Definition

A headache, or cephalalgia in medical terminology, is pain experienced in any part of the head. It is an exceedingly common condition, with most individuals experiencing it multiple times throughout their lives. Headaches come in various types, and the intensity of pain can vary greatly from person to person.

Causes

While most headaches are harmless, there are some that warrant further investigation and could signal a more serious condition. Broadly, headaches are classified into primary and secondary categories.

Primary Headaches

These types of headaches occur independently, without being triggered by an underlying illness or health issue. Primary headaches are more prevalent than secondary ones, and the pain tends to be recurrent. They often arise from disruptions in structures within the head, such as blood vessels, the protective membranes surrounding the brain, muscles, facial tissues, or nerves in the head and spine. The precise mechanism behind primary headaches remains unclear, as the pain emerges without an obvious disorder.

Some individuals may inherit genetic predispositions that heighten their likelihood of experiencing primary headaches. Although primary headaches are not typically dangerous, they can be intensely painful and significantly disrupt daily activities. Types of primary headaches include:

• Tension-type Headache (TTH)

A common form of headache felt on both sides of the head, lasting from 30 minutes to a week. TTH can be triggered by various factors such as stress, lack of sleep, muscle tension, prolonged screen exposure, or sometimes without any identifiable cause.

Read more about TTH here.

• Migraine

Known for its pulsating, one-sided pain, migraines are more common in women than men. The pain can persist for hours or even days, often accompanied by visual disturbances, flashes of light, tingling sensations, or nausea and vomiting. Triggers may include menstrual cycles, sleep deprivation, alcohol, missed meals, stress, or exposure to certain smells, medications, or foods.

Read more about migraines here.

• Cluster Headache

A rare but extremely painful type of headache, more commonly seen in adult males. The pain may last for days or weeks, with symptoms localized to one side of the head and around the eye, which may become red and watery. This type of headache usually recurs on the same side of the head during nighttime or early morning hours.

• New Daily Persistent Headache (NDPH)

This condition presents as a sudden, persistent headache that begins one day and does not improve within 24 hours. NDPH often affects individuals without a prior history of headaches, and its constant nature can severely interfere with daily life.

Secondary Headaches

Headaches classified as secondary occur as a result of an underlying medical condition. These headaches are often a symptom of another illness. Possible causes include:

• Meningitis (infection of the brain's membranes).
• Head injury or brain hemorrhage.
• Brain tumor.
• Leakage of cerebrospinal fluid from the membranes surrounding the brain and spinal cord.
• Sudden, severe hypertension.
• Sinus, ear, or dental infections.
• Referred pain from dental issues.
• Dehydration.

Risk factor

In some cases, a family history of headaches can predispose children to the same condition. For instance, a child with a parent who suffers from migraines has a fourfold increased risk of developing migraines.
Lifestyle and environmental factors can also trigger primary headaches, including:

• Alcohol consumption, especially red wine.
• Certain foods, such as processed meats, caffeine, fermented foods, or chocolate.
• Smoking or exposure to cigarette smoke.
• Sleep disturbances or insufficient rest.
• Poor posture leading to muscle tension.
• Intense physical exertion or exercise.
• Irregular eating patterns.
• Strong chemical or perfume odors.

Symptoms

The hallmark symptom of a headache is pain in the head, which can radiate to the face. The sensation may vary from pulsating to pressing, heavy, or sharp. Headache pain can range from mild to severe, affecting one side or the entire head, and may be constant or intermittent.

Depending on the type, headaches can be accompanied by other symptoms, such as:

• Nausea or vomiting.
• Runny nose.
• Stiffness in the neck or shoulders.
• Watery eyes.
• Sensitivity to noise or light.
• Sensitivity to odors.
• Muscle weakness.
• Dizziness.
• Tingling sensations.
• Difficulty moving limbs.
• Seizures.
• Fever, and more.

Diagnosis

To diagnose a headache, a doctor will review your medical history and inquire about your symptoms. After evaluating your history, they may perform physical and neurological examinations, searching for signs of diseases or conditions that might be causing the headache.

Although radiological tests can help rule out other diseases, they are not particularly useful for diagnosing primary headaches such as migraines, cluster headaches, or tension-type headaches. If the physician suspects an underlying medical condition, they may recommend imaging tests like a CT scan or MRI, which can reveal abnormalities in the brain.

Management

Headache treatment depends on its type. One crucial aspect of managing primary headaches is identifying the triggers, often by keeping a headache diary. Once identified, avoiding these triggers can help reduce headache frequency.

For infrequent headaches, over-the-counter pain relievers like paracetamol or ibuprofen are often effective, though it’s important to consult a doctor regarding their use. Overuse of pain medication can ironically trigger new headaches. In some cases, doctors may prescribe preventive medications.

For secondary headaches, the focus is on treating the underlying medical condition causing the pain.

Complications

Headaches can severely disrupt daily activities and decrease productivity. They are one of the most common reasons people miss school or work.
Complications from headaches often arise not from the headache itself but from its treatment. For instance, overuse of pain medication may lead to stomach issues and gastrointestinal bleeding.

In secondary headaches, complications are usually related to the underlying medical condition, potentially leading to temporary disability, severe neurological impairment, or even death.

Prevention

The key to preventing primary headaches is to avoid the triggers, which are highly specific to each person. Stress management techniques and relaxation practices may help you cope with triggers more effectively.

When to see a doctor?

Seek medical attention immediately if you or your child experience any of the following:

• A sudden, severe new headache.
• A headache accompanied by fever, difficulty breathing, stiff neck, or rash.
• A headache that occurs after a head injury or accident.
• A headache associated with weakness, tingling, difficulty speaking, or seizures.

For frequent or severe headaches, it is advisable to consult a doctor. An accurate diagnosis is vital to receiving specific treatment that can alleviate your discomfort.

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