Almost every one on earth might have had an episode of headache at least once in their life span. More than 90% would have never gone to a specialist for treatment. Either rest or medications over the counter might have solved the problem. The headache disorders are classified into two major groups. The primary headache disorders include such conditions as migraine, cluster headache and tension type headache. The secondary headache disorders are those associated with a variety of organic causes and in which the pain is secondary to an identifiable, distinct pathologic process of which headache is a symptom.
Earlier migraine was classified into two major subgroups; classic and common migraine. Classic migraine characterized by an aura of neurologically significant preheadache phenomena, is now called migraine with aura. Common migraine with attacks of migraine without clear-cut preheadache neurologic symptoms is now referred to as migraine without aura. Focal neurologic disturbances without headache or vomiting have come to be known as migraine equivalents or accompaniments and appear to occur more commonly in patients between the ages of 40-70 years. The term complicated migraine has generally been used to describe migraine with dramatic focal neurologic features, thus overlapping with classical migraine.
Diagnostic criteria for migraine without auraThe headache is usually located over frontal
or temporal, uni-or-bilateral. Onset of pain
is usually after patient awakens and disappears
once sleep sets in. It may be provoked by so
many internal and external factors like food,
odour, and menses etc., usually stops after
second trimester of pregnancy. The headache
can run in cycles of several months to years.
It becomes less frequent and less severe with
aging.
Treatment - Medical management
Many people consider this chronic pain syndrome as a type of migraine variant form. This is characterized by bilateral tight band surrounding head, with neck muscles especially posterior ones being tight. This headache can be in intermittent or episodic form as well as a chronic form. The chronic form can last for more than 15 days per month. It is seen in all age groups with female preponderance. Other associated co morbid conditions include personality disorders, depression, epilepsy, and obsessive-compulsive disorder. Sometimes, tension type headache follows head injury.
Diagnostic criteria4. Both of the following:- Pressing, tightening, non-pulsating.
- Mild or moderate
- Bilateral
- No aggravation by routine physical activity
- No nausea or vomiting; anorexia may occurTreatment - Medical management
- Never both photophobia and phonophobia
Secondary
headaches are termed as nociceptive headache,
wherein obvious pathology can be identified.
Almost every disease is known to cause headache.
The location of headache can give clue about
the pathology. The structures outside skull
like paranasal sinuses, eyes, teeth, arteries,
spine and the supporting muscles might be involved.
The problems inside skull brain tumours, Bleeding
, Blood clotting, infection might require specific
investigations to confirm diagnosis. One should
watch for neurological deficits and tender points.
Some of the common disorders of secondary headaches
encountered by a pain specialist are as follows:
(i). Chronic sinusitis
(ii). Eye problems
(iii). Giant cell arteritis
The exact reason is not known. Most often seen
in elderly age group people, with women preponderance.
Patient complains of headache externally (outside
the skull), dull in nature, and may be unilateral
or bilateral. Other associated symptoms like
fever, weight loss, fibromyalgia, jaw pain are
noted. The headache will be worse at night.
Blindness also has been reported.
(iv). Post-traumatic headache
It is of a different nature in that the neck
pain and headache start immediately following
the accident. These patients are often involved
in legal matters and they are often labeled
as psychosomatic in the absence of objective
diagnostic findings.
(v). Cervicogenic headache