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Treating headaches and migraines

Posted Mar 27 2012 6:44am

This article discusses the common symptoms of headaches and migraines and provides advice for anyone with repeated or severe headaches who is unsure whether this may be due to a more serious condition.

Headaches occur frequently in people within the working population. Among young adults they affect approximately 5% of men and 20% of women. For some people headaches are just a minor inconvenience but for many they are a source of considerable distress and anxiety not least because they may herald serious illness.

It is important for anyone who does suffer from repeated headaches to receive an appropriate response from their doctor to include the following:

1. Rapid access to medical care when needed, to manage symptoms and reduce anxiety.
2. An accurate diagnosisThe process of determining which condition a patient may have.. This is the process of determining which condition a patient may have; it is important to exclude significant disease.
3. Assistance to identify and address headache triggers, including lifestyle and in the workplace.
4. A treatment programme to include effective means of stopping a headache once it has started.
5. The offer of regular preventative therapies to patients experiencing severe and disabling headaches.

It is always necessary to rule out the possibility that headaches are being caused by a serious underlying condition.

Excluding a serious neurological condition

The main things to bear in mind are that:

1. Whilst most sudden and severe headaches are not dangerous, the occurrence of a severe headache (thunderclap headache), often with exercise or intercourse may be due to a subarachnoid haemorrhageBleeding into the subarachnoid space surrounding the brain, the area between two of the three layers (meninges) surrounding the brain and spinal cord (the arachnoid mater and the pia mater).. This is bleeding into the subarachnoidA layer of the brain; in between the innermost membrane (pia) and the middle membrane (arachnoid)., the area between the layers of meninges surrounding the brain and spinal cord.
2. Headache with feverThe raising of the body temperature above norma, which may be accompanied by symptoms such as shivering, headache and sweating., which may be accompanied by symptoms such as shivering, sweating and neck stiffness or signs of infectionInvasion by organisms that may be harmful, for example bacteria or parasites. raises concerns of meningitisInflammation of the membranes covering the brain and spinal cord, due to infection or encephalitisInflammation of the brain..
3. There is always the possibility that a headache is being caused by the presence of a tumourAn abnormal swelling.. The key features of intracranialWithin the skull. hypertensionHigh blood pressure. are headaches which are worse at night or accompanied by personality or cognitive change, weakness or unsteadiness. New onset headaches in the elderly must also be taken seriously.
4. Recent onset headache in the elderly; fever, weight loss, unilateralInvolving or affecting only one side. pain with local tenderness could all be caused by temporal arteritisAn uncommon disease, usually affecting older people, in which the walls of the arteries in the scalp over the temples become inflamed.. An uncommon disease, usually affecting older people, in which the walls of the arteries in the scalp over the temples become inflamed.
5. Headaches felt on one side can be a symptom of carotid arteryOne of the two main arteries found on either side of the neck. dissection, which is where the layers of the artery wall that supplies bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. to the head separate.

The brain has no pain receptors and the pain-sensitive structures (such as meninges or large vessels) are supplied by nervesBundles of fibres that carry information in the form of electrical impulses.. The main symptom of sinusMay describe one of a set of air spaces within a bone, or an abnormal channel within the body that may contain blood (usually venous blood) or pus (usually a fistula passing from a deeper infection to the surface). disease may be a frontal headache (and similarly primary headaches are often treated as sinusitisInflammation of one or more of the sinuses, air spaces within the facial bones, caused by infection that has usually spread from the nose.). Jaw grinding may also cause headaches.

The presence of cervicalRelating either to the cervix (the neck of the womb) or to the cervical vertebrae in the neck (cervical spine). disease may result in pain felt in the occiputThe back of the head.. Similarly headaches may result in protective cervical spasm and may trigger a cycle of pain. A close working relationship with a physiotherapistA healh professional who specialises in physical therapies, such as exercise, massage and manipulation. is often invaluable in treating all aspects of the pain syndrome.

These form the majority of cases of headache and although they are “unpleasant but not dangerous” they can still have a considerable impact on quality of life.

Pure menstrual migraine

These headaches form a spectrum with intermittentStopping or ceasing for a time. severe migraines on one end, and daily tension-type headaches on the other. Many people suffer from a mixed pattern called a “transformed migraine” often caused by a combination of anxiety and over-use of non-prescription painkillers.

The key features of migraine headaches are an episodic, unilateral headache with accompanying nausea and vomitingExpusion of the contents of the stomach through the mouth. and sensitivity to light, noise and movement. Only a quarter of patients will experience a migraine aura. Although obvious in people with previous auras, these may be mistaken for a strokeAny sudden neurological problem caused by a bleed or a clot in a blood vessel.. Unusual migraine variants may include an isolated aura, vertigoA feeling that one or one's surroundings are spinning. It is caused by a disturbance of the semicircular canals in the inner ear or the nerve tracts leading from them., eye weakness or even loss of consciousness.

Common triggers for migraines are stress, sleep disturbances (both lack of sleep and excess), missing meals, excesses of caffeine and alcohol. Menstruation is a common trigger and some women with pure menstrual migraine may respond to hormonal treatment.
 

Common migraine auras/symptoms
Visual

Partial loss of sight (Scotoma)

Flashes of light (Photopsia)

Flickering arc of light (Fortification spectra/Scintillating scotoma)

Sensory

Pins and needles (Paraesthesia)

Motor

Weakness

Lack of muscleTissue made up of cells that can contract to bring about movement. coordination (Ataxia)

Lanuage

Poor articulation of basic language (Dysarthria)

Difficulty in remembering words (Aphasia)

Patients who suffer from primary headaches require effective and well-tolerated therapy to control them. Suggested therapy starts with rest and if the headache does not ease after rest there is a progressiveContinuously increasing in extent or severity. escalation of treatments starting with simple analgesicsAnother term for painkillers. such as paracetamol and escalating to non-steroidal anti-inflammatory drugs (NSAIDs)A group of drugs that give pain relief and reduce inflammation. and triptans. People who suffer from at least two attacks per month or whose headaches cause considerable disruption may benefit from regular medications. These include beta blockers, tricyclics and Topiramate, a novel anti-epileptic drug that is often effective in resistantA microbe, such as a type of bacteria, that is able to resist the effects of antibiotics or other drugs. cases. Botulinum toxinA substance poisonous to the body. (Botox) has recently been licensed for use in patients with chronicA disease of long duration generally involving slow changes. migraine.

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