Questions

HEAD-ACHES

Headaches are a very common condition that most people will experience many times during their lives. The main symptom of a headache is a pain in your head or face. This can be throbbing, constant, sharp or dull. Headaches can be treated with medication, stress management and biofeedback. If your head is throbbing, you’re not alone. Headache is one of the most common pain conditions in the world. Up to 75% of adults worldwide have had a headache in the past year. Headaches are a major cause of absenteeism from work and school. They also take a toll on social and family life. For some people, continually battling headaches can lead to feeling anxious and depressed.

Causes of Headache include

Your headache symptoms can help your doctor determine its cause and the appropriate treatment. Most headaches aren't the result of a serious illness, but some may result from a life-threatening condition requiring emergency care. Headaches are generally classified by cause:

Primary headaches

A primary headache is caused by over activity of or problems with pain-sensitive structures in your head. A primary headache isn't a symptom of an underlying disease. Chemical activity in your brain, the nerves or blood vessels surrounding your skull, or the muscles of your head and neck (or some combination of these factors) can play a role in primary headaches. Some people may also carry genes that make them more likely to develop such headaches.

The most common primary headaches are:

·        Cluster headache

·        Migraine

·        Migraine with aura

·        Tension headache

·        Trigeminal autonomic cephalalgia (TAC), such as cluster headache and paroxysmal hemicrania

A few headache patterns also are generally considered types of primary headache, but are less common. These headaches have distinct features, such as an unusual duration or pain associated with a certain activity. Although generally considered primary, each could be a symptom of an underlying disease. They include chronic daily headaches (for example, chronic migraine, chronic tension-type headache, or hemicranias continua)

 

Secondary headaches

A secondary headache is a symptom of a disease that can activate the pain-sensitive nerves of the head. Any number of conditions — varying greatly in severity — may cause secondary headaches. Possible causes of secondary headaches include:

·        Acute sinusitis (sinus infection)

·        Arterial tears (carotid or vertebral dissections)

·        Blood clot (venous thrombosis) within the brain — separate from stroke

·        Brain aneurysm (a bulge in an artery in your brain)

·        Brain AVM (arteriovenous malformation) (arteriovenous malformation) — an abnormal formation of brain blood vessels

·        Brain tumor

·        Carbon monoxide poisoning

·        Chiari malformation (structural problem at the base of your skull)

·        Coronavirus disease 2019 (COVID-19)

·        Dehydration

·        Dental problems

·        Ear infection (middle ear)

·        Encephalitis (brain inflammation)

·        Giant cell arteritis (inflammation of the lining of the arteries)

·        Glaucoma (acute angle closure glaucoma)

·        Hangovers

·        High blood pressure (hypertension)

·        Influenza (flu) and other febrile (fever) illnesses

·        Intracranial hematoma

·        Medications to treat other disorders

·        Meningitis

·        Monosodium glutamate (MSG)

·        Overuse of pain medication

·        Panic attacks and panic disorder

·        Post-concussion syndrome

·        Pressure from tight headgear, such as a helmet or goggles

·        Pseudotumor cerebri

·        Stroke

·        Toxoplasmosis

·        Trigeminal neuralgia (as well as other neuralgias, all involving irritation of certain nerves connecting the face and brain)

Some types of secondary headaches include:

·        External compression headaches (a result of pressure-causing headgear)

·        Ice cream headaches (commonly called brain freeze)

·        Medication overuses headaches (caused by overuse of pain medication)

·        Sinus headaches (caused by inflammation and congestion in sinus cavities)

·        Spinal headaches (caused by low pressure or volume of cerebrospinal fluid, possibly the result of spontaneous cerebrospinal fluid leak, spinal tap or spinal anesthesia)

·        Thunderclap headaches (a group of disorders that involves sudden, severe headaches with multiple causes)

Risk factors

Headaches are relatively common, but some people are more prone to it than others. This problem can be found prevalent in any age group but is usually found in adults of 20-30 age group and older adults above the age of 65 years. The following factors can put anyone at an increased risk of headaches and its related symptoms

Age Headaches can affect all ages, from children to older people, but are most common from young adulthood through middle age. In men, the typical age of onset is in the 30s. In women, cluster headaches usually develop in the 60s.

Gender Men are 3 to 4 times more likely to have cluster headaches than women. Unlike with migraines, fluctuations in estrogen and other female hormones do not appear to play a role in cluster headaches.

Lifestyle Factors: Lifestyle factors play a role in cluster headaches. They include:

Alcohol consumption is a major risk factor. Alcohol, especially red wine and beer, is the most common attack trigger during active periods of headaches.

