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Understanding headaches with special emphasis on tension headaches

Post by on Sunday, June 19, 2022

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Headache is pain in any region of the head which may occur on one or both sides of the head, be isolated to a certain location, or radiate across the head from one point. It may appear as a sharp pain, a throbbing sensation or a dull ache, develop gradually or suddenly, and may last from less than an hour to several days. Headaches can be more complicated than most people realize. Different kinds can have their own set of symptoms, occur for unique reasons, and need different treatments.

CAUSES OF HEADACHES

The pain one feels during a headache comes from a mix of signals between one's brain, blood vessels, and nearby nerves. Specific nerves in one's blood vessels and head muscles switch on and send pain signals to brain. However, it isn’t clear how these signals get turned on in the first place. Common causes of headaches include:

ILLNESSES

This can include infections, colds, and fevers. Headaches are also common with conditions like sinusitis (inflammation of the sinuses), a throat infection, or an ear infection. In some cases, headaches can result from a blow to the head or, rarely, a sign of a more serious medical problem.

STRESS

Emotional stress and depression as well as alcohol use, skipping meals, changes in sleep patterns, and taking too much medication. Other causes include neck or back strain due to poor posture.

ENVIRONMENT

Second-hand tobacco smoke, strong smells from household chemicals or perfumes, allergens, and certain foods. Stress, pollution, noise, lighting, and weather changes are other possible triggers.

GENETICS

Headaches, especially migraine, tend to run in families. Most children and teens (90%) who have migraines have a strong positive family history. When both parents have a history of migraines, there is a 70% chance their child will also have them. If only one parent has a history of these headaches, the risk drops to 25%-50%.

TYPES OF HEADACHES

There are over 150 types of headaches, but the most common types include:

TENSION HEADACHES

Tension headaches are the most common type of headache among adults and teens. They cause mild to moderate pain and come and go over time. Special emphasis on tension headaches is given in the later part of this article.

MIGRAINE HEADACHES

Migraine headaches are often described as pounding and throbbing pain. They can last from 4 hours to 3 days and usually happen one to four times a month. Along with the pain, people have other symptoms such as sensitivity to light, noise, or smell; nausea or vomiting; loss of appetite; and upset stomach or belly pain. When a child has a migraine, they may look pale, feel dizzy, and have blurred vision, fever, including digestive symptoms like an upset stomach, or vomiting that occur about once a month.

CLUSTER HEADACHES

Cluster headaches are the most severe. One could have intense burning or piercing pain behind or around one eye. It can be throbbing or constant. The pain can be so bad that most people with cluster headaches can’t sit still and will often pace during an attack. On the side of the pain, the eyelid droops, the eye reddens, pupil gets smaller, or the eye makes tears. The nostril on that side runs or stuffs up.

They are called cluster headaches because they tend to occur in groups. One might get them one to three times per day during a cluster period, which may last 2 weeks to 3 months. Each headache attack lasts 15 minutes to 3 hours. They can wake a person up from sleep. The headaches may disappear completely for months or years, only to come back later. Men are three to four times more likely to get them than women.

SINUS HEADACHES

With sinus headaches, one may feel a deep and constant pain in cheekbones, forehead, or on the bridge of one's nose. They occur when cavities in one's head, called sinuses, get inflamed. The pain usually comes along with other sinus symptoms, like a runny nose, fullness in the ears, fever, and a swollen face. A true sinus headache results from a sinus infection so the discharge that comes out of nose will be yellow or green, unlike the clear discharge in cluster or migraine headaches.

The goal of managing sinus headaches is usually to relieve one's symptoms and treat an infection or any associated allergies. One may need to take antibiotics, as well as antihistamines or decongestants for a short time. One can also use inhaled nasal decongestants, but only for up to 3 days. Longer use can make one's symptoms worse. One may need to take pain relievers, or corticosteroids to ease the inflammation in sinuses. One can also feel better with simple at-home tricks, such as drinking more fluids, using a humidifier, or saltwater nasal spray. It is also possible to relieve sinus pain and pressure using a device that emits micro-current waveforms. In rare cases, one may be recommended for sinus surgery to remove polyps or open up small or constantly swollen sinuses.

CHRONIC DAILY HEADACHES

One can have this type of headache 15 days or more a month for longer than 3 months. Some are short. Others last more than 4 hours. It is usually one of the four types of primary headache.

POST-TRAUMATIC STRESS HEADACHES

Post-traumatic stress headaches usually start 2-3 days after a head injury. One may feel a dull ache that gets worse from time to time, vertigo, light-headedness, trouble concentrating, memory problems, tiring quickly and irritability. Such type of headaches may last for a few months. But if it doesn’t get better within a couple of weeks, it warrants medical attention.

EXERCISE HEADACHES

When a person is active, the muscles in head, neck, and scalp need more blood, for which the blood vessels swell to supply them. The result is a pulsating pain on both sides of one's head that can last anywhere from 5 minutes to 48 hours. It usually hits while one is active or just afterward, whether the activity is exercise or sex.

