Overview:
Migraine and Headache
According to the World Health Organization, about 4% of the world’s adult population experience headaches for about 15 days or more in a month.
A headache is defined as a sensation of pain arising in different parts of the head or the upper neck and is caused by the irritation/inflammation of the tissues in parts of the body, such as the neck, back of the head, forehead, the temple, and behind the ear. Typically, these episodes of pain can last anywhere between 30 minutes to a week.
These episodes of pain sensations can be caused by a multitude of factors including:
- Stress, depression, or anxiety
- Muscle strain
- Lack of proper sleep
- Eye pain or infection
- Irritation of the nerves
- Weather changes
Headaches, depending on the cause, can range in severity from being a mild sensation of discomfort to acute pain that feels “piercing”, “throbbing” or “stabbing”. For mild headache pain, relaxation techniques, some caffeine, adequate rest and/or basic over-the-counter medicines may be used to reduce or eliminate discomfort.
In some cases, pain symptoms from headaches can escalate into an acute or chronic condition such as a migraine or nerve pain headaches. There could be an underlying disease, infection, or trauma causing this reaction and subsequent pain.
What are the causes and symptoms of the different types of headaches?
Headache symptoms range from mild, single episodes to severe acute cases and chronic conditions that progress in intensity and duration.
An acute headache is one that is experienced for a few hours (or even days), and patients are often advised to see a doctor immediately to provide pain relief and diagnose the root cause(s) of this condition.
A chronic headache can last for months (or even years).
The underlying trigger(s) of headaches determine the classification as either “Primary” or “Secondary”.
Primary
Primary headaches usually occur from any of the causal factors listed below. They are limited to sensations of irritation and/or inflammation in the nerves, muscles, blood vessels, and tissues in the regions of the head and neck.
While these type of headaches can be debilitating (and in some cases “chronic”), they do not have life-threatening implications. Primary headaches include migraine headaches, tension headaches, cluster headaches, and hypnic headaches.
Migraine headaches
As the 3rd most prevalent illness in the world, migraines can affect adults and children although usually this condition occurs in people between the ages of 18 and 44. Migraine headaches can occur sporadically or as a chronic daily condition. Migraine can become a chronic condition either when left untreated or due to medication overuse. When left untreated, a single migraine episode can last anywhere between 4 hours to 72 hours.
Migraine is a neurological disease that can be caused due to a variety of reasons such as:
- Sensory stimulants such as bright lights, strong smells, or loud noises
- Specific foods (salty and processed foods) and erratic eating patterns
- Increased physical activity
- Changes in sleep patterns
- Weather changes
- Hormonal changes in women (including menopause)
- Specific medications (such as contraceptives)
- Chemical imbalances in the brain
- Genetic predispositions
- Alcoholic stimulants
Migraines can be progressive in nature. There are 4 specific stages of progression for a migraine headache, although not everyone who has a migraine experiences all four. The stages of migraine headaches and their symptomatic indications are divided as:
- Prodrome — This is a stage where there are subtle symptoms that can cause a migraine such as:
- Increased frequency of urination
- Stiffness in the neck
- Changes in moods
- Increased thirst
- Food cravings
- Constipation
- Aura — This stage can occur before or during a migraine with symptoms experienced usually affecting a person’s vision, such as:
- Changes in vision which could be seeing different shapes or bright spots, flashes, etc.
- Weakness and numbness in one side of the body
- Temporary loss or blurring of vision
- Uncontrollable movements
- Attack — During the actual migraine episode, the most common symptoms characterizing the condition are:
- Throbbing/pulsating pain in one or both sides of the head
- Sensitivity to sensory stimulations
- Nausea and vomiting
- Post-drome — Post-migraine, the person may be left feeling exhausted and confused along with sporadic episodes of pain.
Tension headaches
Tension headaches are one of the most common “primary headaches” with women being more susceptible to experience them more than men versus men. Per the World Health Organization, approximately 75% of people all over the world experience tension headaches, while only 3% experience it as a chronic condition.
Tension headaches are characterized by pain that begins slowly and develops gradually. They can be caused by:
- Disturbances in sleep
- Emotional stress
- Erratic eating patterns
- Fatigue
- Dehydration
Tension headaches often initially express themselves with the following symptoms:
- Constant dull ache on one (or both) sides of the head
- Feelings of tightness or pressure in the head or neck
- Sensitivity to sensory stimulations
- Spreading of the pain sensations
These headaches can be episodic (they last just a few hours) or chronic (occurring at least 15 days in a month).
Cluster headaches
Cluster headaches occur in “clusters” or “patterns” in the body and last from weeks to months. Cluster headaches are also known as Horton’s syndrome. Though rare, cluster headaches are categorized as the most painful type of primary headache. Unlike other types of primary headaches, cluster headaches are not caused by any specific triggers, though the use of a drug nitroglycerin is considered a possibility.
