Is Headache Ruining Your Life?

Dr. Daisy Noble,                                                                Dr. Noble Zachariah

German Medical Care,                                                       Specialist Physician

Jleeb Al Shyouk, Kuwait                                                      ACFMS, Jahra

About 90% of us have at least one headache per year. Severe, disabling headache occurs at least once a year in 40% of people worldwide. There are many causes of headache as shown below.

International Headache Society Classification of Headache

A sufferer of longstanding headache does not have to be scared from this long list of causes. Headache in most cases does not indicate  any serious disease, but occasionally it is the manifestation of a serious illness such as brain tumor, subarachnoid hemorrhage, or meningitis. In emergency settings, only about 5% of patients with headache are found to have a serious underlying disease.

Headaches can be divided into Primary where there is no obvious organic cause and Secondary where the headache results from an underlying cause. The vast majority of headache ( over 90%) is Primary.T

e majority of headaches seen in clinical practice is primary headache (approximately 90% or more).

The majority of headaches seen in clinical

The most common types of headaches are as follows.

Tension Headaches: Also called chronic daily headaches or chronic non-progressive headaches, tension headaches are the most common type of headaches among adults and adolescents. These muscle contraction headaches cause mild to moderate pain, which come and go over a prolonged period of time.

Migraines: The exact causes of migraines are unknown, although they are related to blood vessel contractions and other changes in the brain. There may also be inherited abnormalities in certain areas of the brain. Migraine pain is moderate to severe, often described as pounding, throbbing pain. They can last from 4 hours to 3 days and usually occur 1 to 4 times per month. Migraines are associated with symptoms such as light, noise or odours sensitivity; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain. When a child is having a migraine they often look pale, feel dizzy, have blurred vision, fever, stomach upset, in addition to having the above listed symptoms.

A small percentage of paediatric migraines include recurrent (cyclic) gastrointestinal symptoms, in which vomiting is most common. Cyclic vomiting means that the symptoms occur on a regular basis - about once a month. These types of migraines are sometimes called abdominal migraines.

Mixed Headaches: These are also called transformed migraines. These are a combination of migraine and tension headaches. Both adults and children experience this type of headache.

Cluster Headache:  This is the least common, although the most severe, type of primary headache. The pain of a cluster headache is intense and may be described as having a burning or piercing quality that is throbbing or constant. The pain is so severe that most cluster headache sufferers cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term "cluster headache" refers to headaches that have a characteristic grouping of attacks. Cluster headaches occur one to three times per day during a cluster period, which may last 2 weeks to 3 months. The headaches may disappear completely (go into "remission") for months or years, only to recur.

Sinus Headache: Many people who had an attack of sinusitis tend to blame all their further headaches on the sinus. Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead or bridge of the nose. The pain usually becomes worse with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.

Acute headaches: Seen in children, these are headaches that occur suddenly and for the first time and have symptoms that subside after a relatively short period of time. If there are no neurological signs or symptoms, the most common cause for acute headaches in children and adolescents is a lung or sinus infection.

Hormone headaches: Headaches in women are often associated with changing hormone levels that occur during menstruation, pregnancy, and menopause. Chemically induced hormone changes, such as with birth control pills, also trigger headaches in some women.

Rebound Headaches

When the occasional headache strikes, most people take an over-the-counter pain medication, such as Paracetamol, ibuprofen, aspirin, or pain-relieving medications containing caffeine.

While over-the-counter pain-relievers are helpful in improving headache, they must be taken with caution because they could actually make the headache worse if they aren't taken correctly. The overuse or misuse of pain relievers (such as taking the medications 3 or more days per week or not following your doctor's advice) can cause a "rebound" into another headache.

When the pain medication wears off, one may experience a withdrawal reaction and take more medication, which only leads to another headache and the desire to take more medication. And so the cycle continues and one starts to suffer from chronic daily headaches with more severe and more frequent headaches. Pain-reliever overuse appears to interfere with the brain centres that regulate the flow of pain messages to the nerves, worsening headache pain.

