Headache

A headache or cephalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain. Several areas of the head and neck have these pain-sensitive structures, which are divided in two categories: within the cranium (blood vessels, meninges, and the cranial nerves) and outside the cranium (the periosteum of the skull, muscles, nerves, arteries and veins, subcutaneous tissues, eyes, ears, sinuses and mucous membranes).

Classification:

Headaches have numerous causes, and in 2007 the International Headache Society agreed upon an updated classification system for headache. Because so many people suffer from headaches and because treatment sometimes is difficult, it is hoped that the new classification system will allow health care practitioners come to a specific diagnosis as to the type of headache and to provide better and more effective treatment.

There are three major categories of headaches:

1. primary headaches,
2. secondary headaches, and
3. cranial neuralgias, facial pain, and other headaches.

Primary headaches

Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache.

* Tension headaches are the most common type of primary headache. Up to 90% of adults have had or will have tension headaches. Tension headaches occur more commonly among women than men.

* Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience a migraine headache. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. It is estimated that 6% of men and up to 18% of women will experience a migraine headache in their lifetime.

* Cluster headaches are a rare type of primary headache affecting 0.1% of the population (1 in a 1,000 people). It more commonly affects men in their late 20s though women and children can also suffer these types of headache.

Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly while others are debilitated. While these headaches are not life-threatening, they may be associated with symptoms that can mimic strokes or intracerebral bleeding.

Secondary headaches

Secondary headaches are those that are due to an underlying structural problem in the head or neck. There are numerous causes of this type of headache ranging from bleeding in the brain, tumor, or meningitis and encephalitis.

Cranial neuralgias, facial pain, and other headaches

Neuralgia means nerve pain (neur= nerve + algia=pain). Cranial neuralgia describes a group of headaches that occur because the nerves in the head and upper neck become inflamed and become the source of the pain in the head. Facial pain and a variety of other causes for headache are included in this category.

Tension headaches

While tension headaches are the most frequently occurring type of headache, their cause is not known. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may spasm and cause pain. Common sites include the base of the skull where the trapezius muscles of the neck inserts, the temple where muscles that move the jaw are located, and the forehead.

There is little research to confirm the exact cause of tension headaches. Tension headaches occur because of physical or emotional stress placed on the body. These stressors can cause the muscles surrounding the skull to clench the teeth and go into spasm. Physical stressors include difficult and prolonged manual labor, or sitting at a desk or computer for long periods of time concentrating. Emotional stress may also cause tension headaches by causing the muscles surrounding the skull to contract.

Symptoms of tension headaches

The pain symptoms of a tension headache are:

* The pain begins in the back of the head and upper neck and is described as a band-like tightness or pressure.

* Often is described as pressure encircling the head with the most intense pressure over the eyebrows.

* The pain usually is mild (not disabling) and bilateral (affecting both sides of the head).

* The pain is not associated with an aura (see below), nausea, vomiting, or sensitivity to light and sound.

* The pain occurs sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people.

* The pain allows most people to function normally, despite the headache.

Treatment of Headache

Most headaches are tension headaches, caused by a muscle spasm in the back of the head and neck. The spasm can be sparked by emotional stress or by holding the head in a fixed position (for example, while facing a computer screen or driving for hours). Sometimes the pain can be very severe and felt in the back of the head and encircling the head in a vise-like band.

Tension headaches are sometimes helped by measures to relax the tight muscles. These include massage, hot showers and heating pads on the back of the neck or cold packs. Biofeedback and muscle-relaxation training may be helpful.

Some people find relief with other non-traditional techniques, such as acupuncture, hypnosis or meditation. Non-prescription pain relievers often help occasional tension headaches. If not, prescription analgesics may do the trick. These include Aspirin with Codeine (Empirin with Codeine); Acetaminophen with Codeine (Tylenol with Codeine); Aspirin, caffeine, and Butalbital (Fiorinal); or Aspirin and Oxycodone (Percodan).

For chronic tension headaches, prescription analgesics aren't always useful. They tend to lose their effectiveness, encourage dependency, and cause "rebound" headaches when they wear off. A less addictive and often more effective alternative is a tricyclic antideressant, such as Amitriptyline (Elavil) or Imipramine (Tofranil), which can affect the pain pathways in the brain. Tricylics must be used for several weeks before they take effect. Since much lower doses of the antidepressant are needed for pain than for depression, there are generally few or no side effects.

Drugs that constrict blood vessels, notably ergotamine (Ergostat), may relieve migraines if taken at the first sign of the headache. Once a migraine is established, the only recourse is to take a narcotic, such as Meperedine (Demoral) or Codeine, head for a darkened room and try to sleep it off. Recent studies show that nonsteroidal anti-inflammatory agents, such as Ibuprofen (Motrin), Indomethacin (Indameth), and others can alleviate migraines, sometimes as effectively as Ergotamine. A new drug, Sumatriptan (Imitrex), appears to ease migraines about as well as Ergotamine, with much milder side effects.

Preventing migraines requires different drugs than those used for relieving them. While neither Aspirin nor Acetaminophen will relieve migraines, recent research suggests that a regular aspirin regimen may help prevent them. Beta blockers taken daily are often effective, provided side effects (such as lowered pulse or blood pressure) do not develop. If you have asthma, don't take beta blockers. Propranolol (Inderal) is the only beta blocker approved for migraines, but others may also help forestall attacks.

Cluster headaches seldom last more than an hour or two, but those hours - usually in the middle of the night - can be miserable. The attacks can occur daily, for weeks at a time, and then disappear for long stretches. These headaches don't usually last long enough to be treated effectively. Some sufferers need prescription narcotics.