Be Aware of Headache !!

                           Be Aware of Headache

Headache is among the most common reasons that patient seek medical help. Headache can be either primary or secondary. Here we have to distinguish serious from benign etiologies. Most patient who present to emergency ward with worst headache of their lives have migraine. Beside that, headache location can suggest involvement of local structures e.g. temporal pain in giant cell arteritis, facial pain in sinusitis. Time peak intensity can differ cluster headache from migraine. If the headache appears with provocation by environmental factors, it may suggests a benign cause.

Complete neurologic exam is important in evaluation of headache. If exam is abnormal or if serious underlying cause is suspected, an imaging study ( CT or MRI ) is indicated as a first step. Lumbar puncture is required when stiff neck and fever is a possibility. The psychological state of the patient should also be evaluated since a relationship exists between pain and depression.

Following are the most common  type of headache :

            Migraine is a benign and recurring syndrome of headache associated with other symptoms of neurologic dysfunction. It usually afflicts 15 % women and 6 % of men. Onset usually in childhood, adolescence or early adulthood; however initial attack may occur at any age. Women may have increased sensitivity to attacks during menstruation. The common symptoms are premonitory visual sensory, one-side throbbing headache, nausea, vomiting, photo and phonophobia. An Attack lasting 4-72 hours is typical, as is relief after sleep. Attacks may be triggered by wine, cheese, chocolate, contraceptives, stress, exercise or travel. Mild to moderate acute migraine attacks often respond to over the counter analgesics when taken early in the attack.

            Tension headache is a whole-side headache, described as two-side pressure or a tight band. May persist for hours or days; usually builds slowly. Pain can be managed generally with simple analgesics such as acetaminophen or aspirin. Tension headache is often related to stress.

            Cluster headache is a rare form of primary headache characterized by episodes of recurrent, deep, nocturnal, one-side, back-eyes searing pain. Typically the patient awakens 2-4 hour after sleep onset with severe pain, one-side lacrimation, nasal and conjunctival blockade. Unlike migraine, patients with cluster tend to move about during attacks. The pain lasts 30-120 minutes but tends to recur at the same time of night or several times each 24 hour over 4-8 weeks.

            Post Concussion headache is common following motor vehicle collisions or other head trauma. Symptoms of headache, dizziness, vertigo, impaired memory, poor concentration, irritability are typically remits after several weeks to months. 

            Beside the three common type of headache above, We also must aware to some type of headache symptoms that suggest a serious underlying disorder. The symptoms include worst headache ever, first severe headache, subacute worsening over days or weeks, abnormal neurologic examination, fever or unexplained systemic signs, vomiting that precedes headache, pain induced by cough, pain that disturbs sleep or presents immediately upon awakening, known systemic illness and headache onset after age 55.

           

          So what we can do if the symptoms above are appear. If we want to alleviate the symptoms of migraine, just stay away from the trigger that I’ve noted above. If migraine cannot be alleviated by the OTC analgesics drug, so just seek medical help. For tension headache, pain can be managed generally with simple analgesics such as acetaminophen or aspirin. Because Tension headache is often related to stress, so the patient must learn to control stress. For cluster headache, it’s better to find a physician, do not drink alcohol because cluster headache usually can be triggered by alcohol. For post-concussion headache, it’s better to find a physician for further examination. For headache symptoms that suggest a serious underlying disorder, an imaging study ( CT and MRI ) is indicated as a first step.