Definition

A headache involves pain in the head which can arise from many disorders or may be a disorder in and of itself.

  Description

There are three types of primary headaches: tension-type (muscular contraction headache), migraine (vascular headaches), and cluster. Virtually everyone experiences a tension-type headache at some point. An estimated 18% of American women suffer migraines, compared to 6% of men. Cluster headaches affect fewer than 0.5% of the population, and men account for approximately 80% of all cases. Headaches caused by illness are secondary headaches and are not included in these numbers.

Approximately 40-45 million people in the United States suffer chronic headaches. Headaches have an enormous impact on society due to missed workdays and productivity losses.

  Causes and symptoms

Traditional theories about headaches link tension-type headaches to muscle contraction, and migraine and cluster headaches to blood vessel dilation (swelling). Pain-sensitive structures in the head include blood vessel walls, membranous coverings of the brain, and scalp and neck muscles. Brain tissue itself has no sensitivity to pain. Therefore, headaches may result from contraction of the muscles of the scalp, face or neck; dilation of the blood vessels in the head; or brain swelling that stretches the brain's coverings. Involvement of specific nerves of the face and head may also cause characteristic headaches. Sinus inflammation is a common cause of headache. Keeping a headache diary may help link headaches to stressful occurrences, menstrual phases, food triggers, or medication.

Tension-type headaches are often brought on by stress, overexertion, loud noise, and other external factors. The typical tension-type headache is described as a tightening around the head and neck, and an accompanying dull ache.

Migraines are intense throbbing headaches occurring on one or both sides of the head. The pain is accompanied by other symptoms such as nausea, vomiting, blurred vision, and aversion to light, sound, and movement. Migraines are often triggered by food items, such as red wine, chocolate, and aged cheeses. For women, a hormonal connection is likely, since headaches occur at specific points in the menstrual cycle, with use of oral contraceptives, or the use of hormone replacement therapy after menopause.

Cluster headaches cause excruciating pain. The severe, stabbing pain centers around one eye, and eye tearing and nasal congestion occur on the same side. The headache lasts from 15 minutes to four hours and may recur several times in a day. Heavy smokers are more likely to suffer cluster headaches, which are also associated with alcohol consumption.

  Diagnosis

Since headaches arise from many causes, a physical exam assesses general health and a neurologic exam evaluates the possibility of neurologic disease that is causing the headache. If the headache is the primary illness, a doctor elicits a thorough history of the headache. Questions revolve around its frequency and duration, when it occurs, pain intensity and location, possible triggers, and any prior symptoms. This information aids in classifying the headache.

Warning signs that should point out the need for prompt medical intervention include:

• "Worst headache of my life." This may indicate subarachnoid hemorrhage from a ruptured aneurysm (swollen blood vessel) in the head or other neurological emergency.
• Headache accompanied by one-sided weakness, numbness, visual loss, speech difficulty, or other signs. This may indicate a stroke. Migraines may include neurological symptoms.
• Headache that becomes worse over a period of 6 months, especially if most prominent in the morning or if accompanied by neurological symptoms. This may indicate a brain tumor.
• Sudden onset of headache. If accompanied by fever and stiff neck, this can indicate meningitis.

Headache diagnosis may include neurological imaging tests such as computed tomography scan (CT scan) or magnetic resonance imaging (MRI).

  Treatment

Headache treatment is divided into two forms: abortive and prophylactic. Abortive treatment addresses a headache in progress, and prophylactic treatment prevents headache occurrence.

Tension-type and migraine headaches can be treated with aspirin, acetaminophen, ibuprofen, or naproxen. In early 1998, the FDA approved extra-strength Excedrin, which includes caffeine, for mild to moderate migraines. Prescription medications such as antidepressants and muscle relaxants can address tension-type headaches, and ergotamine tartrate or sumatriptan can relieve or prevent migraines. Cluster headaches may also be treated with ergotamine and sumatriptan, as well as by inhaling pure oxygen. Prophylactic treatments include prednisone, calcium channel blockers, and methysergide.

  Alternative treatment

Alternative headache treatments include:

• acupuncture or acupressure
• biofeedback
• chiropractic
• herbal remedies using feverfew (Chrysanthemum parthenium), valerian (Valeriana officinalis), white willow (Salix alba), or skullcap (Scutellaria lateriflora), among others
• homeopathic remedies chosen specifically for the individual and his/her type of headache
• hydrotherapy
• massage
• magnesium supplements
• regular physical exercise
• relaxation techniques, such as meditation and yoga
• transcutaneous electrical nerve stimulation (TENS) (A test that electrically stimulates nerves and blocks the signals of pain transmission.)

  Prognosis

Headaches are typically resolved through the use of analgesics and other treatments.

  Prevention

Some headaches may be prevented by avoiding triggering substances and situations, or by employing alternative therapies, such as yoga and regular exercise. Since food allergies are often linked with headaches, especially cluster headaches and migraines, identification and elimination of the allergy-causing food(s) from the diet can be an important preventive measure.

   Key Terms:

Abortive Referring to treatment which relieves symptoms of a disorder. Analgesics A class of pain-relieving medicines, including aspirin and Tylenol. Biofeedback A technique in which a person is taught to consciously control the body's response to a stimulus. Chronic Referring to a condition that occurs frequently or continuously or on a regular basis. Prophylactic Referring to treatment which prevents symptoms of a disorder from appearing. Transcutaneous electrical nerve stimulation A method that electrically stimulates nerve and blocks the transmission of pain signals, called TENS.

   Resources:

Books

• Rapoport, Alan M., and Fred D. Sheftell. Headache Disorders: A Management Guide for Practitioners. Philadelphia: W. B. Saunders Co., 1996.

Periodicals

• Chaballa, Mark, and Karen J. Tietze. "Headache." American Druggist 213, no. 6 (1996): 42.

Organizations

• American Council for Headache Education (ACHE). 19 Mantua Road, Mt. Royal, NJ 08061. (800) 255-2243. http://www.achenet.org
• National Headache Foundation. 428 W. St. James Place, Chicago, IL 60614. (800) 843-2256. http://www.headaches.org