.
The pain of a classic migraine headache is described as intense, throbbing, or
pounding and is felt in the forehead, temple, ear, jaw, or around the eye. Classic
migraine starts on one side of the head but may eventually spread to the other
side. An attack lasts 1 to 2 pain-wracked days.

If you were about to experience a classic migraine headache, you might find it
difficult to read this article. You could lose part of your vision temporarily and see
zigzag lines and black dots. Such visual problems--and other neurological
symptoms--often precede classic migraine.

The common migraine - a term that reflects the disorder's greater occurrence in
the general population--is not preceded by an aura. But some people experience
a variety of vague symptoms beforehand, including mental fuzziness, mood
changes, fatigue, and unusual retention of fluids. During the headache phase of
a common migraine, a person may have diarrhea and increased urination, as
well as nausea and vomiting. Common migraine pain can last 3 or 4 days.

Both classic and common migraine can strike as often as several times a week,
or as rarely as once every few years, Both types can occur at any time. Some
people, however, experience migraines at predictable times - near the days of
menstruation or every Saturday morning after a stressful week of work.

Research scientists are unclear about the precise cause of migraine headaches.
There seems to be general agreement, however, that a key element is blood flow
changes in the brain. People who get migraine headaches appear to have blood
vessels that overreact to various triggers.

While a food-triggered migraine usually occurs soon after eating, other triggers
may not cause immediate pain. Scientists report that people can develop
migraine not only during a period of stress but also afterwards when their
vascular systems are still reacting. The "Preacher Monday-Morning Headache" is
named for those clergymen who get migraines a day after the stress of delivering
a Sunday sermon. Migraines that wake people up in the middle of the night are
also believed to result from a delayed reaction to stress.

In addition to classic and common, migraine headache can take several other
forms: Patients with hemiplegic migraine have temporary paralysis on one side of
the body, a condition known as hemiplegia. Some people may experience vision
problems and vertigo--a feeling that the world is spinning. These symptoms begin
10 to 90 minutes before the onset of headache pain.

In ophthalmoplegic migraine, the pain is around the eye and is associated with a
droopy eyelid, double vision, and other sight problems.

Basilar artery migraine involves a disturbance of a major brain artery.

Preheadache symptoms include vertigo, double vision, and poor muscular
coordination. This type of migraine occurs primarily in adolescent and young
adult women and is often associated with the menstrual cycle.

Benign exertional headache is brought on by running, lifting, coughing, sneezing,

or bending. The headache begins at the onset of activity, and pain rarely lasts
more than several minutes.

Status migrainosus is a rare and severe type of migraine that can last 72 hours
or longer. The pain and nausea are so intense that people who have this type of
headache must be hospitalized. The use of certain drugs can trigger status
migrainosus. Neurologists report that many of their status migrainosus patients
were depressed and anxious before they experienced headache attacks.

Headache-free migraine is characterized by such migraine symptoms as visual

problems, nausea, vomiting, constipation, or diarrhea. Patients, however, do not
experience head pain. Headache specialists have suggested that unexplained
pain in a particular part of the body, fever, and dizziness could also be possible
types of headache-free migraine.

During the Stone Age, pieces of a headache sufferer's skull were cut away with
flint instruments to relieve pain. Another unpleasant remedy used in the British
Isles around the ninth Century involved drinking "the juice of elderseed, cow's
brain, and goat's dung dissolved in vinegar." Fortunately, today's headache
patients are spared such drastic measures.

Drug therapy, biofeedback training, stress reduction, and elimination of certain

foods from the diet are the most common methods of preventing and controlling
migraine and other vascular headaches. Regular exercise, such as swimming or
vigorous walking, can also reduce the frequency and severity of migraine
headaches. During a migraine headache, temporary relief can sometimes be
obtained by using cold packs or by pressing on the bulging artery found in front
of the ear on the painful side of the head.

There are two ways to approach the treatment of migraine headache with drugs:
prevent the attacks, or relieve symptoms after the headache occurs.

For infrequent migraine, drugs can be taken at the first sign of a headache in
order to stop it or to at least ease the pain. People who get occasional mild
migraine may benefit by taking aspirin or acetaminophen at the start of an attack.
Aspirin raises a person's tolerance to pain and also discourages clumping of
blood platelets. Small amounts of caffeine may be useful if taken in the early
stages of migraine. But for most migraine sufferers who get moderate to severe
headaches, and for all cluster patients, stronger drugs may be necessary to
control the pain.

One of the most commonly used drugs for the relief of classic and common
migraine symptoms is ergotamine tartrate, a vasoconstrictor which helps
counteract the painful dilation stage of the headache. For optimal benefit, the
drug is taken during the early stages of an attack. If a migraine has been in
progress for about an hour and has passed into the final throbbing stage,
ergotamine tartrate will probably not help.

For headaches that occur three or more times a month, preventive treatment is
usually recommended. Drugs used to prevent classic and common migraine
include methysergide maleate, which counteracts blood vessel constriction,
propranolol, which stops blood vessel dilation, and amitriptyline, an
antidepressant.

Antidepressants called MAO inhibitors also prevent migraine. These drugs block
an enzyme called monoamine oxidase which normally helps nerve cells absorb
the artery-constricting chemical, serotonin.

MAO inhibitors can have potentially serious side effects - particularly if taken
while ingesting foods or beverages that contain tyramine, a substance that closes
down arteries.

Drug therapy for migraine is often combined with biofeedback and relaxation
training. Biofeedback is a space-age word for a technique that can give people
better control over such body function indicators as blood pressure, heart rate,
temperature, muscle tension, and brain waves. Thermal biofeedback allows a
patient to consciously raise hand temperature. Some patients who are able to
increase hand temperature can reduce the number and intensity of migraines.
The mechanism of this hand-warming effect is being studied by research
scientists.

