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Headache

A headache in many cases can be a symptom of other underlying issues. In most cases, a headache subsides with the intake of an OTC painkiller or given adequate rest. To pinpoint the exact cause for a recurring, persistent headache, it calls for a detailed history of the patient as a starting point.

A headache is often one of the common symptoms associated with a wide range of ailments, drug interaction or change in weather to hormonal variations. The following list is not exhaustive - but only to suggest as a sample of some possible causes.


Allergic rhinitis - can cause fatigue and headache. Some drugs like alpha blockers cause side effects like drowsiness, tiredness, headache, nervousness, irritability, stuffy or runny nose, nausea, pain in the extremities. Metronidazole drug can also result in headache, nausea and vomiting if taken with alcohol.

Premenstrual Dysphoric Disorder (PMDD) or Premenstrual syndrome (PMS) has symptoms which include abdominal pain, headache, nervousness and irritability along with breast tenderness before menstruation. Antihistamines cause drowsiness and headache as a side effect.
Heat stroke can cause severe head ache, high fever and dry skin.

A cancer in the adrenal medulla known as Pheochromocytoma can cause high blood pressure, headache, palpitations and excessive perspiration.
Cerebral Aneurysms may cause headaches lasting for days or weeks - called as Sentinel Headaches as they are a warning to an impending rupture or Spontaneous Subarachnoid Hemorrhage (SSH).


Migraine Headache refers to the recurrent headache on one side or both sides - often accompanied by nausea or vomiting with episodes of aversion to light.

Cluster Headache is the excruciating pain centered around one eye or temple.

Tension Headache - the common form of headache refers to the dull ache that may appear to exert pressure on the head.


Comparison of Tension Type Headache and Migraine Headache

  Tension Headache Migraine Headache
Interval Time for Onset to peak Hours to days Minutes to 1 hour
Frequency Often daily or continuous Rarely less than 1 per week
Location circumferential Temporal
Character Aching, pressure band like Pounding
Laterality Usually bilateral Always unilateral
Aura Never present May be present
Nausea and vomiting Rare Common
Duration Often days Usually less than 24 hr

Tension Headache

Do you feel a dull ache on both sides of the head? Do the muscles in the neck and head feel tight ? You are most likely suffering a tension headache or stress headache as it is otherwise referred. Such headaches are one of the most common forms of headache and can occur in adults and adolescents. The pain due to tension headache is vise-like and is generalized. Tension headaches may result from fluctuations in the levels of brain chemicals such as serotonin, endorphins and others. Tension headaches are noticed more often in women.


Tension headaches occur due to contraction of neck and scalp muscles. This contraction can be a reaction to stress, anxiety or posture. Excessive smoking, alcohol use, sinusitis, eye strain can also bring on tension headache. Unlike migraine, tension headaches do not cause nausea and vomiting or numbness. Episodic tension headaches come a couple of times a month and last a few hours. If there are frequent episodes of tension headache, the condition is chronic. Skipping meals, stress, hormonal changes and hypertension medication can trigger tension headaches. Such headaches often have a genetic predisposition.


Tension Headache and Treatment

Treatment:
There are many issues to consider before arriving at treating headaches - frequency, severity, the effect on lifestyle, the results of previous treatment and any history of drug abuse. Mild cases of tension headaches which occur occasionally can be managed with symptomatic treatment by using Analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs).

Tension headaches are treated with NSAIDs, aspirin or acetaminophen. A non sedating muscle relaxant such as Skelaxin provides relief to persons suffering from tension headaches. Those who suffer from frequent bouts of tension headaches may need medications to reduce anxiety such as amitriptyline, nortriptyline or desipramine. But overuse of these medicines can lead to rebound headaches. You can try some of the following measures to bring tension headaches under control:


  • Enough rest

  • Regular exercise regimen

  • Warm or cold compress on the head and neck

  • Relaxation exercises, yoga, deep breathing, acupuncture

  • Good posture while sleeping, reading, using the computer

  • Massage

  • Swimming


Prophylactic Therapy :
If the frequency of headaches is so regular or if the severity of the headache is so high that the patient can't normally cope, then prophylactic therapy might be indicated. Antidepressants are the drugs of choice for treating tension type headache. Relief of headache may take about 3 to 4 weeks and the patient may have the following side effects:


  • sedation
  • dry mouth
  • blurred vision
  • constipation
  • urinary retention

Amitriptyline - single dose of 25 mg at bed time may be a good option. Trazodone (75 to 300 mg at bedtime) or Fluoxetine (20 to 40 mg at lunchtime) are other options if the patient does not tolerate the sedative and anticholinergic effects of amitriptyline.

There are other alternate options like Cervical Epidural Nerve Block which can be performed on a regular basis depending on clinical symptoms.



Cluster Headache

Cluster headache or as it is variously known as Histamine Headache, Red Migraine or Horton's disease, is an intense, severe one sided pain centered around the eye or temple. Though the pain lasts for one to two hours on average, it may recur several times in a day. Usually it affects more men than women.


Causes of Cluster Headache Hormonal, Vascular or biochemical changes appear to induce these headaches. Other causes which can as a trigger include:


  • Tobacco
  • Alcohol
  • Allergens
  • Stress
  • Hypoxemia (A condition where there is decreased blood Oxygen levels in the arteries)

Secondary symptoms may include the following:

Flushing
Eye tearing
Nasal congestion
Pupil contraction
Facial drooping

A medical examination includes headache details like frequency, duration, time, severity of the pain, region where it occurs and potential triggers. Careful evaluation is done to exclude other potential causes.


Treatment: Cluster Headache treatment may begin with induction therapy to control the headache cycle and thence to maintenance therapy for the long term. Persons suffering cluster headaches are also likely to experience anxiety, agitation and suicidal feelings. This kind of headache is usually a result of a trigger to the trigeminal autonomic vascular system. Alcohol, stress, glare and specific foods are known to trigger cluster headaches. Sumatriptan, Zolmitriptan or Dihydroergotamine are often prescribed. Stimulating the occipital nerve might help. Corticosteroids or Dihydroergotamine may be used in the beginning. Verapamil, Lithium Carbonate, Ergotamine and Methysergide may be used for the long term treatment.


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Bibliography / Reference

Collection of Pages - Last revised Date: September 19, 2019