What is a headache?
A Headache is defined as a pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes.
How are headaches classified?
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:
What are primary headaches?
- primary headaches,
- secondary headaches, and
- cranial neuralgias, facial pain, and other 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.
What are 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
What causes 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.
What are the symptoms of tension headaches?
The pain symptoms of a tension headache are:
How are tension headaches diagnosed?
- 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.
The key to making the diagnosis of any headache is the history given by the patient. The health care practitioner will ask questions to understand when the headache began, learn about the quality, quantity, and duration of the pain, and ask about any associated symptoms. The history of tension headache will include pain that is mild to moderate, located on both sides of the head, described as a tightness that is not throbbing, and not made worse with activity. There will be no associated symptoms like nausea, vomiting, or light sensitivity.
The physical examination, particularly the neurologic portion of the examination, is important in tension headaches because it should be normal to make the diagnosis. The only exception is that there may be some tenderness of the scalp or neck muscles. If the health care practitioner finds an abnormality, then the diagnosis of tension headache would not be considered until the potential for other types of headaches have been investigated.
How are tension headaches treated?
Tension headaches are painful, and patients may be upset that the diagnosis is "only" a tension headache. Even though it is not life-threatening, a tension headache can affect the activities of daily life.
Most people successfully treat themselves with over-the–counter (OTC) pain medications to control tension headaches. The following work well for most people:
If these fail, other supportive treatments are available. Recurrent headaches should be a signal to seek medical help. Massage, biofeedback, and stress management
can all be used as adjuncts to help with control of tension headaches.
It is important to remember that OTC medications, while safe, are medications and may have side effects and potential interactions with prescription medications. It always is wise to ask your health care practitioner or pharmacist if you have questions about OTC medications and their use. This is especially important with OTC pain medications, because patients use them so frequently.
It is important to read the listing of ingredients in OTC pain medications. Often an OTC medication is a combination of ingredients, and the second or third ingredient may have the potential for drug interaction or contraindication with medications a patient is currently taking. For example:
- Some OTC medications include caffeine, which may trigger rapid heartbeats in some patients.
- In night time preparations, diphenhydramine (Benadryl) may be added. This may cause drowsiness, and driving or using heavy machinery may not be appropriate when taking the medication.
Other examples where caution should be used include the following:
- Aspirin should not be used in children and teenagers because of the risk of Reye's Syndrome, a disease where coma, brain damage, and death can occur if there is a viral like illness when the and aspirin is used.
- Aspirin and ibuprofen are irritating to the stomach and may cause bleeding. They should be used with caution in patients who have peptic ulcer disease or who take blood thinners like warfarin (Coumadin) and clopidogrel bisulfate (Plavix).
- Acetaminophen, if used in large amounts, can cause liver damage or failure. It should be used with caution in patients who drink significant amounts of alcohol or who have liver disease.
- One cause of chronic tension headaches is overuse of medications for pain. When pain medications are used for a prolonged period of time, headaches can recur as the effects of the medication wear off. Thus, the headache becomes a symptom of the withdrawal of medication (rebound headache).