What is Headache ?
Headache is a term used to describe aching or pain that occurs in one or more areas of the head, face, mouth, or neck. Headache can be chronic, recurrent, or occasional. The pain can be mild or severe enough to disrupt daily activities.
Headache is the most common patient complaint. It usually occurs as a symptom of an underlying disorder. Unless the underlying disorder is serious, headache rarely necessitates hospitalization.
About 90% of all headaches are classified as vascular, muscle contraction, or a combination of the two; 10% are caused by underlying intracranial, systemic, or psychological disorders. Migraine headaches, probably the most intensively studied, are throbbing vascular headaches that usually begin to appear in childhood or adolescence and recur throughout adulthood. Migraine headaches affect up to 10% of Americans, are more common in females than in males, and have a strong familial incidence. The patient with a migraine headache usually needs to be hospitalized only if nausea and vomiting are severe enough to lead to dehydration and possible shock.
Types of Headache
Primary headache accounts for about 90% of all headaches. There are three types of primary headache:
Causes of Headache
Most chronic headaches result from tension-muscle contraction-which may be caused by emotional stress, fatigue, menstruation, or environmental stimuli (noise, crowds, bright lights). Other possible causes include glaucoma; inflammation of the eyes or mucosa of the nasal or paranasal sinuses; diseases of the scalp, teeth, extracranial arteries, or external or middle ear; and muscle spasms of the face, neck, or shoulders.
Headaches also may be caused by vasodilators (nitrates, alcohol, histamine), systemic disease, hypoxia, hypertension, head trauma and tumors, intracranial bleeding, abscess, or aneurysm.
Although the cause is unknown, migraine headaches are believed to be associated with constriction and dilation of intracranial and extracranial arteries. Certain biochemical abnormalities are thought to occur during a migraine attack. These include local leakage of a vasodilator polypeptide through the dilated arteries and a decrease in the plasma level of serotonin.Headache pain can emanate from the painsensitive structures of the skin, scalp, muscles, arteries, veins; cranial nerves V, VII, IX, and X; and cervical nerves 1, 2, and 3. Intracranial mechanisms of headache include traction or displacement of arteries, venous sinuses, or venous tributaries and inflammation or direct pressure on the cranial nerves with afferent pain fibers.
Signs & Symptoms of Headache
Pain in one area or multiple areas of the head sometimes is accompanied by other symptoms.
The doctor's initial impression of the patient's condition is used to determine which diagnostic tests to perform. Such tests may include skull X-rays (including cervical, spine, and sinus), EEG, computed tomography scan, and lumbar puncture.
Depending on the type of headache, analgesicsranging from aspirin to codeine or meperidine-may provide relief. A tranquilizer such as diazepam may help during acute attacks.
Other treatment measures include identification and elimination of causative factors and, possibly, psychotherapy for headaches caused by emotional stress. Chronic tension headaches may also require muscle relaxants.
For migraine headache, ergotamine preparations (taken alone or with caffeine) and other drugs, such as metoclopramide or naproxen, work best when taken early in the course of an attack. For acute migraine attacks or cluster headaches, 5HT1 receptor agonists such as sumatriptan or rizatriptan are most effective.
If nausea and vomiting make oral administratior impossible, many of these drugs may be given as rectal suppositories. If migraine headaches occur more than two or three times a month, the doctor may order preventive drugs, such as propranolol and cyproheptadine.
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