It is a very common practice among many people to take analgesics or painkillers when they suffer from headache. But let me share a word of caution – painkillers should not to be taken for all types of headaches; certain types of headaches can worsen when analgesics are taken. Ignorance about the reasons and types of headache and negligence under the misplaced notion that it is a common ailment can cost you dearly.
So in this essay I will try to discuss about what the different types of headache are and how we can diagnose them. We shall also learn about effective management for the same.
DIFFERENT TYPES OF HEADACHES AND THEIR MANAGEMENT
1. Headache due to any brain disease - A very severe headache of very sudden onset suggest the existence or chance brain disease. I would like to emphasize on the word ‘severe’ because strokes due to hemorrhages (subarachnoid hemorrhage) are preceded by a very severe headache. Such a headache is so severe that it is also known as THUNDERCLAPPING headache. Along with this ‘severe’ headache vomiting and stiffness of neck is also felt. This is a medical emergency and the patient needs to be hospitalized immediately.
2. Headache due to infection of the covering of the brain or the meninges - This is known as meningitis. Headache due to meningitis does not have a sudden onset but comes over a period of hours. It is accompanied by neck stiffness and fever. The patient needs to be hospitalized and treated with appropriate antibiotics.
3. Migraines - This is the type of headache which I want to discuss in detail. There are two types of migraine - classical migraine and common migraine.
Classical Migraine - It is a type of headache, which does not come everyday, but comes as a paroxysm i.e., short frequent attack. It is preceded or accompanied by vomiting. Classical migraine is preceded by an ‘aura’. An aura is a feeling which a patient feels and by which he knows that he is going to have migraine attack. Aura can be visual or sensory. A sensory aura may be in the form of a tingling sensation moving from one part of body to another.
HOW DOES A PATIENT OF CLASSICAL MIGRAINE PRESENT?
First the patient has some feeling of uneasiness or discomfort, then she becomes little irritable, it is followed by an aura followed by severe throbbing hemi cranial headache and photophobia or fear of light. Patient prefers to sleep in a quiet and dark room.
Common Migraine - It is similar to classical migraine but it may or may not be accompanied by vomiting. Aura is not present.
90% migraine sufferers have there first attack by the age of 40 years. Migraine is more common in women than in men.
Causes of Migraine
i. Genetic preponderance
ii. Family history
iii. Female preponderance - Migraine headache increases before and during periods which suggest some hormonal influence.
iv. Dietary precipitance - Chocolate cheese and red wine can precipitate an attack in a susceptible individual.
v. Oral Contraceptive Pills - OCPs aggravate migraine and increases the risk of stroke in a patient suffering from migraine.
Management of Migraine
i. The most important thing for the patient is to identify the precipitating and aggravating factor and to avoid the same ,as for example avoidance of chocolate cheese and red wine.
ii. An acute attack can be treated with simple painkillers like aspirin or paracetamol. The painkiller has to be taken with an anti-emetic. Anti-emetic drugs used to prevent vomiting.
iii. A nap in a quiet and dark room will definitely help the patient.
iv. Painkillers containing codeine should not be used for a long time, it may harm the patient.
v. Drugs containing ergometrine like migranil, dihydergot, ergotamine,gynergen, ingagen etc should be avoided because it may cause dependence.
vi. Oral Contraceptive Pills should be discontinued because they increase the risk of stroke in a patient suffering from migraine.
3. Headache as a result of tension - It is the most common type of headache. It is a dull pain and feels like a tight sensation round the head. In contrast to migraine, pain can continue for weeks to months without interruption. It is not associated with vomiting or photophobia. It is characteristically less severe in the early part of the day and becomes more troublesome as the day proceeds. Some patients may experience pain on pressing the scalp.
i. It happens due to excessive contraction of the muscles of the head and neck.
ii. Emotional strain or anxiety.
iii. Anxiety about the headache itself leads to continuation of the symptoms.
Management - Tension headache does not respond to painkillers; on the contrary excessive use of analgesics worsens the headache. Physiotherapy with muscle relaxation and stress management is usually beneficial. Antidepressants may be used.
4. Headache due to problem in eyes - Sometimes headaches may be due to refractive errors of eyes, so eye checkup must be done from time to time.
Headaches have become a menace of modern life. These nuisances which can sometimes turn fatal can be managed if not avoided altogether. Certain small changes in our ways can go a long way in leading a healthy pain free life.
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