MEDICATIONS: COMMON TYPES OF HEADACHES

Headaches are one of the most common health complaints people experience. Although headaches can range from irritating to incapacitating, most are not associated with a serious illness. However, the occurrence of a new type of headache requires medical evaluation to determine the cause.

Tension headaches are the most common type of headache. They are often accompanied by tension in the muscles of the head, neck and shoulders. The pain from tension headaches is a constant, dull pain and is often described as a band squeezing around the head, like a tight hat. The pain is not incapacitating and usually occurs on both sides of the head. Tension headaches come on gradually and can last from hours to days.

Tension headaches can be treated with pain relievers like aspirin and acetaminophen. Stress management and relaxation exercises may also help prevent tension headaches.

Migraine headaches are less common than tension headaches. They are more common in women than in men and can be debilitating. Migraines are episodic disabling headaches that may recur over years.

Migraine sufferers often become nauseous and are sensitive to light and loud sounds during an episode. Some people can tell when they are about to have a migraine headache because they experience certain symptoms, called an aura, before the headache occurs. These symptoms can include visual disturbances such as seeing spots or stripes and blurred vision.

Migraine headaches can be treated with nonprescription and prescription pain medication. Prescription medications to prevent migraine headaches are also available for persons who have frequent migraines.

Cluster headaches are less common than other kinds of headaches and occur more often in men than in women. Cluster headaches come on suddenly with severe pain centered around one eye, which becomes watery. Nasal congestion may occur on the same side of the face. These headaches usually last about 45 minutes and can occur several times a day. Cluster headaches typically occur over a period of weeks or months, known as a cluster period, and then disappear for weeks or months until the next cluster occurs.

Prescription medications are available for treating and preventing cluster headaches. Avoiding alcohol is also recommended because it can trigger cluster headaches in individuals who have them.

While all headaches hurt, not all headaches hurt alike. In fact, the International Headache Society has identified and classified nearly 130 different types of headaches. They can be mild, moderate, or extremely severe and incapacitating. Headaches vary in intensity, frequency and duration depending upon the headache type and your sensitivity to them. While the precise causes of recurring, chronic head pain have not been identified, important advances have been made in the past decade. Current research supports the concept that chronic head pain originates in the structures of the brain.

A physical examination, particularly of the head, neck and neurological system, is an important first step to rule out conditions that may mimic or co-exist with headache syndromes.

Headaches can be grouped into two major headache disorder categories:

· Primary Headache Disorders. Primary headaches are those in which the headache represents the primary symptom of a physiological, or bodily, disorder. No consistently organic cause can be determined for these headaches. Such headaches reflect inherited or acquired disturbances of the brain and its relationship to the rest of the body. Primary headache types include:

o Migraine Headache

o Tension-type Headache

o Cluster Headache

o "Ordinary" Headache (probably a mild form of migraine or tension-type headaches)

· Secondary Headache Disorders. These headaches arise as a symptom of another disorder. More than 300 organic causes of such headaches exist. Some of the more common secondary headache types are:

o Post-Traumatic Headache (one that occurs as a result of an injury or surgery)

o Reactive Headache

o Sinus Headache

o Rebound Headache

Primary Headaches

Migraine Headache

In the past, migraines were considered vascular — or blood vessel-related — headaches. They were thought to occur when shifts in blood flow suddenly dilated (expanded) the blood vessels in and around the head causing pain. However, the most current and respected findings suggest that migraines and other primary headaches arise from disturbances within the central nervous system. These disturbances trigger a cascade of chemical changes that cause inflamed blood vessels and neurological symptoms, including pain. There are two major types of migraines — migraine with aura, which includes specific neurological symptoms such as vision disturbances (formerly called "classic" migraine), and migraine without aura (formerly known as "common" migraine).

Considered an inherited disorder, migraines affect women three times more often than men. The female hormone estrogen is believed to play a role in why more women than men are afflicted by this painful condition.

As with all headaches, migraines affect people in different ways. If you are a female migraine sufferer, your headaches may have started with your first menstrual period or upon menopause (your last menstrual period). Some women find that their migraines go away during pregnancy or after menopause. Regardless of when your headaches first began, identifying your migraine triggers is an important first step in determining effective treatment options.

You may have migraine headaches if you have the following symptoms. (Chances are you will not experience all, or even most, migraine headache characteristics.)

