BY SUNNDEEP CHOPRA
HEADACHE: A headache is a commonplace neurological (nerve related) symptom, but is almost never linked or associated with significant or serious neurological diseases or ailments unless in conjunction with a host of other symptoms or neurological manifestations that indicate otherwise. Patients however have been known to fear the onset of serious or debilitating brain disease. The specialist should steadfastly avoid falling into this trap or becoming a victim of this dichotomy and learn to tread on the side of caution i.e. have the inherent ability to separate fact from fiction and learn to draw a fine distinction between fears both real and imagined and the sea of difference between allayed fears and clinical manifestations of a headache.
A minute, dispassionate and clinical assessment usually leads to the unearthing of one amongst a variety of clinically recognized headaches. Further investigations are more often than not totally unwarranted as the afore mentioned tests and examinations dissipate whatever little doubt there was as regards the onset of a debilitating disease. The patient in turn can be coerced into succumbing to a mandatory period of symptomatic treatment guaranteed to alleviate all his headache related ills.
Tension type or then stress associated is the most common of all forms of headaches and an overwhelming number of people have succumbed to the wiles of the same on at least one occasion or the other. The associated or resultant pain is constant or perennial and more or less confined to one specific region. But often radiates or projects forward from the occipital (visual processing centre of the mammalian brain) region.
The above or then afore mentioned pain is most often described as dull or throbbing tight or constricting or then like a vortex (pressure) band encircling the head. In a marked contrast to a migraine, the associated pain may continue to persist for either weeks or months without a break or interruption. The severity or seriousness of the same may vary or ebb and flow and vomiting and photo phobia (abnormal or then irrational fear of sudden or abrupt exposure to light) are the exception rather than the norm.
A patient can continue to indulge or then carry on with his daily routine without interruption and may even benefit from his nocturnal activities as the pain may be less conspicuous or noticeable when the patient is usefully employed or occupied. The pain is usually at the bottom most point of its trough earlier on in the day and continues to reach it’s pinnacle towards then end of the same.
TENSION HEADACHE SYMPTOMS: The term or nomenclature ‘tension type headache’ commonly refers to a chronic (persistent or long lasting in nature) head-pain or ache syndrome synonymous with the onset of the above mentioned band like constricting feeling around/within the head. The pain in question gradually builds up its tempo, ebbs and flows or fluctuates, and may continue to persist or then manifest itself for a fortnight or more at a time.
Tension Type Headache is the most common or widespread diagnosis in patients whose head-ache related episodes are bereft of such accompanying friends like nausea, vomiting, photophobia, phonophobia (a morbid fear of sounds including your own voice), osmophobia (fear, aversion or psychological hypersensitivity to smells and odours), constant throbbing or hammering within the head and movement related aggravations.
The adoption of such an enlightened approach allows the specialist to draw a clear line of delineation or demarcation between a migraine and tension type headache as a migraine is similarly characterized by one or more of the above mentioned symptoms or causes.
TENSION HEADACHE TREATMENT: The pain often most associated with or resulting from a tension type headache can generally be managed with or by the ingestion of simple analgesics (any member of the group of drugs used to relieve or alleviate pain) such as acetaminophen, aspirin or non steroidal anti inflammatory drugs. Behavioural or then patient centric remedies including relaxation have proved to be an effective form of treatment.
Recently published clinical studies have demonstrated or proved beyond doubt that triptans (family of tryptamine based drugs used to treat migraines and cluster headaches) are not helpful in any manner whatsoever as a counter measure against such headaches. Triptans are only effective or efficacious when the patient experiences a combination or cocktail of both migraines and tension type headaches. Amitriptyline has proved itself to be the most efficacious form of treatment against chronic tension type headaches.
CAUSES OR REASONS FOR HEADACHES: Making an attempt an explaining the onset of headaches by taking recourse to current neurobiological understanding of the same is an exercise in futility as the same has proved to be wholly inadequate in explaining or then rendering a plausible explanation for the incidence of headaches in patients oblivious of or then unaffected by any serious disease.
The dura (including or then inclusive of the dural sinuses and falx cerebri) and the proximal parts or then parts in close proximity with the large pial blood vessels are the most receptive parts to pain within the human skull. The pain sensitive parts or structures are mostly innervated by the trigeminal nerve and upper cervical nerves and most oftentimes explain or account for the pain patterns when these sensitive parts are stretched or over reached.
TYPES OF HEADACHES:
Ø Tension type headache (persistent daily headache)
Ø Migraine
Ø Cluster headache
Ø Raised intracranial pressure
Ø Benign paroxysmal headaches
Ø Trigeminal neuralgia
Ø Atypical facial pain
Ø Post herpetic neuralgia
OLD AGE HEADACHES:
1. Prevalence or then rate of incidence is rare in people past 60 years of age in comparison to/with younger people.
2. Common Causes: include trigeminal neuralgia, temporal arteritis and post herpetic neuralgia, which rarely if at all occur in younger patients.
3. Migraine and tension type headaches are rarely found in the older generation.
4. Raised intracranial pressure can assume much larger proportions before announcing or manifesting itself as the involutional process that is characteristic of an ageing brain allows or accommodates an expanding lesion far more easily in comparison to that of younger people.
DIAGNOSIS:
Patients with normal headaches or common place symptoms or manifestations of the same are highly unlikely to suffer from a life threatening or debilitating disorder unless their previous medical history is suggestive of or then points towards the presence of any structural disease, no matter however distressing or harrowing their symptoms may be. The features or high points that are instrumental in the establishment of a clear diagnosis or prognosis are as under:
Ø The overall pattern or behavior (whether intermittent or continuous)
Ø The tempo or rapidity of onset
Ø The time of the day when the patient complains of the maximum pain
Ø The effect of wrong or faulty posture, coughing and undue straining.
Ø The area where the pain is localized or located.
Ø Any other associated or interlinked symptoms.
Patients can be further sub divided or segregated into those with chronic ( spreading over several weeks or more) headaches and those afflicted with a more heinous from of the same. The manifestation of serious acute neurological disease should always be taken into account when treating patients afflicted with a sudden and abrupt onset of headaches. A subarchanoid haemorrhage (presence of blood within the subarachnoid space or then different regions of the brain) may be the most common cause for the onset of an almost blinding headache or then extremely agonizing headache that may be localized or otherwise, although only one out of every eight people who experiences or undergoes the agonies associated with such a headache will suffer from a subarachnoid haemorrhage.
A patient with a subarachnoid haemorrhage will almost always display classical symptoms like vomiting and stiffness of the neck though the latter may only make an appearance after a few hours have elapsed.
Migraneous headaches or then migraine related headaches manifest or announce themselves over a period of several hours and are far less likely to be associated with any form or shape of structural disease unless accompanied or coupled with other significant or important signs and symptoms.
Intermittent or then spread out headaches spread over a matter of weeks are most likely to be maigrainous though due diligence must be paid to the time of day when they announce their arrival and other precipitating or then contributory factors. Headaches associated with enhanced or increased intracranial pressure most commonly announce themselves immediately on waking up and may then begin to dissipate as the patient assumes a upright posture or position, thereby reducing the intracranial pressure or then upon the ingestion of a simple analgesic.
Headaches that persist or then continue over a matter of weeks, mark their presence throughout the day and which are analgesic resistant or then unresponsive to analgesics are more often than not tension-type headaches irrespective of their other associated characteristics or features.
Giant cell arteritis should always be considered until ruled out completely in the case of patients over 60 who complain of or then exhibit symptoms of headaches localized or then manifested in one or then both temples.
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