Headache is a nearly universal complaint. Majority of the people would suffer from headaches at least once in lifetime. Some causes are benign and some causes are dangerous. Headache is broadly classified as primary headache in which there is no specific cause found after evaluation and secondary headache in which causes are- high BP, sinusitis, infection, blood clot in brain, traumatic headache, tumours etc. Recognition, evaluation and appropriate management of headaches in necessary to improve quality of life in patients.
Dr Soniya Tambe, MD, DM(Neurology), Migraine Certification (Mayo clinic), Neurologist and Epileptologist, Kauvery Hospital, Electronic City, Bangalore explains the different types of headaches.
Tension type headache: It is mild to moderate severity headache, often described as feeling like a tight band around the head. It is most common type headache.
Migraine: Migraine headache is very disabling headache. It occurs on one side of head and lasts from 4-72hrs unless treated by medicines. There is associated nausea/ vomiting and light and sound sensitivity. Patients typically have triggers like missed meal, less sleep, alcohol intake, smell, sunlight.
Cluster headache: It is also known as suicidal headache because of severity of pain. It occurs behind eyes and described as being stabbed in eye. There is associated redness of eye and watering of eye and nose.
Post traumatic headache: It occurs after any head/ neck injury. Starts 7 days after injury and may last up to months. Location is front of the head, side of the head or neck.
Medication over use headache: Patients suffering from recurrent headache tend to use frequent painkillers which causes medication overuse headache.
Sinus headache: It occurs inside of cheeks, forehead. Almost continues pain and there may be associated fever, nose block, post nasal drip of mucosa.
Worrisome symptoms of headache: Some symptoms in headache are called red flags. If these symptoms are present patients need urgent attention and treatment. Recent onset of headache,presence of very high BP, Age more than 50 years, headache in pregnancy, headache that awakens from sleep, double vision, weakness in hands and legs, seizures.
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Treatment of Headache:
Treatment of headache is either abortive or preventive. In abortive therapy patient takes medicine once symptoms occur. In preventive therapy patient takes course of medicine to prevent occurrence of headache. These medicines are to be tailormade for each patient depending their age, gender, associated symptoms, co-morbidities etc.
What to do when headache occurs: Find a dark quiet place, drink tall glass of water, lie down, put cold cloth over forehead, take over the counter/ prescription medicine for headache as advised by doctor and try to take a nap.
When to rush to hospital: Sudden onset of worst severe headache you have ever had, headache with exercise, headache that has lasted more than 3 days, presence of fever, stiff neck, seizures, any neurological deficits, headache following trauma, pregnancy. These patients may need investigations like neuroimaging to rule out serious causes.
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