Headache

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Headache is a pain or discomfort of the head. It is not a disease but a symptom of some other problem in the body, and there are many possible causes. When someone gets a headache it usually is temporary, and only very rarely is it a sign of serious illness.

What Are Headaches?

Headaches are so common that it is hard to imagine someone who has not had a headache, unless perhaps it is a newborn baby. Although there are dozens of causes of headaches, most headaches are due to tension or stress. About 20 percent of people in the United States at some point in their lives may have a recurrent, often severe type of headache known as migraine.

Up to 50 million people in America seek medical help for migraine and other severe headaches each year. It has been estimated that more than 180 million workdays are lost due to headache annually, and that more than a billion dollars are spent for over-the-counter remedies to relieve headaches.

Chronic headaches may accompany emotional disturbances such as depression. Many times, headaches are just one of a number of symptoms, such as fever or dizziness, that are brought on by various diseases or injuries. Migraine headaches frequently are accompanied by nausea and other symptoms that are characteristic of it.

HOW DID MIGRAINE GET ITS NAME?

Aretaeus of Cappadocia, a medical writer in Greece in the second century A.D., is believed to have been the first to recognize migraine as a one-sided headache with stomach and visual disturbances. Galen, a contemporary of Aretaeus, gave this affliction the name hemikrania, meaning “half of the head,” referring to the way it typically affects people. In Old English, the term became megrim, and finally evolved to “migraine.”

Causes and Types of Headaches

The pain of headache may be mild, extremely severe, or anywhere in between. It may involve the entire head, one side only, the forehead, the base of the skull, or it may seem to move around. The pain may be sharp, a dull ache, or throbbing. A headache may last a few minutes or hours. It may recur from time to time, or may become chronic, coming back many times over an extended period.

Many people believe that the brain itself is involved in headaches, but neither the brain nor the skull has nerves that register pain. The sources of head pain are the nerve endings in the blood vessels and muscles in and around the head. Pain may be felt when these tissues become stretched, inflamed, or damaged. Headaches can arise in blood vessels within the brain, as well as in the meninges (me-NIN-jeez), which are the sensitive membranes that cover the brain.

Mild headaches may arise from such things as a change in the weather or hunger. Common causes of mild to severe headache pain include disorders of the eyes, ears, and sinuses. For example, eyestrain and diseases such as glaucoma can produce pain in the front of the head and around the eye. Mastoiditis, an inflammation of bone behind the ear, can. cause severe pain on the affected side of the head. Sinusitis can cause sharp headaches in the front of the head (often called sinus headaches). A jaw or bite that does not close properly also can cause headache.

Many types of infection with fever, such as influenza (flu), cause headache. Other causes include drinking too much alcohol, heavy smoking, withdrawal from caffeine, or inhaling a noxious gas, such as carbon monoxide. Contrary to popular belief, high blood pressure rarely is a direct cause of headache.

Headache is one of the symptoms of concussion, and sometimes becomes chronic following this injury.

Rarely, headaches may be caused by brain abscesses, brain tumors, bleeding into the brain, and meningitis (an inflammation of the membranes covering the brain).

AN ANCIENT, AND DRASTIC, TREATMENT

Prehistoric peoples are known to have surgically cut holes in the skulls of living persons, presumably to relieve some ailment. The purpose of this operation is not known with certainty. Perhaps it was carried out to relieve the pressure of a blood clot under the skull caused by a blow to the head. However, it is believed that in some instances it may have been done in an attempt to cure headaches by releasing evil spirits. Stone Age patients who underwent this surgery apparently often survived, because many of the skulls found by scientists showed new growth of bone around the holes.

*vascular refers to veins and arteries (the blood vessels).

Physicians often classify headaches as those caused by disease or injury (described above); tension headaches; and vascular* headaches. Vascular headaches include migraine and a type called cluster headaches. Tension and migraine headaches are very common.

Tension Headaches

Headaches that are associated with emotional stress or muscular tension are called tension headaches. The muscular tension may be in the neck, face, or scalp. It may be the result of poor posture or of constantly bending over one’s work. These headaches are extremely common, and almost everyone has them at one time or another. A person may have one after working on the computer too long or bending over while doing homework.