HEMICRANIA CONTINUA

Hemicrania continua is a chronic, ongoing headache almost always affects the same side of your face and head. The symptoms include : pain that varies in severity; red or teary eyes; runny or stuffy nose; droopy eyelid; contracted iris; worse pain with physical activity; worse pain with drinking alcohol. Some people also notice migraine symptoms like nausea and vomiting; sensitivity to light and sound.

HARMONE HEADACHES

Women can get headaches from shifting hormone levels during her periods, pregnancy, and menopause. The hormone changes from birth control pills and hormone replacement therapy can also trigger headaches.

REBOUND HEADACHES

One might also hear these called medication overuse headaches. If one use a prescription or over-the-counter pain reliever more than two or three times a week, or more than 10 days a month, one is setting himself up for more pain. When the medications wear off, the pain comes back and one have to take more to stop it. This can cause a dull, constant headache that is often worse in the morning.

ICE PICK HEADACHES

These short, stabbing, intense headaches usually only last a few seconds. They might occur a few times a day at most. Ice pick headaches can be a condition on their own, or they can be a symptom of something else.

SPINAL HEADACHES

One may get a headache after one have a spinal tap, a spinal block, or an epidural. It is called a puncture headache because above mentioned procedures involve piercing the membrane that surrounds one's spinal cord. If spinal fluid leaks through the puncture site, it can cause a headache.

THUNDERCLAP HEADACHES

It comes suddenly out of nowhere and peaks quickly. Causes of thunderclap headaches include: blood vessel tear, rupture, or blockage; head injury; hemorrhagic stroke from a ruptured blood vessel in one's brain; ischemic stroke from a blocked blood vessel in one's brain; narrowed blood vessels surrounding the brain; inflamed blood vessels; blood pressure changes in late pregnancy.

 

SPECIAL EMPHASIS ON TENSION HEADACHES

Tension headaches are dull pain, tightness, or pressure around one's forehead or the back of head and neck. Some people say it feels like a clamp squeezing their skull. They’re also called stress headaches, and they’re the most common type for adults. There are usually two types - episodic tension headaches occur fewer than 15 days per month; while as chronic tension headaches occur more than 15 days a month. These headaches can last 30 minutes to a few days. The episodic kind usually starts slowly, often in the middle of the day. Chronic ones come and go over a longer period of time. The pain may get stronger or ease up through the day, but it is almost always there. 

However, tension headaches don't affect one's vision, balance, or strength. These usually start at the back of one's head and spread forward, become a band of dull pressure or squeezing pain around one's entire head, affect both sides of head equally; or make the muscles in neck, shoulders, and jaw feel tight and sore. Tension headache symptoms include: mild to moderate pain or pressure in the front, top, or sides of one's head; a headache that starts later in the day; trouble sleeping; feeling very tired; irritability; trouble focusing; mild sensitivity to light or noise; muscle aches.

 

TENSION HEADACHE TRIGGERS:

??Not enough rest

??Poor posture

??Emotional or mental stress, including depression and anxiety.

??Fatigue

??Hunger

??Low iron levels

??Alcohol intake

??Caffeine

??Jaw or dental problems

??Straining eyes

??Dehydration

??Skipping meals

??Smoking

??A cold, flu, or a sinus infection

DIAGNOSING TENSION HEADACHES

Getting tension headaches diagnosed correctly is crucial to start the right treatment plan. It is based on a proper history, thorough physical exam, proper deliberation of signs and symptoms -- how often they occur, their onset, duration, progression, deliberation of associated risk/triggering factors etc. And it is important to be as complete as possible with these descriptions. In many cases, it is recommended to do few investigations like blood tests, imaging tests like CT scans, MRI ,EEG to rule out neural causes or other factors associated with the headaches.

TENSION HEADACHE TREATMENT

It is best to treat tension headaches soon after they begin, when the symptoms are still mild. The goal is to ease one's pain and prevent more of them from occurring. Over-the-counter (OTC) painkillers are often the first treatments for tension headaches. People with the chronic kind can use some of these drugs to prevent headaches. But if one takes them a lot, they can lead to what is called a medication overuse or rebound headache. Common OTC treatments include:

??Acetaminophen

??Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen and naproxen.

If OTC pain relievers don't help, a stronger medicine is prescribed such as:

??Indomethacin

??Ketoprofen

??Ketorolac

??Naproxen

Other medications:

??Cyclobenzaprine. 

??Methocarbamol.

??Tricyclic antidepressants like amitriptyline and protriptyline.

??Selective serotonin reuptake inhibitors (SSRIs) including fluoxetine, paroxetine, or venlafaxine.

??Anti-seizure drugs such as topiramate.

 

TENSION HEADACHE PREVENTION

??Biofeedback

??Cognitive behavioural therapy

??Acupuncture

??Massage therapy

??Physical therapy

??Deep breathing

??Meditation

??Hypnotherapy

??Building positive support network

??Exercising regularly

??Drinking plenty of fluids/water

??Eating regular, balanced and healthy meals without skipping

??Getting adequate sleep

??Avoiding alcohol/Smoking

??Limiting caffeine intake

??Limiting OTC pain killers

??Keeping a diary to spot on triggers

??Encouraging sense of humour without hurting others

??Supplements: Coenzymes, multivitamins, magnesium etc.   

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