11/10/2009 5:00:00 AM
I have a headache, Doc!
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By Dr. Muhammed R. Al-Fawakhiri
Headaches are one of the most common health complaints. 90% of headaches are tension headaches, often triggered by stress, presenting as tightness in the muscles of the neck and the scalp. These are mild to moderate, and are mostly described as pressure-like nagging aches. Most of these cases don't find their way to a doctor, as they usually respond to over-the-counter (OTC) medications.
Migraines are the primary example of vascular headache: a headache caused by an abnormal functioning of the brain blood vessels. It is severe and lasts for a few hours and is associated commonly with high sensitivity to light and noise during the attacks. They may be associated with nausea, vomiting, and visual disturbance.
Migraines occur more frequently in women, and may have familial hereditary pattern. As many of my patients know, I suffer migraines myself. My mother and other family members have migraines also.
There are many triggers for migraines, and they differ between patients. Common triggers are: stress, weather changes, sleep deprivation, too much chocolate or alcohol, and in women: hormonal changes. Physical exercise may reduce the frequency and severity of migraine attacks in some patients.
Migraines usually affect either side of the head or both. They are often described as a throbbing pain. Treatment ranges from OTC medications, to medications that target migraines in particular. There are medications that help decrease the occurrence of migraines or its severity. Some experimental medical treatments include relaxation techniques, acupuncture, and electrical or magnetic stimulation of the vessels in the base of the skull, but all therapies should try to identify the triggers and eliminate them.
Chronic headache is similar to tension headache (muscle contractions), but can last for weeks or months. Cluster headache is similar to migraines (brain vessels), but usually affects young men, and mostly strikes around the eyes with tearing and runny nose. They occur in clusters of multiple attacks over several days (hence the name). Less frequent headaches include sinus, toothache-related, headaches associated with brain tumors, bleeding or aneurysms. Some severe infections, such as meningitis, may also be associated with headaches.
While most headaches are benign, there are some features that are red flags and should be reported to your physician ASAP. These include (but not exclusively): sudden onset of severe headache, frequent recurrence of headaches especially if worsening, history of recent head trauma, stiff neck and fever, confusion, convulsions and seizures, loss of consciousness, pain in the eyes or the ears.
I should remind the reader that I specialize in internal medicine (medicine for adults). I'd advise that you consult with your pediatrician for any headaches in children.
For further information, please refer to the following institutions whose web pages were valuable resources for this article: the National Headache Foundation, The National Institute of Neurological Disorders and Stroke, and the American Headache Society.
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Posted: Wednesday, November 11, 2009
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