Headache

Head ache is the Symptom of Pain in the Face , head or Neck . It can occur as a migrane ,tension type, or cluster headache. There is an increased risk of depression in those with severe headaches.

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Headache itself is a painful and disabling feature of a small number of primary headache disorders, namely migraine, tension-type headache, and cluster headache. Headache can also be caused by or occur secondarily to a long list of other conditions, the most common of which is medication-overuse headache.

Types of headache disorders

  • Migraine
  • Tension-type headache
  • Cluster headache
  • Sinus headaches
  • Medication-overuse headache

Migrane

  • Headache disorders are among the most common disorders of the nervous system.
  • It has been estimated that almost half of the adult population have had a headache at least once within the last year.
  • Headache disorders, which are characterized by recurrent headache, are associated with personal and societal burdens of pain, disability, damaged quality of life, and financial cost.
  • Worldwide, a minority of people with headache disorders are diagnosed appropriately by a health-care provider.
  • Headache has been underestimated, under-recognized and under-treated throughout the world.

How common are headache disorders?

Globally, it has been estimated that prevalence among adults of current headache disorder (symptomatic at least once within the last year) is about 50%. Half to three quarters of adults aged 18–65 years in the world have had headache in the last year and, among those individuals, 30% or more have reported migraine. Headache on 15 or more days every month affects 1.7–4% of the world’s adult population. Despite regional variations, headache disorders are a worldwide problem, affecting people of all ages, races, income levels and geographical areas.

What is the burden due to headache disorders?

Not only is headache painful, but it is also disabling. In the Global Burden of Disease Study, updated in 2013, migraine on its own was found to be the sixth highest cause worldwide of years lost due to disability (YLD). Headache disorders collectively were third highest.

Headache disorders impose a recognizable burden on sufferers including sometimes substantial personal suffering, impaired quality of life and financial cost. Repeated headache attacks, and often the constant fear of the next one, damage family life, social life and employment. The long-term effort of coping with a chronic headache disorder may also predispose the individual to other illnesses. For example, anxiety and depression are significantly more common in people with migraine than in healthy individuals.

Types of headache disorders

Migraine, tension-type headache and medication-overuse headache are of public health importance since they are responsible for high population levels of disability and ill-health.

Migraine

  • A primary headache disorder.
  • Migraine most often begins at puberty and most affects those aged between 35 and 45 years.
  • It is more common in women, usually by a factor of about 2:1, because of hormonal influences.
  • It is caused by the activation of a mechanism deep in the brain that leads to release of pain-producing inflammatory substances around the nerves and blood vessels of the head.
  • Attacks typically include:
    • headache, which is:
      • of moderate or severe intensity
      • one-sided
      • pulsating in quality
      • aggravated by routine physical activity
      • with duration of hours to 2-3 days
    • nausea (the most characteristic associated feature);
    • attack frequency is anywhere between once a year and once a week; and
    • in children, attacks tend to be of shorter duration and abdominal symptoms more prominent.

Tension-type headache

  • TTH is the most common primary headache disorder.
  • Episodic TTH, occurring on fewer than 15 days per month, is reported by more than 70% of some populations.

Cluster Headache

  • CH is relatively uncommon affecting fewer than 1 in 1000 adults, affecting six men to each woman.
  • Most people developing CH are in their 20s or older.

It is characterized by frequently recurring (up to several times a day), brief but extremely severe headache, usually focused in or around one eye, with tearing and redness of the eye, the nose runs or is blocked on the affected side and the eyelid may droop.

Sinus Headaches

Sinus headaches are the result of a sinus infection, which causes congestion and inflammation in the sinuses (open passageways behind the cheeks and forehead). People, and even healthcare providers, often mistake migraines for sinus headaches. Symptoms of sinus headaches include:

Bad taste in mouth.
Deep, constant pain in your cheekbones and forehead.
Facial swelling.
Feeling of fullness in ears.
Fever.
Pain that gets worse with sudden head movement or straining.

Medication overuse headaches

Medication overuse headaches (MOH) or rebound headaches affect up to 5% of people. They happen when you frequently take pain relievers for headaches. Eventually, this practice can actually increase your number of headaches. Signs of MOH include:

  • Headaches becoming more frequent.
  • More days with headaches than without.
  • Pain that’s worse in the morning.

Treatment

The main classes of drugs to treat headache disorders include: analgesics, anti-emetics, specific anti-migraine medications, and prophylactic medications.

Acute medications

  • Pain relievers. Simple pain relievers available without a prescription are usually the first line of treatment for reducing headache pain. These include the drugs aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).
  • Combination medications. Aspirin or acetaminophen (Tylenol, others) or both are often combined with caffeine or a sedative drug in a single medication. Combination drugs may be more effective than single-ingredient pain relievers. Many combination drugs are available without a prescription.
  • Triptans and narcotics. For people who experience both migraines and episodic tension-type headaches, a triptan can effectively relieve the pain of both headaches. Opioids, or narcotics, are rarely used because of their side effects and potential for dependency.

Preventive medications

Tricyclic antidepressants. Tricyclic antidepressants, including amitriptyline and protriptyline, are the most commonly used medications to prevent tension-type headaches. Side effects of these medications may include constipation, drowsiness and dry mouth.

Other medications that may prevent tension-type headaches include anticonvulsants, such as gabapentin and topiramate (Topamax, Qsymia, others). More study is needed.

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