Headache & Migraine
Causes: Inflammation/Irritation/Compression of one of many structures in the head i.e. nerves, blood vessels, muscles of the face, neck, scalp, teeth, sinuses, joints, soft tissue and lining of the brain.
Investigations: Detailed clinical history – recognizable pattern. Occasionally – blood test, X-rays, CT-scan, MRI-scan, eye examination, Lumbar Puncture.
TYPES OF HEADACHE:
- Tension Headache: accounts for 90% of headaches, affecting both men and women equally. Usually diffuse with pain over top of head or back of neck, pressure like, as if a constricting band surrounding your head. Neck and shoulder muscles might be tense. Pain may go away after an hour, may last several days or may become chronic. Causes: Anxiety/stress, poor posture, strain of neck and shoulders or stationary repetitive types of work.
- Cluster Headache: relatively uncommon but very severe, affecting more men than women. Typically affect heavy smokers. Abrupt onset of pain, can occur at any time, but typically 2-3 hours after falling asleep. Characterized by intense burning, boring pain typically located in or around one eye and temple or in the cheek/jaw. The affected eye may be bloodshot and teary. The nostril on that side may be blocked/run profusely. May have: reduced pupil size on the painful side, drooping eyelid, flushed face and sweaty brow. The pain intensifies in 5-10 minutes to a peak that persists for up to 2 hours. They can occur daily for days, weeks or months before a remission period.
- Migraine : has a strong genetic component, affecting three times as many woman as men. It mostly begins between ages of 5-35 years. Characterised by intense, throbbing headache, it is worsened by physical activity. The migraine is located in the forehead, temple, jaw, ear or around the eye – mostly one sided. It’s long lasting (4-72 hours) and often associated with nausea, vomiting, sensitivity to light and/or sound. Around 10% of migraine sufferers have an aura – neurological symptoms preceding the headache that include visual disturbances, tingling, numbness or weakness on one side of the face or body, speech problems or confusion. Causes : blood vessels overreacting (spasm/constriction and dilating of certain arteries in the brain/scalp/neck) to various triggers. Triggers : hormonal changes, stress, weather changes, season, altitude, time zone, sleep patterns, meal times or diet (alcohol, especially red wine/beer, aged cheeses, chocolate, pickled foods, MSG, aspartame and coffee). Bright lights, unusual odors, medications or polluted air may also play a role.
- Other Causes : Medical conditions such as sinusitis, abnormalities of the TM joint connecting the jaw to the skull, brain tumors, middle ear infection, head trauma, eye strain, infections, meningitis and head/neck neuralgia (inflammation of nerves).
1. Rest, heat or ice packs alone may give relieve occasionally. Over-the-counter pain medicine may help; over usage might cause the so-called “rebound” headaches!
2. Specific migraine medications/ prophylactic medications – on prescription.
3. Control triggers, stop smoking and avoid alcohol during a headache.
4. Manage stress and exercise regularly.
5. Acupuncture, physiotherapy or biofeedback may be effective.
Contact your doctor if your headache:
- Is accompanied by confusion, unconsciousness or convulsions.
- Involves pain in the eye or ear.
- Is accompanied by fever and nausea.
- Occurs after a blow to the head.
- Is persistent in someone previously free of headaches.
- Is recurrent, especially in children.
- Interferes with normal life.
This article is by: Dr Riaan Hanekom. He has worked for International SOS, Tianjin Clinic for over 2 years.