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Headache: cause, symptoms

 

Headache: Types, cause, symptoms,Medicine

Migraine ,Tension-type headache, Cluster headaches

Headache is one of the common medical conditions. It is may primary or secondary. Tension-type headache, Migraine is the most common type.

Headache cause

 Primary cause:

Migraine 

Tension-type headache
 
Cluster headache
 
Situation headache  (during the stabbing, coughing, sex-related headache) 
 
thunderclap headache 
 
New daily persistent  headache syndrome 
 
 Secondary causes:

Intracranial bleeding 
 
Raised intracranial pressure may be due to cancer or idiopathic
 
May be due to infection of the brain or its covering meninges.

 

Migraine

 Affects about 20% of females and 6% of males at some point in life.  Migraine usually 

appears before middle age, or occasionally in later life; Migraine is usually readily identifiable

 from history.

The cause of migraine is unknown. The female preponderance and the frequency of migraine 

attacks at certain points in the menstrual cycle also suggest hormonal influences. Oestrogen

-containing oral contraception sometimes exacerbates migraine and increases the very small 

risk of stroke in patients who suffer from migraine with aura.

 the role of dietary precipitants such as
 cheese
 chocolate or 
 red wine.
 after a period of stress


 Symptoms

 malaise, irritability, or behavioral change for some hours or days. Around 20% of patients experience an aura and are said to have migraines with aura (previously known as classical migraine). 


The aura may manifest as almost any neurological symptom but is most often visual such as shimmering, silvery zigzag lines marching across the visual fields for up to 40  minutes, sometimes leaving a trail of temporary visual field loss . 

Sensory symptoms characteristically spreading over 20–30  minutes, from one part of the body to another, are more common than motor ones, and language function can be affected, leading to similarities with TIA/stroke. The isolated aura may occur (i.e. the neurological symptoms are not followed by headache).

Migraine headache is usually severe and throbbing, with photophobia, phonophobia, and vomiting lasting from 4 to 72  hours. 

Movement makes the pain worse and patients prefer to lie in a quiet, dark room. In a small number of patients, the aura may persist, leaving more permanent neurological disturbance. 

Tension-type headache
 This is the most common type of headache and is experienced to some degree by the majority of the population. 

Clinical features The pain of tension headache is characterized as ‘dull’, ‘tight’ or like a ‘pressure’, and there may be a sensation of a band around the head or pressure at the vertex.

 It is of constant character and generalized but often radiates forwards from the occipital region. The pain often progresses throughout the day. Tenderness may be present over the skull vault or in the occiput.

Cluster headaches 

are much less common than migraine. Unusually for headache syndromes, there is a significant male predominance and onset is usually in the third decade. 

Patients are more often smokers with a higher than average alcohol consumption. 

Clinical features Cluster headache is strikingly periodic, featuring runs of identical headaches beginning at the same time for weeks at a stretch (the ‘cluster’).

 Patients may experience either one or several attacks within a 24-hour period and typically are awoken from sleep by symptoms (‘alarm clock headache’). 

Cluster headache causes severe, unilateral periorbital pain with autonomic features, such as ipsilateral tearing, nasal congestion, and conjunctival injection.
 The pain, though severe, is characteristically brief (30–90  minutes). 


Trigeminal neuralgia

 This is characterized by unilateral lancinating facial pain, most commonly involving the second and/or third divisions of the trigeminal nerve territory, usually in patients over the age of 50 years.

The severe condition may be a life-threatening disease express as a headache. So some important features must keep in mind. There  are 
Sudden onset 
Focal neurological symptoms 
Constitutional symptoms like  weight loss, general weakness,  fever, rash 
Headache worse in the morning, associated with vomiting.
New age-onset for more than 60 years.
 
The doctor may give some routine investigations. May be given some brain image Technics. Ct scan of brain / MRI of the brain may be given.
CT scan is primarily excluded hemorrhage (intracranial bleeding), skull bone fracture.
MRI of the brain mainly used to detect a tumor, strokes (infarct).
The doctor decides which test is suitable if necessary. 
Paracetamol, NSAIDs other drugs may be prescribed accordingly.

Headache treatment

At first exclude life threatening condition from history and radiological tests. Because there are different treatment protocol for different headache cause. Hemorrhage or blood collection  in Brain need separate treatment. May need emergency operation.

In treatment of simple headache,  Paracetamol is the first-line medicine. NSAIDs like ibuprofen,tolfenamic acid relief the pain. for prevention, beta-blockers like propranolol are used. amitriptyline, pizotifen, sodium valproate are also used.

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