Symptoms of cluster headaches include:
- Redness in the eye along with radiating pain
- Excessive tearing in the eyes
- Symptoms occur at the same time everyday
- Facial sweating
- Drooping eyelid on the affected side
- One-sided pain
Secondary
Secondary headaches are caused from underlying health conditions. These can include:
- Transient ischemic attack
- Cerebral aneurysm
- Brain Tumors
- Encephalitis
- Sinus infection
- Concussions
- Meningitis
- Glaucoma
- Trauma/injury to the neck or brain
- Bacterial or viral infections in the brain
While rare, these types of headaches produce excruciating pain and can also have life-threatening implications. Other types of secondary headaches include medication-overuse headaches, sinus headaches, post-concussion headaches, substance abuse-related headaches, and thunder-clap headaches.
Neuralgias or nerve pain headaches
There are other types of headaches that result from nerve pain that are not classified as either “Primary” or “Secondary”. These can be in the form of cranial neuralgias where there is an inflammation in the cranial nerves connecting the brain to the head and neck. Common “nerve pain headaches” include occipital neuralgia (symptoms include stabbing and/or shooting pain in the posterior of the head) and trigeminal neuralgia which affects the sensory nerve in the face.
Typical symptoms of nerve pain headaches include:
- Sensitivity to touch in the affected parts
- Sudden bouts of shooting, stabbing pain
- Sensitivity to light
- Frequent and intense pain episodes
- Radiating pain
- Pain spasms
What are the risk factors associated with different types of headaches?
There are several risk factors that can increase the incidence of headaches. Risk factors associated with headaches include:
- Sensory stimulants such as bright light and loud noises (in case of migraines)
- Food consumption/Eating patterns
- Sleep apnea
- Arthritis
- Stress
- Nasal infections and problems (in case of sinus headaches)
- Medication overuse
- Hormonal changes
- Substance abuse
- Age and gender
- Alcohol
- Smoking (can cause cluster headaches)
- Genetic predispositions
- Specific food triggers
- Specific medications
- Allergies
Factors that cause headaches differ in primary, secondary and nerve pain headaches.
What are the complications associated with headaches?
In primary headaches, complications can arise when symptoms are ignored and timely treatment or medical intervention is not provided which could potentially lead to a “chronic” condition.
Secondary headaches can be associated with several specific complications, including:
- Brain infections such as meningitis or encephalitis
- Brain trauma or injury
- Brain tumors
- Possible stroke due to inflammation in the blood vessels
- High or low intracranial pressure
When should I see a doctor for my headaches?
Often, headaches are triggered suddenly but also subside just as quickly. In some cases, simple over-the-counter medication, rest, and home remedies may be sufficient to address and reduce pain symptoms and discomfort.
There are some symptoms and indications, however, that may be your body indicating something more serious is occurring that you should immediately see a doctor about. If you are experiencing any of the following symptoms along with the headache, you should call Advanced Pain Care to set up a same or next day appointment in one of their Central Texas Locations (Austin, Waco, Amarillo, Killeen, Kyle):
- Change in behavior with sudden confusion (could indicate a stroke, meningitis, or encephalitis)
- Stiffness in the neck (could be indicative of an aneurysm or meningitis)
- Pain lasts over 72 hours with less than 4 hours pain-free
- Nausea and/or vomiting
- Change in speech patterns
- Change in vision
- Seizures
- Worsening of the pain after coughing, exertion, or any sudden movement
- A sudden and severe headache which feels like a thunderclap
- Different patterns in your usual episodes of headaches
- Suddenly developed pain after the age of 50
- A trauma in the head region
- Pain is unbearable
How are headaches diagnosed?
To make an accurate diagnosis, the Pain Care Management specialists at Advanced Pain Care will first determine the following factors with you:
- Associated symptoms such as nausea, confusion, speech slurring, etc.
- Frequency of the episodes
- Past medical history
- Symptoms and characteristics of the pain condition
- Duration of the headaches
- Severity of the pain
The next step usually involves a physical examination, where the physician examines the entire head and neck region for any abnormalities. In the case any abnormalities are found, further tests including a neurological examination are prescribed.
Some of the tests prescribed to identify types of headaches include:
- Blood Tests — Blood tests such as erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) are used to diagnose an underlying inflammation or infection. They can also assist in the diagnosing headaches due to substance abuse and medication overuse.
- CT Scan — Scan to detect any swelling or hemorrhaging in the skull and brain. Could also indicate any occurrence of a stroke or aneurysm.
- MRIs — This test helps to accurately diagnose any brain-related conditions causing the headaches.
- Lumbar Puncture — This procedure examines the cerebrospinal fluid to determine conditions such as meningitis or other infections.
Depending on the symptoms, the physician may also prescribe other tests such as an eye examination or electroencephalogram.
How are headaches treated?
