Headache is indeed the most common symptom everyone suffers in his day to day life. But rather than going all type approaches for headache, we will be explaining today what are the types of headaches and what possible information a medico should have about headache.

Headache is a symptom which appears as pain occurring anywhere in the region of head and neck. Cutting off the causes of headache, we will just discuss types of headaches as shall be learn by a medical officer.

Types of Headache

There are basically 5 types of headaches that we will be dealing about in this blog. These are:

  1. Migraine
  2. Tension headache
  3. Cluster headache
  4. Hypnic headache
  5. Pseudotumour cerebri

Let’s have a closer look on all the types we just pin pointed:-

MIGRAINE

Migraine is basically a female predominant type of headache. Most common age in which females face migraine has been found to be 10-25 years of age.

Features

  1. It is commonly unilateral (meaning one sided)
  2. Throbbing pain in nature
  3. Severe in intensity
  4. Starts and peaks at 3-4 hours
  5. Associated with photophobia and phonophobia (fear of light and sound)
  6. Associated with nausea and vomiting
  7. Associated with aura

Just to explain, Aura is feeling before migraine actually starts. Visual disturbances are more common in the contralateral eye.

Migraine, again can be of two types, depending whether the aura was present or not.

  • Headache with Aura- 25% – also known as classical migraine.
  • Headache without aura- 75% – common migraine
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Diagnosis

Clinical/ diagnosis of exclusion is done to find out migraine following the symptoms. Other features of migraine include:

  • Xray PNS (paranasal sinus) – normal
  • MRI Brain – normal
  • Fundus examination – normal

 

Treatment

Depends whether the migraine is acute migraine or chronic migraine:

1. Acute migraine

  • First drug- NSAID (Non steroidal anti inflammatory drug)
  • Best drug- sumatriptan ( sumatriptan,though, has 10-13% chances of sudden cardiac death)
  • Other drug- ergotamine

2. Chronic migraine

  • Propanolol
  • Valproate
  • Flunarizine
  • Caramazepine
  • Topirimate
  • TCA (Tricyclic antidepressants)
  • cGRP antagonist which is calcitonin related peptide, eg. OLCAGEPENT
  • PIEZOTIFEN which causes vasoconstriciton and is 5HT2 antagonist

 

Tension headache

There is constant gripping sensation on forehead. Moreover, there is no anxiety and stress. This headache is less severe in intensity and thus mild headache. Therefore, it usually doesn’t interfere with normal life.

The tension headache is further divided into two types as acute and chronic.

  • Acute Tension Headache- less than 15 episodes per month
  • Chronic Tesnion Headache- more than 15 episodes per month

 

Treatment

  • Acute Tension Headache- Nsaids
  • Chronic Tesnion Headache- TCA like amitryptiline

 

Cluster headache

It is a male predominant type of headache and commonly occurs at age of 30-40 years.
Features of cluster headache include:

  1. Rhinnorrhoea- unilateral
  2. Lacrimation- unilateral
  3. Intake of alcohol- on/off effect which is pathognomic of cluster (patient complains of increased intensify and frequency of headache with 3 episodes per day for 1-2 months and then a gap of 1 year)
  4. Tearing type of headache which hampers normal life
  5. Unilateral type
  6. Very severe in intensity
  7. Chemosis which is unilateral
  8. Nasal congestion which is unilateral
  9. Peaks in 10-15 minutes and remains for 45-60 minutes
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Diagnosis

The diagnosis is again made on clinical basis.

Treatment

1. For acute cluster headache:

  • O2 inhalation
  • Application of lignocaine to base of inferior nasal turbinate which blocks pterygopalatine ganglion

2. For chronic cluster headache:

  • DOC,namely verapamil
  • lithium
  • steroids
  • ergotamine

 

Hypnic headache

It is more prominent in elderly females where the mean age is 60 years. The headache occurs within 1-2 hours of sleep and remains for more than 15 minutes. Pathophysiology of  hypnic headache is yet unknown but hypertension may be related since hypothalamic nucleus may have a role.

Features

  1. Occurs 1-2 hrs after sleep
  2. Very severe- patient awakes of headache
  3. Lasts more than or equal to 15 minutes (upto 1 hour)
  4. Frequency should be more episodes per month
  5. Associated with hypertension
  6. Associated with hypothalamic inflammation which gives circadian rhythmic type of headache
  7. MRI of brain is normal
  8. EEG explains REM sleep onset

 

Treatment

  • For acute attacks- NSAID like indomethacin
  • For chronic attacks- Lithium is used

 

PseudoTumour cerebri

It is also known as benign intracranial hemorrhage. It is more predominant in females than males. Common age is 35-50 years of age. The pseudo tumour cerebri is more common in obese patients.

Risk factors of pseudotumour cerebri

  • Addison’s disease
  • Hypoparathyroidism
  • Oral contraceptive pills
  • Hypervitaminosis A

 

Features

  1. Incidentally mild headache which doesn’t hamper daily activity
  2. Maybe unilateral or bilateral
  3. No focal neurological deficit (FND)
  4. Fundus- pappiloedema
  5. MRI brain is normal
  6. CSF examination reveals pressure increased and cells,protein and sugar are normal

 

Treatment

  • For chronic pseudotumour, the approach is either medical or surgical.
  • Medically, we give acetazolamide or sterouds like prednisolone.
  • Surgically, in order to reduce CSF pressure, we perform either optic nerve fenestration or Ventriculo peritoneal shunt is performed.
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So that was all about the five types of headache from the medical point of view.

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