What is a headache ?
Headache, pain localized in and around the head, is almost always an innocent complaint. Brain tissue is numb. The causes of headache should therefore be sought in the muscles and ligaments around skull and neck, blood vessels, the meninges and the brain pressure.
What causes headaches ?
Most of headache is tension headache. Migraine and headache caused by medication are numbers two and three. A patient can have several causes for headaches. For headaches psychosocial causes may play a role.
Headache syndromes
- Tension Headaches caused by excessive sensitivity of the tendon insertions and neck and skull. The patient feels this like a tight band around the head is whether it is from both sides of the head or behind the neck pushed. Usually there is no retching or sensitivity to light or sound. Usually the headache holds several hours.
- Migraine attacks coming in from quite severe throbbing headache on one side of the head, frequently with nausea, vomiting and sensitivity to light and sound. The duration of the attack varies from half a day to three days. Often symptoms such as flickering or black spots before the eyes or tingling on the headache before.
- Medication overuse headache: chronic and often takes more than three days a week. Causes pain relievers (eg for headaches), anti-migraine, coffee, alcohol (hangover) and chocolate.
- Cluster headaches: is very intense throbbing, sharp pain around the eye socket. The attacks last between fifteen minutes and three hours and come in groups for a few weeks. The patient can not lie still or sitting.
Headache as a sign of another problem
- Inflammation of the sinuses
- Fever
- Increased pressure within the skull. This may be caused by bleeding in the brains or in the meninges, hydrocephalus (water main), brain edema, for example, after a head injury and so forth.
- Disease of the meninges; (meningitis), bleeding (arachnoid haemorrhage).
Attention
Extra care is needed when there are neurological signs, such as whether or not a transient paralysis. Even if there is a "new" headache occurs after the age of 50, migraine for the sixth year or for the first time after the age of 40 years is to look extra good on. Furthermore, if the headaches occur after an accident, is severe and getting worse or if it is severe and occurs suddenly. Caution is also in place in elderly patients with pain (one of) the sleep (blood vessel inflammation) and fever, especially if it is accompanied by a stiff neck. In addition, the doctor will be on his guard in pregnancy, small children, a rapidly rising blood pressure and broke free of the headache.
Headache research
In the tension headache, migraine headaches and means-tested physical examination is not found necessary. At suspicion of a disease (infection or bleeding) of the meninges, the patient is urgently referred to a neurologist. This will perform a spinal tap and measure the pressure. When a tumor is suspected, a CT scan or an MRI scan will be made.
Headache treatment
- By keeping a headache diary, the patient can identify precipitating causes (eg sleep, nutrition, quarrel) and try to avoid it.
- By means dependent headache suspect agent but can immediately be completely discontinued.
- If painkiller acetaminophen may stop briefly and possibly an NSAID use.
- In migraine must distinguish between aborting an attack (painkiller with emetic; if that does not help a triptan, such as sumatriptan on the one hand and the prevention of an attack (beta blocker or hormones (like menstrual dependent) or divalproex)
- Cluster headache is treated with triptans.