Headache or Cephalagia is perhaps the most common symptom of a number of different conditions and is defined as pain in the head or upper neck. It is one of the most common locations of pain in the body with so many causes. The brain tissues itself is not sensitive to pain due to lack of pain receptors.
Anxiety is related to this pain is because of its association with the brain, the organ of mind. The brain itself is insensitive but some intra cranial structures have receptors for pain. These are:
• The major venous sinuses,
• The arteries round the base of the brain and
• The meningeal arteries and
• The dura of anterior & posterior fossae but not the middle fossa
• All the extra cranial tissues are pain sensitive.
Types of Headache :
The most important mechanism underlying headaches are:
2. Traction on intra cranial structures
4. Muscles spasm
5. Referred pain and
6. Psychogenic headache
Latest Classification of Headache :
There are three main types of headache:
(1) Primary Headache: are mainly of three types-
i- Tension Headache
ii- Migraine Headache
iii- Cluster Headache
(2) Secondary Headache
Types of Headache :
1. Vascular Headache : For the vascular headache dilatation of intra cranial vessels is responsible for headache
• In influenza and
• Other systemic infections and
• Acute renal infections,
• The headache which follows an epileptic fit,
• Post traumatic headache and
• The headache associated with high altitudes, hunger, hypercapnia, anaemia and
• Use of vasodilator drugs such as Histamine, Nitrites & Alcohol.
• Abrupt elevation of blood pressure may cause headache.
Vascular headache is typically throbbing in nature. The headache of migraine and chronic hypertension on the other hand is due to dilatation of extra cranial arteries.
2. Traction on Intracranial Structures :
• In addition to distension, traction on the great vessels and dura at the base of the brain causes headache.
• Pain is momentarily increased by sudden movement of the head.
• Sometimes pain of this nature indicates the localisation of the cerebral tumour.
• The value of headache as a localising sign is reduced by the fact that the pain may be referred to another part of the head but if unilateral it does help to indicate the side of the tumour.
3. Headache due to Inflammation :
• Meningeal irritation due to-
• Produces generalised headache which is increased by head movement, coughing or straining.
• Involvement of the roots of the cranial nerves contributes to headache by causing spasm of occipital and nuchal muscles.
• Neck rigidity is an important sign of meningeal inflammation.
• Extra cranial inflammation usually causes more localised headache.
• Cranial arteritis is a disease of later life characterised by localised throbbing pain in the head, sometimes associated with arteritis in the other parts of the body.
• Tenderness is localised over and around an inflamed temporal artery and if a segment of a vessel is removed for biopsy the pain often disappears.
4. Headache due to Muscle Spasm :
• This is one of the most common mechanisms of headache.
• Contraction is commonly due to emotional tension, producing the most persistent type of headache which in intensity from a feeling of tightness to a true aching pain.
• It may be unilateral but is usually bilateral.
• Nodular areas and points of tenderness may be palpable in the painful muscles or along the occipital and supra orbital ridges.
• Secondary muscle spasm may contribute to a prolonged pain referred from other structures.
• It may also be caused by irritation of cervical nerve roots by cervical spondylosis though this is probably overestimated as a cause of headache.
5. Referred Headache :
• Disease of structures in the head may cause pain referred to the cranium.
• Eye disease such as glaucoma and iritis causes frontal headache.
• Ciliary spasm induced by some errors of refraction may cause pain but 'eye strain' is certainly not a common cause of headache.
• Nasal and sinus disease causes pain in the molar, nasal and frontal areas which responds to nasal vasoconstrictors.
• Dental, aural and temporo-mandibular joint diseases may cause pain spreading far beyond the area of primary pain.
• Pain may even be referred to the head in angina pectoris.
6. Psychogenic Headache :
• By far the most common cause of headache is emotional upset.
• It is often vascular or tension type but may assume peculiar qualities which have features suggesting a mechanism of conversion hysteria.
• It is often a sense of pressure at the vertex or a tight band round the head, constant day and night, and completely resistant to analgesic drugs.
• There is usually an underlying personality defect in this of 'functional headache' which is much rarer than the vascular or tension types of headache.
Latest classification of Headache :
There are three main types of headache which are as follows-
(1) Primary Headache : is further classified into three main types-
i-Tension Headache : is the most common type of primary headache. About 90% adults have this type of headache. Tension headache occur more frequently in females than males.
ii-Migraine Headache : is the second common type of primary headache. It affects both children and adults. Before puberty boys and girls are equally affected by migraine headache but after puberty females are affected more than males. About 5% of men and 20% of women suffers from migraine headache in their whole life.
iii-Cluster Headache : is rare type of primary headache. It affects more commonly men but women and children also suffer by these types.
Primary headaches can affect the quality of life. These headaches are not life threatening.
(2) Secondary Headaches :
Secondary headache are those that occur due to an underlying structure problem in the head or neck. There are so many causes of this type of headache like-
• Bleeding in the brain
• Brain tumour
Treatment of Headache :
Headache may disappear on removal of a primary cause such as-
• Systemic infection
• Ocular disease
• Sinus disease
• Simple psychological problem
• Otherwise the treatment is symptomatic with simple pain killer (analgesic) such as Paracetamol, Acetaminophen or non steroidal anti inflammatory drugs like Aspirin, Ibuprophen or Diclonac
• Opiates are not advisable.
• Psychogenic headache is resistant to all treatment except psychotherapy.
• If the cause of headache is vascular it may be advisable to use the phenothiazine.
• Ergotamine derivatives recommended for migraine.
• Tension headache may respond to tranquillisers such as diazepam, chlordiazepoxide, meprobamate and barbiturate.
When you seek Medical Advice for a Headache :
When Headache is quite different than usual headaches need medical care:
• Sudden start of headache.
• When headache increased on exertion, coughing, bending or sexual activity.
• Headache associated with nausea and vomiting.
• When headache is associated with fever and neck rigidity.
• Headache associated with epileptic fits.
• Associated with recent head injury of fall
• Associated with weakness and sensational disturbance
• Headache with change in vision, behaviour or speech
• Headache not responding to medical treatment
• Needed more than required dose of analgesic for pain relief
• Disability with work and quantity of life.
In brief patient should seek medical care for new onset of headaches, fever, neck rigidity, change in behaviour, vomiting, weakness or change in sensations etc.