HEADACHE

 

DEFINITION

 

A Headache or cephalgia is pain anywhere in the region of the head and neck. It can be a symptom of the different conditions of head and neck.

 

PRIMARY HEADACHE DISORDERS

 

CHRONIC HEADACHE

 

(FREQUENCY MORE THAN 15 DAYS /MONTH)

 

 


EPISODIC HEADACHE

 

(FREQUENCY LESS THAN 15 DAYS /MONTH

 

1-SHORT DURATION CHRONIC                       2- CHRONIC DAILY HEADACHE

    DAILY HEADACHE                                              (daily or near daily headache lasting more

    (Duration less han 4 hrs or                                              than 4 hrs                                                          

      multiple Discrete episode)                                                                                          

  

 

 

 


CHRONIC            CHRONIC TENSION TYPE         NEW DAILY             HEMICRANIA

MIGRANE                   HEADACHE                         PERSISTENT             CONTINUA

                                                                       HEADACHE

 

 

 

 

Chronic tension headache and migraine are two commonest headache seen in clinical practice.

 

Migraine is a chronic disorder characterized by recurrent moderate to severe headaches often in association with a number of autonomic nervous system symptoms

 

PHASES

 

1-PRE MONITORY PHASE

 

-  Experienced by 50 percent of pts .

Causes irritability, depression, tiredness, food cravings, unusual bursts of energy.

 

2-AURA

–LAST 10-30 MTS

Can affect vision on 1 side; blank patches , bright or flushing lights or colored zigzag lines

-possibly sensory symptoms; pins and needles , numbness

-difficulty in speaking or finding right words.

 

 

 

 

3-PAIN

-can last from 4hrs to 2-3 days

-severe one sided headache, most commonly at the front or in the temple but can occur both

sides of head or anywhere.

-throbbing or bounding headache which is made worse by movement.

-often accompanied by nausea, vomiting may seem to relieve the headache.

-pt may want to avoid light and nosy situations, preferring to be alone in the dark.

 

4-RESOLUTION

-final stage

-headache fades but may leave the pt feeling tired, irritable, depressed with difficulty in

concentrating.

 

MIGRANE

Simplified diagnostic method for migraine

Symptoms associated with your headache

                                                                 Yes              no

          Usually one-sided

          Moderate or severe pain

          Throbbing pain

          Pain aggravated by routine activity

          Nausea or vomiting

Aversion to light or so Migraine peaks during the most productive

If you checked 3 or more of the YES boxes,  you have several of the diagnostic criteria for migraine.  You should talk to your doctor about diagnosing  and treating your headaches

 

COUNSELLING ON POTENTIAL TRIGGERS

 

1-DIET

-certain foods in some people and alcohol but more commonly

delayed, missed, or inadequqte meals, caffeine withdrawl, dehydration.

 

2-SLEEP

-lack of sleep or excessive sleep

 

 

3-OTHER LIFESTYLES

 

-intense exercise, long distance travel across time zones.

 

4-ENVIRONMENTAL

-bright or flickering lights, strong smells, and weather changes.

 

5-PSYCHOLOGICAL-

emotional distress or relaxation after a stress full period.

 

6-HORMONAL CHANGES

- changes in female hormones (in women)that cause

menstruation as well as breaks in hormonal contraception or hormone

replacement therapy.

 

HEADACHE

diary to be maintained.

 

CAUSES

 

1-Exact cause is unknown

2-A failure of normal sensory functioning or sterile neurogenic inflammation has been

suggested as a cause

          Neurons in the brain are activated by a mechanism
not well understood

          This, in turn, causes a cascade of secondary
events leading to:

        Release of inflammatory substances surrounding the blood vessels of the brain

        Inflammation of the blood vessels and the surrounding tissue on the outside of the brain

        Pain pathways are activated

 

MEDICATION OVERUSE HEADACHE

 

Most commonly associated with regular use of simple analgesics on more than 15 days a month

and or regular use of opoids ,ergots ,or triptans or any combination of these more than 10 days

a month.

 

 

 

 

WHAT SHOULD YOU TELL YOUR DOCTOR ABOUT MIGRANE ATTACKS?

 

          How long have you had headaches? How frequent? How disabling?

        When did they start?

          What happens when you have a headache?

        Describe the pain and other symptoms

          Who else in your immediate family gets headaches?

        Any type of headache (migraine, tension or sinus)

          What might cause you to get a headache

        Alcohol, too little sleep, stress, missed meals

 

What kinds of treatments will help?

Medications

          Acute

        Taken when a migraine is experienced like sumatriptan, rizatriptan, Zolitryptan in nasa spray form

        Treats pain and other symptoms after the attack has begun

          Preventive

        Certain preventive medications are effective and to be taken on a daily basis for few months

        Reduces the frequency and intensity of attacks.

        Inj BOTULINIUM TOXIN is beneficial when headache is  refractory to medications.

 

          Behavioral approaches

        Limit caffeine and other triggers

        Reduce stress

        Exercise

        Regular sleep

        Counseling or psychotherapy

        Biofeedback / relaxation

        Eat regularly / don’t skip meals

So which specific food triggers have been shown to be the culprits and therefore should be avoided:

·                     Tyramine containing foods found natu.rally in aged cheeses, and also found in red wine, alcoholic drinks, and some processed meats.

·                     Food additives/preservatives like nitrates and nitrites found in hot dogs, ham, sausage, and other processed or cured meats.

·                     Monosodium glutamate (MSG) in Chinese food.

·                     Alcohol — specifically the impurities in alcohol or by-products your body produces as it metabolizes alcohol.  Culprits include red wine, beer, whiskey and champagne

·                     Caffeine: coffee, chocolate, tea, colas, sodas

·                     Pepperoni, hot dogs, luncheon meats

·                     Bread and other baked goods and crackers

·                     Dried fruits

·                     Smoked or dried fish

·                     Potato chips

·                     Pizza, peanuts, peanut butter

·                     chicken livers, and other specific foods and

Likewise for my diabetics…artificial sweeteners like aspartamecan be bad triggers of headaches.  Also to be avoided are anyCOLD beverages especially after an exercise. Sensitivity to ice cream has been reported among migraine sufferers so avoid the temptation!

Trigger Free To Be Migraine Free!

 

HEADACHE DIARY

DATE

FREQUENCY

INTENSITY

SCORE (0-10)         0-2 mild                  3-6 moderate          7-10 severe pain

REMARKS

 

 

 

DR. PUNEET AGARWAL
M.D, D.M(Neurology), FCCN(UCLA,USA)
Ex Asst. Prof Neurology, AIIMS, N.Delhi
HEAD OF NEUROLOGY

Max Superspeciality Hospital
Saket, N.Delhi
Ph: 011-66116666(O), 9971545666(m),