Headache
From Wikipedia, the free encyclopedia
| ICD-10 | R51 |
|---|---|
| ICD-9 | 784.0 |
A headache (medically known as cephalalgia, sometimes spelled as cephalgia) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. It ranks amongst the most common local pain complaints.
Headaches have a wide variety of causes, ranging from eye strain, sinusitis and tension to life-threatening conditions such as encephalitis, meningitis, cerebral aneurysms and brain tumors (although up to 99% of headaches have a benign cause and do not warrant further treatment other than a painkiller). When the headache occurs in conjunction with a head injury the cause is usually quite evident; however, many causes are more unclear. The most common type of headache is a tension headache. Some experience headaches when dehydrated, or suffering from caffeine withdrawal symptoms.
Treatment of uncomplicated headache is usually symptomatic with over-the-counter painkillers such as aspirin, paracetamol (acetaminophen) or ibuprofen, although some specific forms of headaches (e.g. migraine) may demand other, more suitable treatment.
Contents |
[edit] Pathophysiology
The brain itself is not sensitive to pain, because it lacks pain-sensitive nerve fibers. Several areas of the head can hurt, including a network of nerves which extends over the scalp and certain nerves in the face, mouth, and throat. The meninges and the blood vessels do have pain perception. Headache often results from traction to or irritation of the meninges and blood vessels. The muscles of the head may similarly be sensitive to pain.
[edit] Types
There are five types of headache: vascular, myogenic (muscle tension), cervicogenic, traction, and inflammatory.
- Vascular
- The most common type of vascular headache is migraine. Migraine headaches are usually characterized by severe pain on one or both sides of the head, an upset stomach, and, at times, disturbed vision. It is more common in women. After migraine, the most common type of vascular headache is the "toxic" headache produced by fever.
- Other kinds of vascular headaches include cluster headaches, which cause repeated episodes of intense pain, and headaches resulting from high blood pressure (rare).
- Muscular/myogenic headaches appear to involve the tightening or tensing of facial and neck muscles; they may radiate to the forehead. Tension headache is the most common form of myogenic headache.
- Cervicogenic headaches originates from disorders of the neck, including the anatomical structures innervated by the cervical roots C1–C3. Cervical headache is often precipitated by neck movement and/or sustained awkward head positioning. It is often accompained by restricted cervical range of motion, ipsilateral neck, shoulder, or arm pain of a rather vague non-radicular nature or, occasionally, arm pain of a radicular nature.
- Traction and inflammatory headaches are symptoms of other disorders, ranging from stroke to sinus infection.
Specific types of headaches include:
- Ictal headache
- Ice cream headache
- Thunderclap headache
- Vascular headache
- Toxic headache
- Coital cephalalgia (also known as: sex headache)
- Sinus headache
- Hemicrania continua
- Rebound headache (also called medication overuse headache, abbreviated MOH)
- New daily persistent headache (NDPH)
Like other types of pain, headaches can serve as warning signals of more serious disorders. This is particularly true for headaches caused by inflammation, including those related to meningitis as well as those resulting from diseases of the sinuses, spine, neck, ears and teeth.
[edit] Diagnosis
While statistically headaches are most likely to be harmless and self-limiting, some specific headache syndromes may demand specific treatment or may be warning signals of more serious disorders. Some headache subtypes are characterized by a specific pattern of symptoms, and no further testing may be necessary, while others may prompt further diagnostic tests.
Headache associated with specific symptoms may warrant urgent medical attention, particularly sudden, severe headache or sudden headache associated with a stiff neck; headaches associated with fever, convulsions, or accompanied by confusion or loss of consciousness; headaches following a blow to the head, or associated with pain in the eye or ear; persistent headache in a person with no previous history of headaches; and recurring headache in children.
The most important step in diagnosing a headache is for the physician to take a careful history and to examine the patient. In the majority of cases the diagnosis will be tension headache or migraine, both of which can be managed on the basis of a clear-cut clinical picture. Where doubt remains, or if there are abnormalities detected on examination, further investigations are justified[1]. Computed tomography (CT/CAT) scans of the brain or sinuses are commonly performed, or magnetic resonance imaging (MRI) in specific settings. Blood tests may help narrow down the differential diagnosis, but are rarely confirmatory of specific headache forms.
[edit] Treatment
Not all headaches require medical attention, and respond with simple analgesia (painkillers) such as paracetamol/acetaminophen or members of the NSAID class (such as aspirin/acetylsalicylic acid or ibuprofen). By far the most effective and rapid treatment protocol for the common tension headache is to lower body temperature. This can most easily be achieved by taking a lukewarm or cool shower until the headache is relieved.[citation needed]
In recurrent unexplained headaches, healthcare professionals may recommend keeping a "headache diary" with entries on type of headache, associated symptoms, precipitating and aggravating factors. This may reveal specific patterns, such as an association with medication, menstruation or absenteeism.
[edit] Prevention
Some forms of headache may be amenable to preventative treatment, such as migraine. On the whole, long-term use of painkillers is discouraged as this may lead to "rebound headaches" on withdrawal. Caffeine, a vasoconstrictor, is sometimes prescribed or recommended, as a remedy or supplement to pain killers in the case of extreme migraine. This has led to the development of Tylenol Ultra, a paracetamol/caffeine analgesic. One popular herbal preventive treatment for migraines is Feverfew. Magnesium, Vitamin B2, and Coenzyme Q10 are "natural" supplements that have shown some efficacy for migraine prevention.[citation needed]
[edit] Manipulative therapy
A controversial approach to headache treatment is chiropractic care. Most research supporting the chiropractic adjustment (also known as spinal manipulation by the scientific community) has been self-funded by the chiropractic profession.[citation needed]
The most compelling study of chiropractic efficacy is Nelson's randomized trial, comparing chiropractic to medical care,[2] which included the drug amitriptyline, for the treatment of Migraine Headache. During the 4-week trial, both groups reduced in symptoms. After withdrawal of treatment, the medical group relapsed or got worse, wheras the group receiving chiropractic care maintained their improvements. The amitriptyline is more cost-effective as it is cheaper than the cost of visiting a doctor, but freedom from symptoms or a reduction in frequency only happened in the chiropractic group.
Independent (non-chiropractic) researchers reviewed research on many different types of behavioral and physical treatments for tension-type and cervicogenic headaches [3] and found that cervical spinal manipulation was associated with improvement in cervicogenic headache outcomes (but not for tension-type headache), and was superior to soft-tissue therapies like massage.
[edit] References
- ^ Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM. Does this patient with headache have a migraine or need neuroimaging? JAMA 2006;296:1274-83
- ^ "The Efficacy of Spinal Manipulation, Amitriptyline and the Combination of Both Therapies for the Prophylaxis of Migraine Headache." J Manipulative Physiol Ther 1998; 21 (8) Oct: 511–519.
- ^ "Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache." Duke University Evidence-based Practice Center, Center for Clinical Health Policy Research.
