Sunday July 6, 2008

An aching head

Getting to know different types of headaches.

TELL ME ABOUT:By DR.Y.L.M

MY mother has migraine and so I am very familiar with it. But recently, I developed a headache which is most severe around my temples. I went to a doctor and she told me it was not a migraine. You mean there are other types of headaches other than migraine?

Of course. A headache is any pain in your head located above your eyes or ears, behind you head or in the back portion of your upper neck. Any ache in anywhere other than this region is considered an ache of another part of your face.

There are in fact two types of headaches:

Primary: these are not caused by other diseases

Secondary: these are caused by other diseases, which span the gamut from the mild (viral infection in your nose, lack of sleep, withdrawal from caffeine or certain medications) to the severe (brain cancer, meningitis, encephalitis, subarachnoid haemorrhage).

There are even mixed headaches, in which tension headaches or secondary headaches can trigger migraines.

What types of primary headaches are there?

The most common type of primary headache is not migraine, as most people think, but is actually tension headache. As many as 90% of all people in this world have at one time in their lives or other had a tension headache. These headaches are more common in women than men.

Migraine is of course the 2nd most common type of headache, with as much as 12% of the population suffering from it. Migraines affect women more than men in adulthood.

A rarer type is cluster headache, which affects only 0.1% of the population. Men are the predominantly affected this time.

How can I differentiate which type of headache I’m having?

Tension headaches begin in the back of your head or upper neck. It feels like a band-like tightness or pressure, as though you are wearing a very tight headgear encircling your head, especially over your eyebrows.

The pain is mild and affects both sides of your head. You will be able to function despite it.

Migraine is very chronic. There will be recurrent attacks. Unlike tension headaches, migraines usually involve one side of the head, predominantly sited at your temple, though sometimes it can be located in your forehead, around your eye or the back of your head. (But in one third of cases, the migraine can involve both sides of your head.) This one sided headache typically switches to the other side the next time!

It is an intense, throbbing pain which is usually aggravated by daily activities like walking. Migraines are associated with nausea, vomiting, diarrhoea, cold hands and feet and sensitivity to light and sound. An attack can last from four to 72 hours and you will have to lie in a quiet, dark room.

Up to half of migraine sufferers have warning symptoms for hours or days of the impending attack, such as sleepiness, irritability, fatigue, depression, or even a craving for salty foods. About 20% of migraine sufferers have something called an “aura”, which precedes the headache.

These auras are usually flashing, bright lights in a zig-zag pattern, a “hole” in your vision, pins-and-needles in your arms or around the mouth and nose on the same side of your coming headache. Some people even hear hallucinations and have abnormal taste or smell.

Cluster headaches come in groups that last for weeks or months. During these clusters, pain occurs once or twice a day, from 30 minutes to 1.5 hours each. This headache often awakens you from sleep and is very, very painful. The pain is usually located around one eye and is described as a “red hot poker-like pain”.

The affected eye may become red and watery, and the nose on that side may become blocked or runny. Cluster headaches are so painful that the sufferer is usually restless, sometimes walking up and down and banging their heads on the wall.

From what you describe, I believe I have a tension headache. What can I do?

It is normal to get the occasional tension headache. If it doesn’t interfere too much with your life, then you can take some simple analgesics such as paracetamol or aspirin or non-steroidal anti-inflammatory agents.

If in any doubt about a chronic headache, consult a doctor. Sinister secondary causes must be ruled out for headaches that occur too frequently for too long a duration.

Can I prevent migraines? Or are they medicated only when they come on?

You can indeed take certain medication to abort migraines. The triptans stops the migraine. If you use the triptans early, you can abort the migraine in 80% of cases within two hours. You can also use the ergots to abort migraines, but they have more side effects than the triptans.

As for preventing migraines, you must understand your own particular triggers and avoid them. For example, a lot of migraines are triggered by stress, not enough sleep, bright or flickering lights, alcohol, cheeses, coffee, etc. Make sure you avoid these foodstuffs and drinks and always get enough sleep.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health advice, computers and entertainment. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.