This rebound is worse if the medication contains caffeine, which is often included in many pain-relievers to speed up the action of the other ingredients. The caffeine in medications, combined with consuming caffeine from other sources (coffee, tea, soft drinks or chocolate), makes a person more vulnerable to a rebound headache.

In addition to the rebound headache, over-use of pain-relievers can lead to addiction and possible serious side effects. Any person with tension headache, migraine or transformed headache can be affected by rebound headaches if he or she overuses certain medications. Many commonly used immediate relief medications, when taken in large enough amounts, can cause rebound headaches. Medications once thought of as "safe" may be the culprits. These include:

• Aspirin

• Sinus relief medications

• Paracetamol

• Non-steroidal anti-inflammatory medications

• Sedatives for sleep

• Codeine and prescription narcotics

• Over-the-counter combination headache remedies containing caffeine

• Ergotamine preparations

• Butalbital combination pain-relievers

While small amounts of these medications per week may be safe (and effective) ,the continued medication use can lead to the development of low grade headaches that last long. Taking larger or more frequent doses of immediate relief medication is not recommended. This not only exposes the person to a higher level of the medication's harmful ingredients, but it can make the headache worse and continue indefinitely.

One can prevent rebound headaches by using pain-relieving medications on a limited basis, only when necessary. Do not use them more than once or twice a week, unless instructed otherwise by your doctor. Also, avoid caffeine-containing products while taking a pain-relieving medication, especially medication that already contains caffeine.

Chronic progressive headaches: Also called traction or inflammatory headaches, chronic progressive headaches get worse and happen more often over time. These are the least common type of headache, accounting for less than 5% of all headaches in adults and less than 2% of all headaches in kids. Chronic progressive headaches may be the result of an illness or disorder of the brain or skull.

In a population based study it was found that 78% of the people had at least one episode of Tension Headache which made it the most common. Many fear that headche is caused by serious diseases like the Brain Tumour. But, in reality, only a small percentage( 0.5%) have a serious illness in the Brain.

How Headache is caused:

Headache results from signals interacting between the brain, blood vessels, and surrounding nerves. During a headache, specific nerves of the blood vessels and head muscles are activated and send pain signals to the brain. It's not clear, however, why these signals are activated in the first place.

A migraine begins when hyperactive nerve cells of a  "pain centre” in the mid-brain area send out impulses to the blood vessels. These cause constriction first and then dilation of these vessels and also release certain substances that cause the pulsation to be painful.

Headaches that occur suddenly (acute-onset) are usually due to an illness, infection, cold or fever. Other conditions that can cause an acute headache include sinusitis (inflammation of the sinuses), pharyngitis (inflammation or infection of the throat) or otitis (ear infection or inflammation).

In some cases, the headaches may be the result of a blow to the head (trauma) or rarely a sign of a more serious medical condition.

Common causes of tension headaches or chronic non-progressive headaches include emotional stress related to family and friends, work or school; alcohol use; skipping meals; changes in sleep patterns; excessive medication use; tension and depression. Other causes of tension headaches include eyestrain and neck or back strain due to poor posture.

Headaches can also be triggered by specific environmental factors that are shared in a family's household, such as exposure to second-hand tobacco smoke strong odours from household chemicals or perfumes, exposure to certain allergens or eating certain foods. Stress, pollution, noise, lighting and weather changes are other environmental factors that can trigger headaches for some people. Too much physical activity can also trigger a migraine in both adults and children.

Headaches, especially migraines, have a tendency to run in families. Most children and adolescents (90%) who have migraines have other family members with migraines. When both parents have a history of migraines, there is a 70% chance that the child will also develop migraines. If only one parent has a history of migraines, the risk drops to 25%-50%.

More details on the different types of headache, prevention and treatment would appear in the next article. If you suffer from headache it is important that you consult your doctor, find out what type of headache it is and chart out a plan of management than just consume some OTC pain killer for temporary relief..