Headaches are very common in people of different age groups, regardless of gender, health or life situation. It is a type of subjective pain that occurs within the head in the outer part (orbital-temporal part of the head) and in the inner part (deep inside the skull). It is the most common disease, the basis of which can be very diverse, as well as its course. Pain may take various forms, last longer or shorter, and vary in intensity depending on the case and the person. Sometimes a headache is just a symptom of a more serious illness. It is estimated that only 15% of people suffering from headaches out of more than 90% of people (who have this condition at least once a year) struggle with recurring pain of a disease that can form the basis of medical control.
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The reasons
A headache can be caused by many factors and for many reasons. To a large extent, it is based on the simplest grounds, such as fatigue, sinusitis, the effects of alcohol consumption or lack of sleep. A head injury may also be a reason for the appearance of a headache. Pain is felt as a result of irritation of peripheral pain receptors, regardless of the factor causing this effect. In most cases, the organism reacts immediately to pain, trying to locate the source and eliminate the cause. Sometimes, however, when trying to eliminate the problem, the pain-sensitive peripheral tracts are damaged. As a result, the pain may affect elements such as the scalp, dural sinuses, the sickle of the brain, proximal sections of the large arteries of the dura mater, and the departure of larger arteries - these are structures within the head that are prone to pain.
Autonomic symptoms are nasal congestion or lacrimation. They appear as a result of inappropriate stimulation of the parasympathetic fibers of the cranial nerves.
Headache can also occur as a result of other clinical diseases or psychotic conditions, such as depression.
Migraine
Headache is a characteristic symptom of a chronic condition such as migraine. However, among the symptoms of migraine, the most common are also vegetative disorders, such as nausea, dizziness, photophobia and visual disturbances. With migraines, very often movement and changes in the head position contribute to the aggravation of the pain.
The migraine attack usually lasts from 4 to 72 hours, during which the pain may vary. The frequency of migraine attacks per year varies - it can be a single attack or even several attacks per month. Migraine attacks are classified into three categories according to the pain level and the patient's performance during their duration. These are: mild migraines, during which the person is able to function normally, although it is harder for him to do so; medium - when the patient is unable to perform his daily tasks; heavy - requiring bed rest.
Migraine usually takes two forms:
It is a type of pain of moderate or very severe intensity. It spreads in a pulsating manner, most often covering the area of the middle of the head in a variable manner. Migraine without an aura is characterized by intense pain in the area behind the eye and vegetative disorders.
It is accompanied by neurological symptoms that occur in a variable manner before the onset of the headache. Pain usually appears after several or even several dozen minutes. The aura is about the ailments that come along with a migraine attack. The most common is the visual aura, which is characterized by the appearance of flickering spots or lines in the field of vision (bilaterally or unilaterally). Rarely do you experience blindness or aphasia. There may be numbness in the hand or face. The aura is short-lived and precedes the onset of a pain attack.
The pathogenesis of migraine is not fully known, but it is believed to arise from an inappropriate response of the neurovascular system to the received external and internal stimuli. It is presumed that this is due to a genetic condition, corresponding to a disturbance in the work or structure of ion channels. The disease is chronic and may accompany the patient for the rest of his life, although it is likely to weaken over time.
It is best for a sick person to simply avoid the factors that lead to the appearance of a migraine state. Conventional medicine proposes two pathways to tackle the problem of migraine. The first is pharmacological treatment based on non-narcotic analgesics, acetylsalicylic acid, triptans, ergotamine and paracetamol. Until the early 20th century, ergotamine was considered the most effective treatment for migraines. The second treatment option is prophylactic pharmacotherapy, primarily using β-blockers, antiepileptic and antidepressant drugs, and non-steroidal anti-inflammatory drugs.
Tension headache
The most common type of headache known as common, stress, or psychogenic headache. The affliction affects more women than men. Contrary to migraine, it is incidental and does not take the form of seizures. The pathogenesis of the disease is not clearly defined, but the factors contributing to the development of tension headache are known. Factors conducive to the development of ailments include, among others: stress, depression, exhaustion, lack of sleep, anxiety and strong emotions. Tension headache only affects the central nervous system, not touching the peripheral components as is the case with migraine.
The condition takes the form of a compressive, spontaneous headache occurring on both sides. The pain most often affects only the area of the forehead, temples or the back of the head. The feeling increases with physical activity. Often the pain is associated with muscle spasms in the neck, shoulder or coif. Rarely, there is also photophobia or nausea. The pain is moderate and rather oppressive and dull. It may take an hour and may even tire the patient over a period of several days.
The three most common forms of tension headache are:
- Episodic headache - this occurs extremely rarely, about once a month;
- Frequent headaches - occur relatively frequently, up to 15 times a month;
- Chronic headaches - occurring every day or almost every day.
Tension headache treatment is a troublesome process due to the multitude of causes of pain and the lack of effective, unequivocal management. As in the case of migraine, there are two treatment options - prophylactic and emergency. Emergency treatment is significantly similar to the method of migraine treatment and is based on the intake of acetylsalicylic acid or paracetamol, ibuprofen, and diclofenac. For severe pain, prescription antidepressants (such as opipramol or amitriptyline) or anxiolytics (benzodiazepines) are used. The preventive treatment path is based on relaxation techniques, psychological support and methods to improve mood. However, the prophylactic treatment route has no proven clinical properties to improve the condition of patients with this condition.
Cluster headache
A cluster headache is a type of pain that affects only one side of the body. It is accompanied by autonomic symptoms, also only in the middle of the body. The most common form is in the form of short-term pain stabs in the orbital area. Cluster headache occurs each day as usually a few short attacks over a period of 4 to 8 weeks. There are about one-year breaks from seizures between painful periods. Each seizure may last up to 180 minutes.
The basis of cluster headache formation is not fully understood. However, imaging studies have shown that chronic disease is associated with increased activity of the hypothalamic nuclei and stimulation of the C fibers of the trigeminal nerve system.
In the treatment of ailments, drugs from the triptan group are most often used, as well as oxygen therapy. The treatment process has two paths - the first is short-term treatment, immediately after the end of the seizure and lasting up to 3 weeks, and the second option is chronic treatment. In the course of chronic treatment, salts are used, among others topiramate, baclofen or lithium. A risky but effective treatment method in this case is surgical intervention. During the procedure, the trigeminal nerve is damaged mechanically or with the use of alcohol injections. However, this procedure is associated with many complications, e.g. the appearance of permanent nerve dysfunction in the form of lack of sensation in the face area or corneal ulceration.
Source
- https://ichd-3.org/classification-outline/
- Prusiński A., Miejsce nowoczesnych niesteroidowych leków przeciwzapalnych (NLPZ) w leczeniu bólów głowy . „Medycyna i życie”, reprint z Vol. 5/Nr 3 (16), 2012 , s. 6.
- Prusiński A.: Bóle głowy. Red. B. Pec. Warszawa: PZWL, 1999.
- Prusiński A.: Leczenie migreny i innych bólów głowy. Poznań: Termedia, 2010.
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