Headaches are one the most common afflictions in life, with up to 90% of people reporting having suffered from headaches at some point in their lives. Most headaches, other than being painful and bothersome, do not signify anything more serious. However, some type of headaches are signals of more serious conditions and require immediate medical attention.
A large community based study of headaches in Singapore (Ho KH, Ong BK. A community based study of headache diagnosis and prevalence in Singapore. Cephalalgia 2003 Feb;23(1):6-13) found that the overall lifetime prevalence of headaches in Singapore was 82.7%, and this did not vary between racial groups. The types of headaches were classified into: migraines (9.3%), episodic tension type headaches (39.9%), chronic tension type headaches (2.4%) and unclassified headaches(31.2%).
PATHOPHYSIOLOGY
Because the brain itself does not have any pain receptors, the pain in headache is actually from several structures in the head and neck region. These include the scalp and neck muscles, meninges (brain lining), extra-cranial arteries, large veins, cranial and spinal nerves. Pain from sinuses, eyes and temporomandibular joint can also radiate to the head to cause headaches.
TYPES OF HEADACHES
Causes of headaches may be classified as being Primary (where it is not caused by an underlying condition) or Secondary (where an underlying condition exists).
A. PRIMARY HEADACHES
Tension Type Headaches
Tension headaches are the most common types of headaches experienced. The pain is described as being a mild to moderate constricting, pressing or tight pain on both sides of the head. It is generally not made worse by routine physical activity, such as walking, and there is usually no significant associated nausea or vomiting.
Tension headaches are thought to be caused by muscle tension origination in the neck, shoulders, forehead and skull. These muscles tighten due to poor posture, stress, eye strain or fatigue, resulting in a headache.
Tension type headaches respond well to simple pain killers, such as paracetamol or NSAIDS (non-steriodal anti-inflammatory drugs). Caffeine has also been shown to help. Patients with chronic tension-type headaches may occasionally need to consider prophylactic treatment.
Migraine Headaches
Migraines usually begin more frequently in the young, and are characterized by severe, throbbing pain, typically on one side of the head. There is usually associated nausea and vomiting, and increased sensitivity of light and sound. The pain on migraine is generally made better by resting in a darkened room.
Acute migraine attacks may be treated with oral pain-killers and migraine-specific medication (ergotamine and triptans). If vomiting is significant, injections may be required for pain relief and nausea control. For patients who get frequent migraine attacks, there is a role for prophylactic treatment which your doctor may recommend.
Cluster Headaches
Cluster headaches are the least common type of primary headaches and occur almost exclusively in males. They are usually extremely painful and have a pattern of occurring in "clusters", usually at the same time of the day for several weeks. They are usually described as constant, deep and excruciating, always located on one side of the head. There may be associated symptoms such as a runny or blocked nose, nausea or droopy, red, teary eye.
Cluster headache sufferers often feel compelled to pace up and down the room or rock in a chair. This is unlike the migraine sufferer who usually wants to curl up in bed and be still.
B. SECONDARY HEADACHES
Secondary headaches are the symptom of an underlying condition and it is thus important for them to be recognized and not dismissed. Conditions which may cause secondary headaches include infections of the brain and meninges (lining of the brain), strokes, tumours, bleeding in the brain from some form of trauma, sleep apnoea, very high blood pressure, acute glaucoma and rhino-sinusitis.
DIAGNOSIS
Your doctor will make an assessment of your headache by conducting a clinical interview, followed by a thorough neurological examination. If there are symptoms or physical signs suggestive of a more serious secondary cause, your doctor may recommend a referral to the Emergency Department or imaging investigations in an outpatient setting.
SIMPLE MEASURES FOR HEADACHES
Most primary headaches respond to simple measures.
Pain-killers: Pain killers such as paracetamol and NSAIDS (non-steriodal anti-inflammatory drugs) are often sufficient to control most headaches. For migraine and cluster headaches, specific medication such as ergotamine and triptans may be used.
Sleep: Having insufficient good quality sleep can contribute to headaches. Make sure that you get a good nights rest to enjoy more headache-free days.
Cold Therapy: An ice pack or cold pack placed over the painful area during an acute headache attack, can temporarily provide some relief by numbing the soreness and reducing tension.
Adequate Rest and Reduction of Anxiety: Tension and migraine type headaches are often precipitated by stress. Stress management methods, exercise, meditation etc, can all help reduce and possibly prevent such headaches.
Healthy Eye Care: Eye strain from prolonged reading or computer work can trigger headaches. Ensure that you have properly prescribed glasses to correct for any vision problems, as short or long sightedness can aggravate eye strain.
ไม่มีความคิดเห็น:
แสดงความคิดเห็น