A headache is one of the most common complaints of all human physically. It is not a disease rather it is a symptom; it may indicate diseases like a Neurological disease, a stress response, vasodilation ( dilation of blood vessels ), skeletal muscle tension (a tension Headache ) or a collection of different factors. A primary Headache is one for which no organic cause can be identified. These headaches include a Migraine Headache, cluster headache, tension headache and other related headaches. At first, the classification of a headache was issued by the Headache classification committee of the international headache society in 1988, then was revised in 2004. Some of the classified headaches are:
- A Migraine
- Tension-type headache
- A cluster headache
- Headache associated to head or neck trauma
- A headache associated to cranial or neuro vascular disorder
- Headache associated to substances or its withdrawal
- A headache associated to infection and facial pain ( neuralgia )
- Headache associated to psychiatric disorder
- A headache associated with stroke and panic attacks
- Headache associated with trauma
- A headache associated to glaucoma
A Migraine Headache
Migraine is the most common form of primary headache. It is a complex of all symptoms characterized by periodic and recurrent attacks of severe headache lasting from 4 – 72 hours causing throbbing pain on one or both sides of the head, pulsating ache which may be accompanied by nausea, visual disturbances ( blurred ), light-headedness and sensory or motor disturbances. The exact cause of migraine is still idiopathic, However it is primarily associated vascular imbalance and disturbance that occurs more commonly in women and has strong familial tendency. The peak period of the onset is at puberty, and the incidence rate is 18% in women and 6% in men ( Lipton, Bi gal, Diamond, ET AL., 2007 )
Tension-type of headache appears to be chronic and less severe and probably the most common type of headache, whereas cluster headaches are form of vascular headache. They are five times more frequent in men than in women. There are other headaches triggered by cough, exertion and sexual activity. Headache caused by cranial arteritis is a inflammation of cranial arteries which is characterized by severe localized headache seen in older age above 70 years.
A migraine can be triggered by the menstrual cycle, bright lights, loud sounds and noise, stress, sleep deprivation, fatigue, an overdose of certain medications or from certain food products usually dairy products.
Signs and symptoms of a Migraine headache
The sign and symptoms can be divided into four phases:
- Pro dome phase ( premonitory or warning phase ):
It is experienced by 60% of the patient with physical and psychological changes including lethargy, depression, irritability, cravings for food, Dyspepsia, anorexia, Diarrhea/constipation. These phases can last from 1 to 24 hours.
- Aura phase:
This phase occurs in a minority of patients about 1 in 5 people. It is a sensory phenomenon that occurs before an actual migraine such as visual auras ( flashing lights, blind spots ), balancing and coordination problem, a rigidity of neck, a difficulty is speech. It lasts from around 10 minutes to an hour.
- Headache phase ( Attack phase ):
This phase occurs due to the vasodilation and decrease in serotonin levels, a throbbing headache intensifies over several hours. Throb may worse during physical activity so the best option is to take rest. Other symptoms include; photophobia, nausea, vomiting and also fainting may occur. Its duration varies ranging from 4 to 7 hours.
- Recovery phase ( postdrome or termination ):
In this phase the pain gradually subsides, muscle contraction in neck and scalp is common with muscle ache, exhaustion and confusion. Any physical exertion exacerbates the head pain. The patient may sleep for extended periods.
- A migraine complex, with clinical features that changes over the time and severity of duration/pain. Attacks may or may not always involve all these phases. A person can get a migraine, or a migraine without aura, or even just any other type of a headache related to the serious disease. So, it is very necessary to consult medical advice.
How do we diagnose a Migraine Headache?
The diagnostic evaluation includes a complete assessment of detailed medical history, physical & Neurological examination. The medical history focuses on assessing the headache itself, as a headache may differ over the course of a lifetime, from person to person. The set of questions are asked involving the medications, onset of a headache and its duration, frequency, the triggering factors or events, various psychological and physiological factors and the relieving factors as well.
- Diagnostic tests are usually not helpful in investigating headache. However, those patients who demonstrate abnormalities on Neurological and physical examination, the X-ray, CT, MRI and angiography can be useful to detect the underlying cause such as an intracranial tumour or an aneurysm. Laboratory tests may include complete blood count, Erythrocyte sedimentation rate, electrolytes, glucose, creatinine and thyroid hormone levels for possible infection and hormonal disorder causing the headache (a migraine).
Treatment of a Migraine Headache
The treatment includes preventive approach and abortive ( symptomatic) approach.
It is used in most frequent attacks at predictable intervals. It involves avoiding specific triggering factors of which patient is already aware. A patient needs counselling over the anxiety, depression and frustration. Medications are prescribed to prevent the migraines including beta-blocking agent (propranolol), and metoprolol, other medicines include amitriptyline hydrochloride, flunarizine, a serotonin antagonist and calcium antagonist. Such medicines are only prescribed by the consulting doctor under the observation and after running some lab tests. As it is indicated for Cardiovascular, psychological and Neurological disorder.
Abortive ( symptomatic ) approach:
It is used in those patients who have less frequent attacks, aimed to relieve or limit a headache at onset. The medications used are triptans, serotonin receptor agonists are the specific anti-migraine agents widely used. The agents cause vasoconstriction (constriction of vessels), reduce inflammation, thus reduce the pain transmission. The most widely used triptan is sumatriptan succinate and is effective for the treatment of an acute migraine. In a secondary headache, the patient may refer to a hospital for further lab tests.
Note: These medications are only to be prescribed by the consulting doctor or physician. The above treatment does not allow a person to use as a prescription for a migraine or any other type of a headache.