Headache: Understanding and Treatment

Headache: Understanding and Treatment

Headache is a common symptom caused by the irritation of sensitive structures in the head region. These structures can be located inside the skull (intracranial) or outside the skull (extracranial), including:

Intracranial structures:

• Sinuses and meninges, including dura mater, arachnoid mater, pia mater.

• Arteries of the dura mater, arachnoid mater, pia mater.

• Basilar artery and its major branches.

Extracranial structures:

• Skin, subcutaneous tissue, mucosa, muscles.

• Periosteum of the skull.

• Extracranial arteries.

• Sensitive structures of the eyes, ears, nose, sinuses.

Nerves involved in headaches:

• Trigeminal nerve: affects the face and sinuses.

• Greater and lesser occipital nerves: affect the scalp.

• C2, C3, C4 roots: affect the area behind the ear.

• Hypoglossal nerve: affects the meninges of the area below the tentorium.

• Trigeminal nerve, facial nerve, hypoglossal nerve, vagus nerve, three upper cervical nerve roots.

Headaches are classified into three main types:

• Primary headaches: Including migraine, tension-type headache, trigeminal autonomic cephalalgias, and other primary headache types.

• Secondary headaches: Due to trauma, vascular conditions, intracranial disease, medications or withdrawal, infection, endocrine disorders, psychiatric disorders.

• Cranial nerve pain and facial pain: Including cranial neuralgia and other headache types.

Approaching headache patients:

• Determine whether the headache is primary or secondary: Is it a new or old headache? Are there any warning signs?

• Find the cause:

• Old headache: Usually benign, may gradually decrease over time.

• New headache: Should be examined by a doctor to rule out serious causes.

Warning signs (SNOOP):

• S: Systemic symptom: Infection, meningitis, brain metastasis, malignancy, HIV…

• N: Neurologic: Focal neurological signs, altered consciousness, brain tumor, stroke, hydrocephalus…

• O: Onset: Sudden, thunderclap: Cerebral hemorrhage, cerebral infarction, vasculitis…

• O: Older: Onset after the age of 50, progressively worsening: Brain tumor…

• P: Positional: Changes when lying down or sitting: Decrease in intracranial pressure…

• Prior: Change in headache characteristics: Brain tumor…

• Papilledema: Decreased vision: Increased intracranial pressure…

• Precipitated by: Worsened by sneezing, coughing: Posterior fossa lesion…

Headache diagnosis and treatment:

• Migraine: The most common type of headache, often causing unilateral throbbing pain, accompanied by nausea, vomiting, photophobia, and phonophobia.

• Tension-type headache: The second most common type of headache, often causing dull, pressing pain on both sides of the head, lasting from 30 minutes to a week.

• Other types of headaches: Need to be examined and diagnosed accurately by a doctor for appropriate treatment.

Treatment:

• Non-pharmacological treatment: Living a balanced lifestyle, avoiding stress, late nights, exercising regularly, eating a healthy diet, psychotherapy.

• Pharmacological treatment:

• Abortive treatment: Triptans, Ergots, analgesics, antiemetics, sedatives.

• Preventive treatment: Beta-blockers, calcium channel blockers, anticonvulsants, antidepressants, anti-spasmodics…

Note:

• Do not self-treat headaches, see a doctor for examination and accurate diagnosis.

• Maintain a healthy lifestyle to reduce the risk of headaches.

Additional information:

• Tension-type headaches account for 45% of the population.

• Migraines account for 30% of the population.

• Migraine incidence is higher in women than men.

• Cluster headaches account for < 1% of the population.

In conclusion, headache is a common symptom and can be caused by many factors. Accurate diagnosis and appropriate treatment are crucial to controlling pain and improving the quality of life of patients.