Key Migraine Headache Characteristics
The following recognized migraine symptom phases might occur alone or in combination with other phases:

· Prodrome. This consists of events that occur hours to days before the actual headache. Prodrome symptoms include:

o Mood changes

o Stiff neck

o Chilled feeling

o Sluggishness and fatigue

o Increased frequency of urination

o Constipation or diarrhea

o Loss of appetite or food cravings

o Increased sensitivity to light, sound and smells

o Fluid retention

· Aura (present in migraine with aura). These neurologic symptoms typically occur five to 20 minutes before the headache and last up to 60 minutes. Occasionally, the aura symptoms occur during the headache phase. The most common aura symptoms are visual, such as bright zigzag lines, sparkling moving figures, blind spots and distorted objects.

· Headache Phase. Sixty percent of migraine headaches occur on one side of the head (unilateral), while 40 percent occur on both sides (bilateral). For some people, migraine headaches consistently occur on a particular side of the head, while others experience pain on different sides of the head at different times. Migraine headaches typically last hours to days, but rarely last less than four hours. Other common headache phase symptoms include:

o Throbbing and pulsating pain that may vary in intensity

o Nausea or vomiting

o Loss of appetite

o Diarrhea

o Blurred or restricted vision and sensitivity to light

o Other sense changes, such as sensitivity to sound, smells or touch

o Fatigue, depression, irritability and anger

o Mental dullness, confusion, hyperactivity

o Lack of coordination, vertigo (spinning sensation), double vision

o High or low blood pressure

o Skipped heart beats

o Nasal congestion

· Postrome. After a severe migraine attack, people often feel tired or "washed out," irritable and listless. Other symptoms may include:

o Impaired concentration

o Muscle weakness and aching

o Food cravings or loss of appetite

o Feelings of euphoria or hyperactive behavior

Migraine Triggers
A wide range of factors — both internal and external — can trigger migraine attacks. Knowing what triggers your migraine headaches is the first step in learning how best to manage them.

Tension-Type Headache

Many headache experts believe that tension-type headaches are simply a milder form of migraine headaches with many of the same headache triggers. As a result, treatment options may include many of the same therapy approaches. You may have tension-type headaches if you have the following symptoms. (Chances are you will not experience all, or even most, tension-type headache characteristics.)

Key Tension-Type Headache Characteristics

· Tension-type headaches affect women more frequently than men.

· Pain is more intense as the day advances.

· Pain is episodic (occurring randomly and lasting for hours to days at a time) or chronic and persistent (occurring daily).

· Associated with sensations of tightness, pressure, or band-like constriction around the head.

· Associated with changes in muscle tension in the neck or head.

Be aware that what appears to be a "daily" tension-type headache may actually be a rebound reaction to pain-relief medications.

Cluster Headache

Just as migraines are far more common in women, cluster headaches are 16 times more common in males than females. The term "cluster headache" was originally used to describe the clustering of painful attacks that occur many times throughout the day from weeks to months at a time and then subside for a few weeks or months. This "quiet period" is called the interim. (In the chronic form of cluster headaches recurring attacks can occur for years at a time without an interim phase.)

Cluster headaches can resemble migraine headaches and be unbearably painful — so much so that cluster headache sufferers report frequently feeling suicidal due to the intense pain. Without proper diagnosis and treatment options, cluster headaches can last for years. Potent blood vessel dilators, such as alcohol, nitroglycerin and histamines can trigger an attack. You may have cluster headaches if you have the following symptoms. (Chances are you will not experience all, or even most, cluster headache characteristics.)

Key Cluster Headache Characteristics

· Can resemble a migraine headache.

· While the attacks can begin at any age, they typically begin between ages 20 and 40.

· Extremely painful headaches that last from 30 to 90 minutes and commonly occur up to six times a day during the cluster headache "active" phase.

· Frequently occur at night, and often at the same time each day.

· Can be associated with panic or fear.

· Generally localized (or restricted) to one side of the head, affecting the eye, forehead, cheek, or temple.

· Associated with nasal congestion, eye drooping, contracting of eye pupils, excessive tearing, and other facial changes.

· Accompanied by tenderness in the neck.

