Health Topics

Healthy Living

April 2011
The Headache Manual
Dr. Ketan Patel

A headache or cephalgia is pain anywhere in the region of the head or neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain.

There has been an increase in the number of children suffering from headaches in the recent years. The 20-50 years age group suffers the most – possibly also because of the fact that using a cell phone for longer duration can cause headache.

15 Types & Causes of Headaches
  • Migraine:A common type of headache that may occur with symptoms such as nausea, vomiting, or sensitivity to light. In many people, a throbbing pain is felt only on one side of the head.
  • Tension headache: Pain or discomfort in the head, scalp, or neck, usually associated with muscle tightness in these areas.
  • Cluster headache: One-sided head pain that may involve watering of the eyes and a stuffy nose. Attacks occur regularly for one week to one year, separated by long pain-free periods that last at least one month, possibly longer.
  • Head injury: Goes without saying – an impact on the head does produce considerable headache.
  • Stroke: A sudden loss of consciousness resulting when the rupture or occlusion of a blood vessel leads to lack of oxygen in the brain.
  • Subarachnoid Haemorrhage (SAH): Bleeding in the subarachnoid space – the area between the brain and the thin tissues that cover the brain.
  • Tumour:Whether it is benign or malignant, tumours are a certified cause of headaches.
  • Meningitis:Inflammation of the thin tissue that surrounds the brain and spinal cord, called the meninges.
  • Encephalitis: An inflammation of the brain.
  • Hypertension:Blood pressure remaining abnormally high (a reading of 140/90 mm Hg or greater).
  • Sinusitis: Your sinuses are hollow air spaces within the bones surrounding the nose. They produce mucus, which drains into the nose. If your nose is swollen, this can block the sinuses and cause pain and infection.
  • Glaucoma: An eye disease that damages the optic nerve and impairs vision(sometimes progressing to blindness).
  • Chronic analgesic use and abuse: Medication Overuse Headaches (MOH), also known as rebound headaches, usually occur when analgesics are taken frequently to relieve headaches. They typically occur in patients with an underlying headache disorder such as migraine or tension headaches that "transforms" over time from an episodic condition to chronic daily headache due to excessive intake of acute headache medications.
  • High altitude: As altitude increases, the concentration of oxygen remains that of sea level (21 percent) but the number of oxygen molecules per breath is reduced. It falls down to 40 per cent fewer oxygen molecules per breath, when you reach 12,000 feet. High altitude and lower air pressure also cause fluid to leak from the capillaries, which can cause fluid build-up in both the lungs and the brain.
  • Hypoglycaemia: Abnormally low blood sugar usually resulting from excessive insulin or a poor diet.
Tests & Diagnosis
  • CT scan: For head injury and SAH.
  • MRI Scan: Useful for stroke, encephalitis, tumour, etc.
  • Fundoscopy: Also known as ophthalmoscopy, this procedure with a fundoscope examines the back portion of the eye. This part of the eye, known as the fundus, includes the blood vessels that feed the eye, the retina, the optic disk, and the choroid.
  • Lumbar Puncture: Lumbar puncture is required for suspected cases of meningitis and clinical suspicion of SAH with negative CT scan report.
  • X-Ray
Treatment Options
  • Abortive treatment addresses a headache in progress. Numerous medications are available to treat and prevent headaches, though some of them can cause gastric trouble, liver and renal damage on longer usage. Any one of these tablets - Acetaminophen, Aspirin, or Ibuprofen – could help stop a headache.
  • Prophylactic treatment which looks at preventing the occurrence of headache, calls mainly for lifestyle changes,like:
    • Eating at regular times.
    • Not skipping meals.
    • Reducing the use of caffeine and pain-relievers.
    • Restricting physical exertion,especially on hot days.
    • Keeping regular sleep hours,but not oversleeping.
    • Managing time effectively to avoid stress at work and home.
When to See the Doctor
Is your headache unbearable? Do you have these associated symptoms?
  • Neck pain
  • Altered level of consciousness
  • Vomiting
  • Fever
  • Visual disturbance
  • Seizure
  • Changes in speech or behaviour
If you have had a recent head trauma or a fall, or if the ache is not responding to over-the –counter (OTC) medicines, it would be better to seek a doctor – a General Physician or a Neurologist - at the earliest.
Medicines Causing Headaches

  • Heart and blood pressure medicines (vasodilators)
  • Birth control pill (oral contraceptives)
  • Indomethacin
  • Caffeine
  • Cold medicines such as antihistamines and decongestants
Dr. Ketan Patel is Consultant & Head, Dept. of Emergency Medicine at Apollo Hospitals International Limited, Ahmedabad.
  • The information on this site does not constitute medical advice and is not intended to be a substitute for medical care provided by a physician.
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