|
30 June 2010
Every day, an untold number of people around the world suffer from headaches, which are classified as any pain or discomfort occurring in any part of the head.
About 16-17% of the population will suffer from a headache during their life. The World Health Organization estimated in 2003 that 303 million people worldwide were enduring the pain associated specifically with migraine headaches.
Overview
There is a myriad of causes of headaches. Some originate from the head itself (musculature, vasculature, neuropathic); others are referred from the neck and upper back, as well as due to vision problems.
Most causes of headaches are benign and have no underlying significant pathology, however, it is important to have a physician or pain specialist exclude more severe causes before beginning treatment for headaches.
One of the most common complaints a physician sees, headaches can be distinguished as either primary or secondary. More common, primary headaches are then separated into three categories, which are cluster headaches, migraine headaches and tension headaches.
Tension Headaches
These are the most common type of headache and is characterized by pain that feels as though it is wrapping around the head and is causing pressure. These headaches are usually slow to come on, and can be made worse by environmental causes (noise, or bright lights), but most commonly by stress. Some patients will find the onset of tension headaches to be associated with depression, sleep interruption and possible difficulty concentrating. While they can be in any location of the head, they generally will occur in the back of the head and upper neck, which is medically known as the occipital region.
Cluster Headaches
These affect men more often than women, and generally begin to occur around 25 years of age. Cluster headaches are named such as they occur in a cluster – or usually the same time of day, same time of year and same area of the head. Cluster headaches often cause pain directly behind the eye, and sometimes can cause a stuffy nose or nasal discharge.
Migraine Headaches
Unlike cluster headaches, migraine headaches are more common in women, and affect all age groups. Migraines can affect one or both sides of the head and is generally an intense headache. Migraines are broken down even further into classical and common migraine headaches.
One of the known phenomena of a classical migraine headache is that many people, although not all, have an associated aura that may occur before, during, or after the onset of the migraine. An aura can be flashes of light, the seeing of spots, intermittent vision loss, numbness of the face or extremities, and sometimes weakness or dizziness. Common migraines have no preceding aura.
Some who suffer from migraines will experience accompanying nausea and/or vomiting. Many who experience regular migraines will begin to learn what triggers their migraines; it can be smells, certain foods, bright lights, extreme exertion, medications, emotional distress, or stress, though everyone will have different triggers.
Video
Treatment
Most often, headaches are treated pharmacologically and fall into two categories: abortive, meaning to treat the pain immediately, or preventative, which is to lessen the number and intensity of the headaches.
Abortive treatment, while it treats pain quickly if not immediately, does not do anything to lessen the number, intensity or frequency of the headache. Often, it also will not prevent the headache from reoccurring. Abortive treatment includes NSAIDs, oxygen treatments, triptans and prescription pain medications. Dependence and overuse are concerns with medication therapy as well.
Preventative treatment includes antihistamines, anti-seizure medications, and anti-depressants. Non-pharmacological therapies can also be used to treat headache pain – yoga, biofeedback, acupuncture and massage have all been shown to aid in treating headache pain.
Botox (botulinum A toxin) injections have been studied in recent years in their efficacy at treating headaches, as some people who had been receiving Botox injections for wrinkles had noticed improvement in their headache frequency and intensity. Studies done showed that Botox injections for headaches had very little side effects and adverse effects.
Interventional pain management physicians also may offer occipital nerve stimulation for headaches. Using the technology of the spinal cord stimulator (known as the pacemaker for pain), occipital nerve stimulation has shown success in recent years as a viable means to treating chronic, daily headaches.
Other minimally-invasive procedures available for headache may include: facet injections, epidural steroid injections, and/or nerve blocks.
As headaches are extremely complex, it is important to find a treating pain physician who finds the source of your headache pain. A combination of treatments may also help; pharmacological treatment paired with minimally-invasive procedures may be the key to treating your chronic headaches.