"Ordinary" Headache

What many people refer to as an "ordinary" headache may actually be an extremely mild form of migraine. Most "ordinary" headaches respond to simple remedies, such as mild non-prescriptive analgesics (painkillers) or relaxation techniques. You may have an "ordinary" headache if you experience the following symptoms:

Key Common Headache Characteristics

· Occurs once in a while.

· Is not associated with an underlying medical condition, such as head injury or allergies.

· Responds to minimal treatment such as rest and nonprescription pain relievers, or goes away without treatment.

· Be sure to check with your health-care provider if you begin to experience headaches on a regular basis.

Secondary Headaches

Post-Traumatic Headache

Post-traumatic headaches frequently occur in people with head and neck injuries, including closed-head injury and whiplash, regardless of the severity of the accident or injury. For example, one study indicated that headaches occur in up to 88 percent of people with mild head injury, while another study found that 60 percent of patients had headaches for more than two months following the initial mild to moderate head or neck trauma.

You may have post-traumatic headache or resulting post-traumatic syndrome if you experience the following symptoms after a head- or neck-related injury, accident or surgery. (Chances are you will not experience all, or even most, post-traumatic headache characteristics.)

Key Post-Traumatic Headache Characteristics

· Headache, neck and shoulder pain

· Sleep disturbance

· Trouble thinking or concentrating

· Mood and personality changes

· Dizziness with or without vertigo (spinning sensation)

Reactive Headache

Reactive headaches are those triggered by a "reaction" to something in your environment or your life. Reactive headaches can be caused by literally hundreds of factors, ranging from allergens, such as dust and mold, to kidney failure and brain tumors. Help for Reactive Headache Sufferers

Perhaps the best solution for reactive headache sufferers is to identify and, if possible, avoid or eliminate whatever triggers the headache. A visit to your physician to rule out the more serious causes of reactive headaches is in order. You also may want to keep track of headache triggers in your Personal Headache Journal. If your headaches seem to be triggered by an allergic reaction, consider seeking help from a medical professional, such an allergist, who specializes in identifying and treating allergic reactions.

You may have a reactive headache if you experience the following symptoms. (Chances are you will not experience all, or even most, reactive headache characteristics.)

Key Reactive Headache Characteristics:

· May be a part of an allergic response to dust, pollens, animal dander, household chemicals, medication or other external substances.

· Goes away when the headache factor (dust, pollen, etc.) is not present.

Sinus Headache

Sinus headache may well be the most misdiagnosed headache disorder. Some 80 percent to 90 percent of people who believe they have sinus headaches actually suffer from a form of migraine instead. The reason for this confusion has to do with the feeling of pressure around the sinuses, which also can occur during a migraine or other headache attack. Furthermore, certain sinus medications contain pain-relieving ingredients that can ease headaches symptoms, further convincing a person that he or she suffers from sinus headaches.

You may have a sinus headache if you have the following symptoms. (Chances are you will not experience all, or even most, sinus headache characteristics.)

Key Sinus Headache Characteristics

· Dull or aching pain generally located in the front of the face and forehead.

· Pain ranges from mild to severe.

· Pain relief typically occurs when fluids are drained from the sinus cavity.

· If you suffer from what appears to be frequently occurring sinus headaches, seek the advice of a headache specialist to find out if you actually have a migraine or some other type of headache.

Rebound Headache

Rebound headaches — also known as "toxic" headaches — are caused by excessive use of certain medications, including many of the analgesics and other agents used to treat chronic headaches. Preventive medications will not be effective until the medication that caused the headache is discontinued and withdrawal is complete. Withdrawal may require hospitalization.

Rebound headaches are fairly common. In fact, one study found that 73 percent of headache clinic patients suffered from chronic, daily headaches caused by overuse of medications.

You may have rebound headaches if you have some of the following symptoms. (Chances are you will not experience all, or even most, rebound headache characteristics.)

Key Rebound Headache Characteristics

· Gradual increase in headache frequency.

· Daily frequent use of rebound-headache-inducing agents at regular, predictable intervals, especially if you are taking headache medications (including over the counter or non-prescription pain relievers) regularly.

· Alternate or preventive medications fail to control the headache attacks.

· Psychological or physical dependency on rebound-headache-inducing medications.

· The headache predictably begins within hours to days of the last dose of the medication.

· Waking up with or experiencing a headache at the same time each day when this had not been your headache pattern.