Headaches are believed to be the result of an electrical and chemical imbalance at centers in the brain that regulate pain perception and sensitivity, and flow in blood vessels around the head and neck. Headaches may be induced by a wide variety of factors including stress, reactions to certain foods, hormonal imbalances, genetic predisposition, fatigue, noise, and glare. Headaches can be either acute onset or chronic , being present for many years. The headches may be continuous or intermittent.
It is a myth that bilateral headaches are not migraines which leads to underutilization of treatment. The headache may be accompanied by giddiness and worsens with activity. It is associated with nausea /vomiting and an abnormal sensitivity to loud sound/light. In certain individuals it is preceded by scintillating lights/blurring of vision which represents migraine aura. However a diagnosis of migraine should not be considered unless there are many attacks over years and in recent onset migraine like episodes, investigations for other brain diseases in consultation with a neurologist are necessary. The other common headache is tension type or muscle-tension headache which is typically associated with muscle contraction in the head and neck. Lasting between five and six hours, a tension headache is characterized by dull, steady pain that feels like a band tightening around your head. The symptoms of migraine like nausea and photophobia are commonly absent. These headaches are either episodic or may have chronic daily continuous dull ache. Cluster headaches, which typically affect men, are accompanied by throbbing pain around one eye, redness, watering of eyes , and nasal congestion. A sinus headache is characterized by congestion and steady pain behind your face that worsens if you bend forward. Certain people with severe spondylitis leading to spasm of neck muscles and pain at the back of head called cervicogenic headache. Also in people taking too many analgesics the headache may become modified or persistent and is called analgesic abuse headache. Thus excessive use of over the counter pain killers should be avoided. Certain people have severe short lasting pain which occur in special situations like coughing, intercourse. The above mentioned headaches are usually long standing , cause significant discomfort but are not commonly associated with brain lesions. However , in certain cases a headache may be a symptom of a more serious condition and a neglect of symptoms and delay in diagnosis can result in serious consequences.
There are many ways available to prevent headaches by employing different simple remedies like regular exercise, reduced stress levels, identifying precipitating factors including foods, alcohol, and oversleeping. Trigger foods typically include hard cheeses, chocolate, dairy products, MSG, and caffeine. One should also try to avoid overuse of pain relievers to prevent analgesic abuse headache. In most cases, you will probably find some relief in OTC pain relievers (aspirin, acetaminophen, and ibuprofen) but for chronic headaches, you should consult your neurologist for systematic evaluation , diagnosis and proper evidence based treatment . Current research has brought out many new medicines that can bring meaningful relief from headache. At our headache clinic we were able to find several patients suffering from cluster headaches without relief for many years being treated as migraines, getting relieved with proper medication. Similarly we our able to find certain people with intracranial hypertension , hypnic headaches and indomethacin responsive headaches and were able to give them useful benefit.
Biofeedback and relaxation therapy have been shown to help relieve tension headaches. Biofeedback is a method of learning to regulate biological processes such as heartbeat, blood flow, and blood pressure. Relaxation therapy takes many forms, including meditation, visualization, and breathing exercises, which are most productive if practiced daily. Currently even botox is being used for treatment for chronic unremitting headaches.
Headache may be a common complaint but awareness of headache spectrum is lacking among public at large and many medical professionals. A systematic evaluation by a concerned neurologist specializing in headaches can open new vistas foe many patient troubled by chronic headache and you ma y suddenly start asking ‘where’s the party tonight.’
