FAQ's on Headache

Q- What are the causes of headache?

Migraine headache is caused by a combination of vasodilatation (enlargement of blood vessels) and the release of chemicals from nerve fibers that coil around the blood vessels. The chemicals cause inflammation, pain, and further enlargement of the temporal artery. The increasing enlargement of the artery magnifies the pain.

Tension headache does not have a clear cause. Many physicians attribute tension headaches to excess stress or a hectic day

Cluster headache also does not have a clear cause, although alcohol and cigarettes can precipitate attacks.

Q- What diseases cause secondary headaches?

Ans- Tumors in the brain, including tumors that have spread (metastasized) to the brain from another organ such as the lung or breast

Subdural hematomas, which are collections of blood underneath the dura (the covering of the brain) due to bleeding from ruptured veins after a fall or other trauma to the head.

Epidural hematomas, which are rapid collections of blood due to the rupture of arteries that run on the inner surface of the skull and are the result of skull fractures

Infections such as meningitis caused by bacteria (meningococcus and pneumococcus), tuberculosis, Lyme disease, or Cryptococcus

Strokes either due to blood clots within the arteries of the brain or rupture of the blood vessels in the brain

Subarachnoid hemorrhages which are caused by bleeding into the space between the brain and its outer arachnoid lining.

Sudden onset of severe high blood pressure

Temporal arteritis, a vasculitis (inflammation) of the temporal artery which runs beneath the skin of the temple. Without proper treatment, temporal arteritis may lead to blindness and strokes.

Acute angle glaucoma with sudden elevation of pressures inside the eyes

Infections of the sinuses (sinusitis), ear (otitis), and teeth

Hypothyroidism, a condition in which the thyroid gland does not produce enough thyroid hormone

Repeated carbon monoxide poisoning

Parkinson's disease

Medications such as indomethacin, estrogen, progestins, calcium channel blockers (commonly used for treating high blood pressure), and selective serotonin reuptake inhibitors (commonly used to treat depression)

Overuse of over-the-counter or prescription pain relievers which cause headaches to recur (rebound headache).

Cardiac ischemia (lack of blood supply to the muscles of the heart caused by coronary artery disease.The headache may occur with or without the accompanying chest pain of a heart attack or angina. As with angina, in some individuals the headache may occur with exertion and subside with rest.

Q- How are secondary headaches diagnosed?

Ans- Conditions causing secondary headaches can cause serious brain damage or even death. Therefore, timely and accurate diagnosis of secondary headaches is crucial. Special blood tests, brain scans, CT scans or MRI, and lumbar puncture (spinal tap) are necessary to establish these diagnoses. The doctors rely upon information obtained from the initial patient interview and physical examination:

The mode of onset of the headache, the age of the patient, the location of the headache, associated fever and neck stiffness ,associated mental deterioration, seizures, or weakness of the extremities or face or any recent head trauma.

Q- When should one consult a doctor for headaches?

Ans- Many people who suffer from mild headaches medicate themselves with over-thecounter analgesics, and they usually do not seek medical care. But the alarming signals to consult a doctor are:

Severe ("the worst ever")

Different than the usual headaches

Starts suddenly during exertion

Aggravated by exertion, coughing, bending, or sexual activity

Associated with persistent nausea and vomiting

Associated with stiff neck, fever, dizziness, blurred vision, slurred speech, unsteady gait, weakness or unusual sensations of the arm or leg, excessive drowsiness or confusion

Associated with seizures

Associated with recent head trauma or a fall

Not responding to treatment and is getting worse

Disabling, and interfering with work and the quality of life

Requires more than the recommended dose of over-the-counter analgesics for relief

Q- What is the treatment for tension headaches?

Ans- Individuals with occasional tension headaches or mild migraine headaches that do not interfere with daily activities usually medicate themselves with over-the-counter (OTC, non-prescription) pain relievers (analgesics) like non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen etc. NSAIDs relieve pain by reducing the inflammation that causes the pain and they are different from corticosteroids such as prednisone, in that, NSAIDs do not have the same side effects that corticosteroids have. Finding an effective analgesic or analgesic combination often is a process of trial and error because individuals respond differently to different analgesics. In general, a person should use the analgesic that has worked in the past. This will increase the likelihood that an analgesic will be effective and decrease the risk of side effects.

There are several precautions that should be observed with OTC analgesics:

Children and teenagers should not use aspirin for the treatment of headaches, other pain, or fever, because of the risk of developing Reye's syndrome, a lifethreatening neurological disease that can lead to coma and even death.

Patients with balance disorders or hearing difficulties should avoid using aspirin because aspirin may aggravate these conditions.

Patients taking blood thinners such as warfarin (Coumadin) should not take aspirin and non-aspirin NSAIDs without a doctor's supervision because they add further to the risk of bleeding that is caused by the blood thinner.

Patients with active ulcers of the stomach and duodenum should not take aspirin and non-aspirin NSAIDs because they can increase the risk of bleeding from the ulcer and impair healing of the ulcer.

Patients with advanced liver disease should not take aspirin and non-aspirin NSAIDs because they may impair kidney function. Deterioration of kidney function in these patients can lead to rapid and life-threatening deterioration of their liver disease.

Patients should not overuse OTC or prescription analgesics. Overuse of analgesics can lead to the development of tolerance (increasing ineffectiveness of the analgesic) and rebound headaches (return of the headache as soon as the effect of the analgesic wears off, usually in the early morning hours).

Q- What is the treatment of cluster headaches?

Ans- There are two approaches to treat cluster headaches: abortive and prophylactic. Abortive treatment is taken to stop the headaches. Prophylactic treatment is used to abolish or shorten the cycle of headaches.

Abortive treatments include inhalation of 100% oxygen at 8-10 liters/minute using a non-rebreathing facemask for 10-15 minutes along with a triptan such as sumatriptan (nasally, or under the skin) or an ergot such as DHE (intravenously, under the skin, or intramuscularly).

A calcium channel blocker, verapamil is the medication of choice for prophylactic treatment of cluster headaches. Other prophylactic medications include valproate, ergotamine, lithium, and methysergide. Prophylactic medications usually are begun early during a cycle of cluster headaches and continued for two weeks longer than the usual cycle. The dose of medication then is reduced gradually.