In most cases, physicians treat headaches (especially primary headaches), with a simple protocol of:
- Over-the-counter prescription and non-prescription medication including aspirin and ibuprofen
- Anti-nausea medicines such as promethazine in case of a migraine
- Calcitonin gene-related peptide (CGRP) antagonists
- Calcium channel blockers
- Antidepressants
- Pain relievers
Physicians may look at preventing situations to control the incidence of headaches. For example, following a diet with less salt and processed additives can help prevent the onset of a migraine. Reducing reliance on substances can reduce the incidence of substance use headaches. Headaches are almost always treated with a combination of medication in combination with lifestyle changes. There are cases, though, where a greater degree of medical intervention is required. This level of treatment can include:
- Inhalation of high concentration of oxygen
- Injection of triptan medications
- Use of lidocaine in the nostrils
In the case of neuralgia, nerve pain treatment protocol may include medications such as pain relievers, antidepressants, and anticonvulsants, as well as treatments such as electrical stimulation.
In some cases, surgical intervention may be the best option.
When is surgery required for headaches?
If the pain relief from headaches using non-surgical interventions is short-lived, physicians may recommend surgery. In the case of cluster headaches and some chronic sinus headaches, surgery is usually the preferred method of long-term treatment. At times, surgery is also recommended to treat chronic migraine cases or for relieving the pressure on the nerves in the vase of occipital neuralgia or trigeminal neuralgia).
The most common types of surgery for treating headaches include:
- Nerve stimulation devices
- Nerve decompression
- Nerve blocks
- Neurectomy
- Endoscopic surgery in case of sinus headaches
At Advanced Pain Care, patients are monitored in a multi-disciplinary effort (Neurologists, Neurosurgeons, Rheumatologists and/or Pain Management Specialists).
Most surgeries for headaches are minimally-invasive, and side-effects (although rare) include swelling, bruising, and numbness in the affected area.
Bleeding or infections are extremely rare and minimized by the constant supervision of the multidisciplinary team at Advanced Pain Care. Depending on the specific procedure, the recovery may also be quick.
Patients are also given a specific list of steps to follow (based on the procedure they received) to ensure a quick and successful recovery.
How can headaches be prevented?
Many primary headaches can be prevented with simple changes in lifestyle. These changes include:
Headaches are caused when specific pain-sensitive areas in the head and the neck are stimulated due to a variety of reasons. If you have been experiencing headaches and have not found relief, visit http://www.austinpaindoctor.com/ or call 512-244-4272 to set up a same or next day appointment with a Neurosurgeon, Rheumatologist and/or Pain Care Management doctor.
FAQs
Q: What causes migraine headaches?
A: A migraine can be caused for several reasons such as:
- Genetic predispositions
- Chemical imbalances in the brain
- Hormonal changes in women (including menopause)
- Specific medication (such as contraceptives)
- Alcohol and stimulants
- Sensory stimulants such as bright lights, strong smells, or loud noises
- Increased physical activity
- Weather changes
- Changes in sleep patterns
- Specific foods (salty and processed foods) and erratic eating patterns
Q: What causes migraines in females?
A: The most common reasons triggering migraines in women include the following:
- Hormonal changes (fluctuations in estrogen) before or during menstruation
- Hormonal changes (fluctuations in estrogen) during pregnancy or after
- Hormonal changes (fluctuations in estrogen) before or during menopause
Q: How do I know if I’m having a migraine?
A: A migraine can last from hours to several days. The condition can be so debilitating due to pain that affects one’s activities completely.
The following are some of the characteristic symptoms of migraines:
- Nausea and vomiting
- Throbbing/pulsating pain in one or both sides of the head
- Sensitivity to sensory stimulations
- Stiffness in the neck
- Increased thirst
- Increased frequency of urination
- Constipation
- Changes in moods
- Food cravings
- Temporary loss or blurring of vision
- Changes in vision which could be seeing different shapes or bright spots, flashes, etc.
- Weakness and numbness in one side of the body
- Uncontrollable movements
Q: What are the different types of headaches?
A: Headaches are predominantly classified as:
- Primary headaches such as migraines, tension headaches, tension headaches, etc.
- Secondary headaches such as sinus pain, brain tumor, brain infections, stroke, etc.
- Cranial neuralgia, trigeminal neuralgia, etc. Known as “nerve pain” headaches.
Q: When should you worry about a headache?
A: Headaches may occur due to a variety of factors or. In some cases, simple over-the-counter medication, rest, and some home remedies may be sufficient to relief the pain and symptoms.
Some symptoms and indicators may be your body’s way of telling you that you should see a doctor immediately. These could indicate a more serious condition, with a headache being a symptom.
Contact the doctors at Advanced Pain Care if you are experiencing any of the following symptoms along with a headache:
- Nausea and/or vomiting
- Stiffness in the neck (could be indicative of an aneurysm or meningitis)
- Seizures
- Change in vision
- Change in speech patterns
- Change in behavior with sudden confusion (could indicate a stroke, meningitis, or encephalitis)
- A trauma in the head region
- Pain is unbearable
- Different patterns in your usual episodes of headaches
- Worsening of the pain after coughing, exertion, or any sudden movement
- A sudden and severe headache which feels like a thunderclap
- Suddenly developed pain after the age of 50
- Pain lasts over 72 hours with less than 4 hours pain-free
