Headache: Types, Causes, Symptoms and Treatment/Management.

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Headache: 
Headaches are the most common nervous system disorders around the world. It usually occurs
in adults >18 years old and commonly seen in females more than males. Among other causes of headaches, personal, social and physical/medical cause is significant. Based on symptoms, durations, and causes, headaches can be classified as primary and secondary. Migraine, tension, cluster, sinus and hormonal headaches are examples of primary headaches whereas the headache which arises from any medical condition such as trauma, tumor, or over use of drugs can be considered as secondary headaches. Headaches are not only a painful condition but it can also affect a person’s quality of life, hence treatment is necessary.

Risk factors:
1. Female sex
2. Anxiety
3. Depression
4. Sleeping disorder
5. Obesity
6. Overuse of caffeine
7. Overdose of drug
8. Chronic pain condition
Causes:
Primary headaches can be idiopathic but secondary headaches can have following causes-
1. Pain due to irritation of structures such as dura (covering of brain), cranial nerves or
extra cranial structures.
2. Trauma or tumor
3. Intra cranial hemorrhage (Bleeding inside the skull/brain) 
4. Meningitis (Infection of the brain and spinal cord coverings) 
5. Hydrocephalus (Buildup of fluid in the brain cavities) 
6. Infection such as temporal arteritis or sinusitis
Symptoms:
A) Primary headaches:
1. Migraine headaches: Location: unilateral. Characteristics: Recurrent attack and gradual increase of pain with moderate to severe intensity. Duration: 4 – 72 hours. Associated symptoms: nausea, vomiting, photophobia and phonophobia.
2. Tension headaches: Most common headache. Location: bilateral. Characteristics: band like constant pain. Duration: variable (>30mins). Associated symptoms: None.
3. Cluster headaches: Commonly seen in men. Location: unilateral around the eye. Characteristics: quick and sudden onset, deep continuous pain. Duration: 30min-3hours. Associated symptoms: pain, ptosis, miosis, lacrimation and nasal discharge.
4. Sinus headaches: Due to infection in the sinus. Pain around the sinus area.
5. Hormonal headaches: Due to hormonal imbalance specially occurs because of low level of estrogen during early menstruation in female or sudden withdrawal of estrogen therapy.
B) Secondary headaches: Systemic symptoms or illness. Neurologic symptoms. Sudden                                                                onset in age > 30 years old due to trauma.

Diagnosis:
1. Primary headaches: Based on symptoms.
2. Secondary headaches: Based on symptoms and incase of trauma or other medical event,                                                          head CT or MRI.

Complication:
Those who have serious chronic headaches are most likely to suffer from other medical
            conditions such as depression, anxiety and sleep disturbance. Constant pain can lead to social,
            financial, or even family issues.

Prevention: Self care is the best way to prevent headache.
1. Avoid excess caffeine intake.
2. Eat healthy balanced diet.
3. Exercise regularly.
4. Avoid too much light or too much sound.
5. Do not over dose with any drug.
6. Don’t skip meals.
7. Get enough sleep.
8. Reduce stress.
Treatment:
1. Migraine headaches: NSAID/ Aspirin + antiemetic and hydration. Beta blocker,
                                                  valproate, topiramate or amitriptyline can be prescribed.
2. Tension headaches: Acetaminophen, Amitriptyline for chronic pain.
3. Cluster headaches: Sumatriptan or O2. Don’t use triptan for patients with CAD or CVD.
4. Sinus headaches: Acetaminophen and antibiotic for acute infection.
            5. Secondary headaches: Treat the underlining medical condition. 

 By- 
Maruful Bhuiyan
MD Candidate, Chicago. IL, USA. 

 Editor-
Fariha Ahmed 
Student at City University OF New York (CUNY). 
New York, USA. 

 (Any suggestion, comment or correction will be highly appreciated)  

 Reference: 

WHO-Headache disorders

Ministry of Health- Headache

PubMed-Head pain or discomfort















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