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Headaches, Know The Common and Dangerous Headaches

Jan 5, 2018 | Alex Sarkodie MD
Headaches, Know The Common and Dangerous Headaches

Headaches are often not taken very seriously, because most headaches are usually mild and episodic. A few headaches, however, may lead to death, if there is delay in seeking medical help.

Headaches, usually present as part of an illness, like malaria, common cold, dehydration, after drinking alcohol, and these headaches clear with the resolution of the underlying illness.

DEFNITIONS
Chronic Headaches: Headaches occurring daily or on more than 15 days in a single month.

Episodic Headaches: Headaches occurring on fewer than 15 days in a single month

Primary headaches Most primary headaches are related to muscle contractions, and blood flow problems, around the skull, and other biologic problems of the brain. Primary Headaches are very common.

Secondary headaches are due to identifiable lesions inside the skull. They are not common, but may be worrisome.

The lesions could be:
Rupture of cerebral aneurysm,
Rupture and Blockage of cerebral blood vessels(stroke),

Increase in CSF (fluid) pressure or
Brain tumor.
Secondary Headaches are EMERGENCY situations, often requiring immediate evaluation with CT scan and MRI of the brain, and any time wasted, could lead to unfavorable outcomes.

PRIMARY HEADACHES
1.) TENSION HEADACHES
These dull muscle tension headaches are also called Stress headaches. Tension headaches are the Commonest of the headaches, but they are usually mild, and continuous, and most people do not seek medical help.

These headaches are absent in the morning, usually begin in the late afternoon and evening. They are related to stress. The pain is bilateral and is usually located in the front, the temples, and the back of the head where muscles attach to the skull. These constant dull aches feel like wearing a tight head band. The pain may improve when one massages the scalp

TREATMENT: Paracetamol, Ibuprofen, Aspirin helps.
PREVENTION OF TENSION HEADACHES
Amitriptyline is taken daily, if one experiences headache on more than 8 days per month.

Chronic tension headache is a serious disorder, with significant morbidity, and requires acute and prophylactic therapies. A brain MRI maybe done to make sure nothing pathological, happening in the brain

2.) MIGRAINE HEADACHES
Migraine headaches, usually start in childhood, around age 9-10 years, and these recurrent headaches may persist into old age.

A migraine attack may last 4-72 hours, if untreated and usually is aggravated by routine activities.

Attack frequency varies from an attack per week, to an attack per year.

Migraine headaches typically have the following characteristics which are easily remembered with the mnemonic POUND. Headache that is

Pulsatile (or throbbing)
Once daily, (an episode may last up to 3 days).
Unilateral (one sided)
Nausea and vomiting, and no tolerance for noise and bright lights.

Disabling, one cannot do anything and this leads to loss of work and school days.

Any person, having 4 or more of these symptoms has migraine headache.

Some migraine headaches may be associated with an aura. The auras may be a form of transient visual lights, numbness. Women who have migraine with aura are at risk for stroke, and must not be on oral contraceptives pills, which increase the risk for stroke

TREATMENT
Ibuprofen, Naproxen, and Aspirin or Sumatriptan, zolmitriptan.

PREVENTION OF MIGRAINE
If someone experiences migraine headaches, more than 8 separate days in a month or misses more than 4 work days, in a single month, that person needs migraine prevention medication

The Blood pressure medication like Propranolol, Atenolol and anti-seizure medication like Topiramate have been administered daily to prevent migraines

3.) CLUSTER HEADACHES.
Cluster headaches, are not that common (1:1000), affect men, 6 times more than women. These headaches, come in clusters, with a bout of headache, lasting 15 minutes to 3 hours, occurring up to 8 times a day, especially at night, for several weeks, then disappears until another season.

Risk Factor for cluster headache: Male, over age 20 years, cigarette smoker.

Cluster headaches have been described as the most painful of the primary headaches. The affected person is restless and agitated.

The pain, described as sharp or burning, typically is located around one of the eyes, which becomes teary, and pink with small pupil, with the eyelid swollen and drooping. There is runny nose and a feeling of ear fullness, all on the same side. The forehead, on the same side, is sweaty

The Doctor may do brain MRI, for first timers with this headache, to exclude underlying serious pathology.

TREATMENT
Oxygen inhalation
Sumatriptan injection, subcutaneous.
SECONDARY HEADACHES
There is an identifiable problem inside the skull, leading to headaches.

Some of the problems may be due to:
1.) A rupture, or blockage of blood vessels in the brain (this is a stroke)

2.) Bleeding in the area between the brain and brain covering (Sub Arachnoid Hemorrhage)

3.) Others may be due to raised fluid pressure in the brain and Brain Tumors.

4.) Other secondary headaches may be related to Concussion, Glaucoma, Panic Attack, Carbon monoxide inhalation, Alcohol induced hangover

The following headaches need to be evaluated by a physician/medical officer ASAP.

The list includes:
New headache in persons younger than 5 years or older than 50 years

New headache in pregnant women
New headache in a cancer patient or someone with depressed immunity

Headache triggered by exertion, sexual activity, bearing down

Headache that gets worse over 24 hours.
Other secondary headaches, require immediate visit to the emergency room, as they are symptoms of a stroke, or bleeding into and or around the brain. An example is Thunderclap headache.

THUNDERCLAP HEADACHE
This is often due to a life-threatening condition like raptured cerebral vessel or aneurysm, or a Blood clot in the large veins and sinuses in the brain.

Features: Abrupt onset of very severe headache, (as if you have been hit with a baton on the head). The pain reaches maximal intensity in less than a minute and may take over 5 minutes to wane.

Anyone who experiences, such sudden intense headache should seek immediate medical attention, by calling for an Ambulance (and not a Taxi).

Other characteristics of headache that need immediate medical attention, include

Changes in the pattern of existing headaches
Headaches associated with double vision, focal weakness.

Headache associated with:
confusion,
seizure,
trouble speaking,
trouble understanding speech,
trouble walking,
stiff neck, or
loss of consciousness
The physician will do a quick check, including a check on your eyes, the Neck, and the blood vessels in the neck region. One may need, a head CT and/or MRI and a spinal tap.

Alex Sarkodie MD
Alex Sarkodie MD

Alex Sarkodie,MBChB has over 30 years experience in the field of Medicine

Disclaimer: "The views/contents expressed in this article are the sole responsibility of Alex Sarkodie MD and do not neccessarily reflect those of Modern Ghana. Modern Ghana will not be responsible or liable for any inaccurate or incorrect statements contained in this article."

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