Types of Headache

TYPES OF HEADACHE – Chronic Tension Headache, Migraine Headache and Cluster Headache

Headache is pain in any region of the head. Headaches may occur on one or both sides of the head, isolated to a certain location, radiate across the head from one point, or have a vise-like quality. A headache is a sharp pain, throbbing sensation or dull ache. Headaches may appear gradually or suddenly, and they may last less than an hour or for several days.

TYPES OF HEADACHE

1. Chronic Tension Headache
2. Migraine Headache
3. Cluster Headache

CHRONIC TENSION HEADACHE

Chronic tension-type headaches maybe the result of stress or fatigue, but more than likely, they can be attributed to physical problems, psychological issues, or depression.  A pattern of chronic tension-type headaches generally begins between the ages of 20 and 40, and every personality type can experience them.

Symptoms

• The muscles between head and neck contract for hours and days
• A tightness around neck or even feel as if head and neck were in a cast and only certain positions seem to provide relief
• Feeling of soreness, a tightening band around head (a ‘vice-like’ ache), a pulling, or pressure sensations
• The pain is continuous, annoying, but not throbbing
• Headache primarily occurs in forehead, temples or the back of head and neck

• Changes in sleep patterns if headaches are related to anxiety, then you may have trouble falling asleep or may suffer from insomnia. If headaches are associated with depression, then you may awaken frequently during the night, awaken before you wanted to in the morning, or you may be sleeping excessively (hypersomnia).
• Shortness of breath
• Constipation
• Nausea
• Weight loss
• Ongoing fatigue
• Decreased sexual drive
• Palpitations
• Dizziness
• Unexpected crying
• Menstrual changes

Etiology and Risk Factors

• Poor posture, close work under poor lighting conditions, or cramps from assuming an unnatural head or neck position for long periods of time
• Arthritis, particularly cervical arthritis
• Abnormalities in neck muscles, bones or disks
• Eye strain caused when one eye is compensating for another eye’s weakness
• Misalignment of teeth or jaws
• Noise or lighting
• Job conflicts and family relationships
• Grief
• Depression

Management

• There are two goals when treating any type of headache: prevent future attacks, abort or relieve current plan
• Prevention includes taking prescribed medications, avoiding or minimizing the causes, and learning self-help measures, such as biofeedback or relaxation exercises
• NSAIDs (Nonsteroidal Anti-inflammatory Agents), fenoprofen, flurbiprofen, ketoprofen
• Antidepressants – Tricyclics (nonsedating), protriptyline, desipramine
• Antidepressants – tricylics (sedating), amitriptyline, doxepin

MIGRAINE HEADACHE

Migraines deserve the attention they receive, one headache can put the life ‘on hold’ for a few hours or several days. Migraine is responsible for more job absenteeism and disrupted family life than any other headache types.

Symptoms

Migraine often begins as a dull ache and then develops into a constant, throbbing and pulsating pain at the temples, as well as the front or back of one side of the head. The pain is usually accompanied by nausea and vomiting, and sensitivity to light and noise

The two most prevalent types of migraine are migraine with aura (formerly referred to as classic migraine) and migraine without aura (formerly referred to as common migraine).

Etiology

Physical and Environmental Causes

• Stress
• Fatigue
• Oversleeping or lack of sleep
• Fasting or missing a meal
• Food or medication that affects the diameter of blood vessels
• Caffeine
• Chocolate
• Alcohol
• Menses
• Hormonal changes
• Changes in barometric pressure
• Changes in altitude

Food and Diet

Specific foods are suspected of triggering at least 30 percent of the migraine headaches. Foods that contain: additives such as nitrates and nitrites (usually in processed meats), yellow (annatto) food coloring, and MSG (monosodium glutamate). Canned or processed foods, Chinese foods, tenderizer, and seasonings such as soy sauce may contain MSG.

Tyramine

Red wines and most alcoholic beverages, aged cheeses and processed meats (including pizza and hot dogs), peanuts, chicken livers, pickled foods, sourdough bread, bread and crackers containing cheese, broad beans, peas, lentils. Foods to eat in moderation include: avocados, bananas, citrus fruits, figs, raisins, red plums, raspberries, and chocolates

Management

• There are two goals when treating migraine, or any other headache: to relieve the pain and prevent future attacks
• Once migraine has been diagnosed, treatment will begin by identifying those circumstances or factors that trigger it
• Keep a daily calendar of activities, foods, beverages, prescription and over-the-counter medications, physical and environmental factors, stressful situations, sleep patterns, and characteristics of the headache itself.
• Beta-blockers, propranolol, timolol
• Calcium channel blockers, verapamil, diltiazem
• Antiepilepsy medication, divalproex sodium, neurontin
• NSAIDs, fenoprofen, flurbiprofen
• Antidepressants – tricyclics (nonsedating), protriptyline, desipramine

Self-Help Treatments for Migraine and Tension-Type Headaches

• Counseling and psychotherapy
• Relaxation training
• Progressive muscle relaxation
• Guided imagery
• Biofeedback
• Acupuncture
• Physical and massage therapy

CLUSTER HEADACHE

In this the attacks come in groups. The pain arrives with little, if any, warning, and it has been described as the most severe and intense of any headache type. It generally lasts from 30 to 45 minutes, although it might persist for several hours before it disappears.

Cluster headaches frequently surface during the morning or late at night, the cluster cycle can last weeks or months and then can disappear for months or years.

Symptoms

• The headache is usually unilateral and rarely switches sides from one attack to another
• One might feel the pain begin around one eye, ‘like a nail or knife stabbing or piercing’ the eye, or as if someone ‘were pulling out’ eye, it may be accompanied by a tearing or bloodshot eye and a runny nose on the side of the headache.
• It can radiate from the eye to the forehead, temple and cheek on the same side
• The pain of a cluster headache has been described as piercing, burning, throbbing, and pulsating

Etiology

Unlike migraine headaches, cluster headaches are not the result of heredity. Sufferers, however, usually do have a history of chronic smoking, and alcohol frequently triggers a cluster headache.

Because the level of histamine increases in a person’s blood and urine during a cluster headache, which dilate or expand blood vessels, influence a cluster headache.

Management

Verapamil, prednisone, ergotamine tartrate, lithium carbonate, divalproex sodium, histamine acid phosphate