Cigarette smoking and tobacco products are risk factors for headaches. These headaches are more common in people who smoke. However, quitting smoking does not appear to stop attacks.

Emotional stress and physical exertion are risk factors for triggering headaches.

Seasonal Changes: Headache attacks often coincide with times of seasonal change, such as in spring or autumn. Changes associated with daylight savings during these times of year may alter the normal sleep-wake cycle and trigger attacks.

History of Migraine: About half of people with cluster headache have a personal or family history of migraine. It is possible for people to have both kinds of headache.

Head Injury: Head injury with brain concussion appears to increase the risk of c headaches, although a causal relationship has not been proven.

Sleep Disorders: Headaches tend to occur during specific sleep stages and are associated with several sleep disorders, including narcolepsy, insomnia, restless legs syndrome, and sleep apnea.

Preventive Measures

Certain care strategies can help prevent headaches or ease the pain. A person could:

  • Use a heat or ice pack against the head or neck, but avoid extreme temperatures, and never apply ice directly to the skin.
  • Avoid stressors whenever possible, and use healthful coping strategies for unavoidable stress.
  • Eat regular meals, taking care to maintain stable blood sugar levels.
  • Get enough sleep, by following a regular routine and keeping the bedroom cool, dark, and quiet.
  • Exercise regularly to boost overall health and lower stress.
  • Limit alcohol intake and drink plenty of water.
  • Take breaks when working to stretch and prevent eye strain.

When to seek medical help?

A headache can be a symptom of a serious condition, such as a stroke, meningitis or encephalitis. Go to a hospital emergency room or call your local emergency number if you're experiencing the worst headache of your life, a sudden, severe headache or a headache accompanied by:

·        Confusion or trouble understanding speech

·        Fainting

·        High fever, greater than 102 F to 104 F (39 C to 40 C)

·        Trouble seeing

·        Trouble speaking

·        Trouble walking

See a doctor if you experience headaches that:

·        Occur more often than usual

·        Are more severe than usual

·        Worsen or don't improve with appropriate use of over-the-counter drugs

·        Keep you from working, sleeping or participating in normal activities

Treatment overview

A doctor can usually diagnose a type of headache after asking the person about their symptoms, the type of pain and the timing and pattern of attacks. In some cases, the doctor may perform or request tests to rule out more serious causes of head pain. The tests may involve blood samples or imaging, such as a CT or MRI scan.

Rest and pain relief medication are the main treatments for headaches. Options include:

  • over-the-counter pain relief medications, such as no steroidal anti-inflammatory drugs
  • prescription pain relief medications
  • preventive medication for specific conditions, such as migraine
  • other treatments for underlying conditions

To prevent medication overuse headaches, it is crucial to follow a doctor’s guidance.

Alternative and integrative treatments. Several alternative — now known as integrative — forms of headache treatment are available, but it is important to consult a doctor before making any major changes or beginning any new treatments. Some of these approaches include:

  • Acupuncture
  • Cognitive behavioural therapy
  • Herbal and nutritional health products
  • Hypnosis
  • Meditation

Some evidence has suggested that migraine episodes may be more likely to occur when a person has low levels of magnesium and vitamin while the evidence is not conclusive; a person may find that taking 400–500 milligrams of magnesium oxide per day helps prevent episodes. Nutrient deficiencies may result from the quality of a person’s diet, malabsorption issues, or other medical conditions.

Physiotherapy treatment for Headaches

 Physical therapy is commonly prescribed for individuals who experience cervicogenic headaches. The physical therapist will complete a comprehensive musculoskeletal exam to determine which structures are contributing to the symptoms. The exam includes assessment of: range of motion of the head/neck; joint mobility; musculature tightness, tenderness, and trigger points; strength and endurance of the deep neck flexor muscles; strength and endurance of the axioscapular muscles; and posture. The physical therapist will also include other appropriate tests and measures. Based on the results of the examination, the physical therapist will then design a specific treatment plan. The physical therapist will likely perform manual therapy techniques in order to decrease pain and increase the movement of the head/neck.

 The role of the physical therapist is to identify a mechanical trigger of the headache symptoms, restore mobility to the joints, correct muscle imbalances and manage their symptoms. The challenge lies in determining the type of headache, determining the root cause and developing an appropriate treatment plan to empower headache sufferers to self-manage their symptoms. Treatment for headaches and migraines is focused on a variety of things including:

·        Specific postural, ADL and work modifications

·        Gentle joint mobilizations

·        Soft tissue mobilization/myofascial release

·        Light strengthening and conditioning to improve postural control

·        Acupuncture

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