Scientists estimate that a small percentage of migraine sufferers will benefit from
a treatment program focused solely on eliminating headache-provoking foods
and beverages.

Other migraine patients may be helped by a diet to prevent low blood sugar. Low
blood sugar, or hypoglycemia, can cause dilation of the blood vessels in the
head. This condition can occur after a period without food: overnight, for
example, or when a meal is skipped. People who wake up in the morning with a
headache may be reacting to the low blood sugar caused by the lack of food
overnight.
Treatment for headaches caused by low blood sugar consists of scheduling
smaller, more frequent meals for the patient. A special diet designed to stabilize
the body's sugar-regulating system is sometimes recommended.

For the same reason, many specialists also recommend that migraine patients
avoid oversleeping on weekends. Sleeping late can change the body's normal
blood sugar level and lead to a headache.
After migraine, the most common type of vascular headache is the toxic
headache produced by fever. Pneumonia, measles, mumps, and tonsillitis are
among the diseases that can cause severe toxic vascular headaches. Toxic
headaches can also result from the presence of foreign chemicals in the body.
Other kinds of vascular headaches include "clusters," which cause repeated
episodes of intense pain, and headaches resulting from a rise in blood pressure.

Repeated exposure to nitrite compounds can result in a dull, pounding headache

that may be accompanied by a flushed face. Nitrite, which dilates blood vessels,
is found in such products as heart medicine and dynamite. Hot dogs and other
meats containing sodium nitrite can also cause headaches.

"Chinese restaurant headache" can occur when a susceptible individual eats

foods prepared withmonosodium glutamate (MSG)--a staple in many Oriental
kitchens. Soy sauce, meat tenderizer, and a variety of packaged foods contain
this chemical which is touted as a flavor enhancer.
Jokes are often made about alcohol hangovers but the headache associated
with "the morning after" is no laughing matter. Fortunately, there are several
suggested remedies for the pain, including ergotamine tartrate. The hangover
headache may also be reduced by taking honey, which speeds alcohol
metabolism, or caffeine, a constrictor of dilated arteries. Caffeine, however, can
cause headaches as well as cure them. Heavy coffee drinkers often get
headaches when they try to break the caffeine habit.
Cluster headaches, named for their repeated occurrence in groups or clusters,
begin as a minor pain around one eye, eventually spreading to that side of the
face. The pain quickly intensifies, compelling the victim to pace the floor or rock
in a chair. "You can't lie down, you're fidgety," explains a cluster patient. "The
pain is unbearable." Other symptoms include a stuffed and runny nose and a
droopy eyelid over a red and tearing eye.

Cluster attacks can strike at any age but usually start between the ages of 20
and 40. Unlike migraine, cluster headaches are more common in men and do not
run in families. Research scientists have observed certain physical similarities
among people who experience cluster headache. The typical cluster patient is a
tall, muscular man with a ragged facial appearance and a square, jutting or
dimpled chin. The texture of his coarse skin resembles an orange peel. Women
who get clusters may also have this type of skin.

Studies of cluster patients show that they are likely to have hazel eyes and that
they tend to be heavy smokers and drinkers. Paradoxically, both nicotine, which
constricts arteries, and alcohol, which dilates them, trigger duster headaches.
The exact connection between these substances and cluster attacks is not
known.

The sudden start and brief duration of cluster headaches can make them difficult
to treat. By the time medicine is absorbed into the body, the attack is often over.
However, research scientists have identified several effective drugs for these
headaches. The antimigraine drug ergotamine tartrate can subdue a cluster, if
taken at the first sign of an attack. Injections of dihydroergotamine, a form of
ergotamine tartrate, are sometimes used to treat clusters.

Chronic high blood pressure can cause headache, as can rapid rises in blood
pressure like those experienced during anger, vigorous exercise, or sexual
excitement.
The severe "orgasmic headache" occurs right before orgasm and is believed to
be a vascular type. Since sudden rapture of a cerebral blood vessel can also
occur during orgasm, this type of headache should be promptly evaluated by a
doctor.

Tension headache is named not only for the role of stress in triggering the pain,
but also for the contraction of neck, face, and scalp muscles brought on by
stressful events. Tension headache is a severe but temporary form of muscle-
contraction headache. The pain is mild to moderate and feels like pressure is
being applied to the head or neck. The headache usually disappears after the
period of stress is over.

Acute tension headaches not associated with a disease are treated with muscle
relaxants and analgesics like aspirin and acetaminophen. Stronger analgesics,
such as propoxyphene and codeine, are sometimes prescribed. As prolonged
use of these drugs can lead to dependence, patients taking them should have
periodic medical checkups and follow their physicians' instructions carefully.

Nondrug therapy for chronic muscle-contraction headaches includes

biofeedback, relaxation training, and counseling. A technique called cognitive
restructuring teaches people to change their attitudes and responses to stress.
Patients might be encouraged, for example, to imagine that they are coping
successfully with a stressful situation. In progressive relaxation therapy, patients
are taught to first tense and then relax individual muscle groups. Finally, the
patient tries to relax his or her whole body. Many people imagine a peaceful
scene--such as lying on the beach or by a beautiful lake. Passive relaxation does
not involve tensing of muscles. Instead, patients are encouraged to focus on
different muscles,suggesting that they relax. Some people might think to
themselves, Relax or My muscles feel warm.

If you suffer from headaches and none of the standard treatments help, do not
despair. Some people find that their headaches disappear once they deal with a
troubled marriage, pass their law board exams, or resolve some other stressful
problem. Others find that if they control their psychological reaction to stress, the
headaches disappear.