Pressures from school, friends, or family may play a role. Adults may develop tension headaches because of stress at work. Tension headaches may be mild to moderate and occur in various parts of the head. The feeling has been described as a steady ache or as a tight sensation.

The pain of tension headaches can be chronic or recurrent, sometimes coming on every day. Muscles near the site of the pain, such as at the back of the neck, or on the sides of the head, are often tense and tender. Sometimes chronic tension headache is a symptom of depression.

Migraine

Migraine is a moderate to severe headache that can interfere with a person’s life. The pain is typically, although not always, in one side of the head, at least at the beginning, and may last from hours to days. Migraine headaches occur every so often, usually beginning in adolescence or early adult life. They tend to become less frequent with age, and tend to be rare or absent after the age of 40 to 50.

Migraine is one of the most common types of headaches, affecting about 20 million people in the United States alone. Women are four times more likely to experience migraine than men. People in all walks of life have been afflicted, including Sigmund Freud, Thomas Jefferson, Charles Darwin, and Lewis Carroll, the author of Alice in Wonderland. Contemporary sufferers have included the late Princess Diana of Great Britain and the basketball player, Kareem Abdul-Jabbar.

The cause or causes of migraine headaches are not known with certainty. They are classified as vascular headaches because blood vessels in the head dilate, or expand, during an attack. It is believed that certain chemical substances in the nerve cells surrounding the vessels are involved in the attack. The precise mechanism is not fully understood, however.

Migraine headaches tend to run in families. However, one does not catch this headache from someone else.

Most migraine attacks begin without warning. Typically, the pain is throbbing, often growing in intensity. It usually is accompanied by nausea and sometimes vomiting. The slightest noise or movement can make it worse. Ordinary light coming through a window may seem unbearable.

The Aura

In about 15 percent of people who get migraines, the headaches are preceded by a distinctive type of warning called an aura (OR-uh). An aura can be a blank spot in the vision bordered by zigzag and flashing lights or numbness or weakness in parts of the body. After several minutes, the aura goes away and the pain of the headache begins. Migraine preceded by an aura has been called a classic migraine, or migraine with aura.

Triggers

In a number of individuals, certain factors, or triggers, can bring on a migraine attack. Common examples include red wine and foods such as cheese, nuts, chocolate, and citrus fruit. Nitrites, which are used as meat preservatives in products such as bacon or cold cuts, are another recognized trigger. Other triggers include excessive sleep, relaxation after exercise, fatigue, and stress. Still others are related to hormonal changes, such as those that occur at the onset of menstruation. Sometimes the trigger is not known.

Cluster Headaches

Intensely painful headaches that occur one or more times daily are called cluster headaches. These headaches may keep recurring for weeks or months, then not return for years. The pain is centered on one side of the head around the eye. Besides pain, the symptoms include a watery eye and a runny nose on the affected side.

Cluster headaches occur in men more often than in women, and usually first appear about age 40. Their cause is unknown.

Should I See a Doctor?

Most headaches, although unpleasant, are not signs of serious health problems. A person should see a doctor if the headaches are unusually persistent or severe, if there are any changes in vision or speech, or if there is weakness or numbness in any body part.

How Are Headaches Treated?

Over-the-counter pain-relieving drugs, such as acetaminophen, may ease mild headaches. Relief also may come from such simple measures as getting some fresh air, taking a hot bath, getting a muscle massage, or just lying down for a while. Tension headaches can be dealt with by addressing the cause of the emotional or physical stress.

For severe headaches, such as migraine, the best approach, is prevention, that is, avoiding the factors that the individual knows are most likely to trigger an attack. Once an attack begins, pain-relieving drugs may help to ease symptoms. The doctor also can prescribe medicines that will narrow the blood vessels in the brain that have dilated during an attack. If migraine attacks occur frequently, the doctor can prescribe medications to prevent the migraine. Biofeedback, a relaxation technique, has proven helpful in relieving and avoiding some headaches.

Cluster headache attacks may be over before pain-relieving drugs can take effect. However, some prescription medicines may be useful in prevention.

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