HEADACHE

 Headache

By H/Dr. FNAwan 

INTRODUCTION

Headache is defined as a pain arising from the head or upper neck of the body. The pain originates from the tissues and structures that surround the skull or the brain because the brain itself has no nerves that give rise to the sensation of pain (pain fibers). The thin layer of tissue (periosteum) that surrounds bones, muscles that encase the skull, sinuses, eyes, and ears, as well as thin tissues that cover the surface of the brain and spinal cord,  meninges , arteries, veins, and nerves, all can become inflamed or irritated and cause headache.

 The pain may be a dull ache, sharp, throbbing, constant, intermittent, mild, or intense.

Categories of headache

There are three major categories of headache based upon the source of the pain.

1.Primary headaches

2.Secondary headaches

3.Cranial neuralgias, facial pain, and other headaches 

1.PRIMARY HEADACHES 

A primary headache is when the headache itself is the main problem. It is not a symptom of an underlying disease or condition. While the pain from primary headaches can be disabling, the headaches are not dangerous. The brain cannot feel pain, so the pain associated with primary headache comes from the inflammation of pain sensitive parts of the body in and around the neck and head, including:

Nerves

Blood vessels

Muscles

There are several categories of primary headaches. Some of the most common types of primary headaches include:

1.tension headaches 

2.migraine

3. cluster headaches

4.Hypnic headache

and a variety of other less common types of headaches.

1.Tension headaches

Tension headaches are the most common types of primary headaches .They are often referred to as "hatband" headaches because they are typically painful around the back of the head, the temples and forehead, as if a tight hat were in place. They tend to be pressure-like at onset and can last from hours to days. Tension headaches can co-exist with migraine, and one can transform or trigger the other. 

Tension headache is often responsive to physical therapy, relaxation therapy and anti-inflammatories or muscle relaxants.

Tension headaches occur more commonly among women than men. According to the World Health Organization, 1 in 20 people in the developed world suffer with a daily tension headache.

The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may become inflamed, go into spasm, and cause pain. Common sites include the base of the skull where the trapezius muscles of the neck insert, the temples where muscles that move the jaw are located, and the forehead.

There is little research to confirm the exact cause of tension headaches. It is believed that tension headaches occur because of physical stress on the muscles of the head. For example, 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 concentrating for long periods. Emotional stress also might cause tension headaches by causing the muscles surrounding the skull to contract.

2.Migraine headaches 

Migraine headaches are the second most common type of primary headache. The term "migraine" refers to a headache which is usually (but not always) on one side of the head. It is a headache that lasts from 2-72 hours  and it is often associated with nausea and/or vomiting, sensitivity to light and/or sound. The character of the pain is  throbbing pain. 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. 

Migraine headache is caused by inflammation or irritation of structures that surround the brain or affect its function. While the brain itself has no pain nerve fibers, everything else above the shoulders, from the neck, skull, and face, can cause a person to have head pain. Systemic illnesses, including infection or dehydration, can have associated headache. These are known as toxic headaches. Changes in circulation and blood flow or trauma can also cause headache.

Changes in brain chemistry may also be associated with headache. 

Medication reactions, drug abuse and drug withdrawal can all cause pain.

3.Cluster headaches 

Cluster headaches are a rare type of primary headaches .A cluster headache is a type of headache which is relatively short-lived (compared with migraine) lasting usually between 20 min- 2 hours. It is always one-sided and is associated with symptoms such as 

#a stuffy nose on one side, 

#tearing, 

#an enlarged pupil, 

#or a droopy lid. 

It more commonly affects men in their late 20s, though women and children can also suffer from this type of headache. 

The cause of cluster headaches is uncertain but may be due to a sudden release of the chemicals histamine and serotonin in the brain. The hypothalamus, an area located at the base of the brain, is responsible for the body's biological  clock and may be the source for this type of headache.

Cluster headaches also tend to run in families and this suggests that there may be a role for genetics. 

It may also be triggered by changes in sleep patterns,  medications (for example, nitroglycerin used for heart disease), cigarette smoking, alcohol, and some foods (for example, chocolate, and foods high in nitrites like smoked meats)  are also potential causes for headache.

4.Hypnic Headaches 

This is a rare headache form that occurs in people between the ages of 40 and 80. It is unique headache that occurs exclusively at night, typically lasting between 15 and 60 minutes. The headaches tend to occur at the same time each night and tend to be global (not just on one side) and are not associated with runny nose, tearing or other "cluster" features. 

2.SECONDARY HEADACHES 

Secondary headaches are those that are due to an underlying structural or infectious problem in the head or neck. This is a very broad group of medical conditions ranging from dental pain from infected teeth or pain from an infected sinus, to life-threatening conditions like bleeding in the brain or infections like encephalitis or meningitis.

Traumatic headaches  fall into this category including post-concussion headaches. 

Medication overuse headaches

This group of headaches also includes those headaches associated with substance abuse and excess use of medications used to treat headaches. 

"Hangover" headaches  fall into this category as well. People who drink too much alcohol may wake up with a well-established headache due to the effects of alcohol and dehydration.

3.Cranial neuralgias, facial pain, and other headaches

Neuralgia means nerve pain (neur=nerve + algia=pain). Cranial neuralgia describes inflammation of one of the 12 cranial nerves coming from the brain that control the muscles and carry sensory signals (such as pain) to and from the head and neck. Perhaps the most commonly recognized example is trigeminal neuralgia, which affects cranial nerve V (the trigeminal nerve), the sensory nerve that supplies the face and can cause intense facial pain when irritated or inflamed.

CAUSES OF HEADACHES 

1.Migraine headache is caused by inflammation or irritation of structures that surround the brain or affect its function. While the brain itself has no pain nerve fibers.

2.Everything else above the shoulders, from the neck, skull, and face, disorders of the Neck,Eyes, Brain, Jaw and Teeth can cause a person to have head pain. 

3.Systemic illnesses, including infection or dehydration, can have associated headache. These are known as toxic headaches. 

4.Changes in circulation 

5.blood flow 

6.trauma 

7.Changes in brain chemistry may also be associated with headache

8.Medication reactions

9 Drug abuse and 

10.Drug withdrawal can all cause pain.

11.Changing hormone levels 

Other factors, also known as triggers, tend to be environmental or linked to diet. 

12.Pulsating or bright light

13.Certain foods (caffeine, red wine, chocolate, aged cheeses)

14.Stress

15.Sleep (too much or too little). 

Every person is different so the history of the headache is important. Recognizing patterns or precipitating (foods eaten, stress, etc.) factors, in combination with the physical examination and associated symptoms, can help identify the cause for each individual's specific headache.

HOMEOPATHIC MEDICINES 

Some of the medicines used for migraine and tension headache are:

Belladonna, Bryonia, Gelsemium, Glonoinum, Ignatia, Iris versicolor, Natrum muriaticum, Sanguinaria, Sepia, Spigelia, Silicea (also called Silica). 

NUX.VOMICA   for Hangover Headaches. 

USNEA.BARBATA    for Cluster Headaches.