Headaches
Introduction:
Headache, also termed cephalgia, is pain or a feeling of discomfort in the head, scalp or neck region. The cause of headaches varies with lifestyle (eating habits, stress, depression, anxiety and so on).
Diagnosis:
The various types of headaches are tension-type headache, migraine headache, rebound headache, cluster headache and sinus headache. The occurrence of headaches can be gradual or sudden, lasting from a few hours to several days. Diagnosis of headaches and measurement of response to treatment have been aided by a number of recently developed tools.
Management:
The treatment of headaches can be medicinal and non-medicinal.
Medicinal Treatment
- Analgesic medications
The most common method of treatment is the use of analgesics (painkiller) such as aspirin, ibuprofen, acetaminophen, paracetamol and so on. They are best administered as the first line/symptomatic treatment of migraine and tension-type headaches. They help to cure the pain quickly but temporarily. Prolonged use of analgesics causes headaches to become recurrent with an increase in intensity.
- Abortive medications
Drugs such as ergotamine, prednisone and triptans aid in relieving the headache soon after it occurs. These drugs are used to treat migraines and cluster headaches. It is suggested that these medications should be avoided as it can lead to increased frequency of headache occurrence.
- Prophylactic or preventive medications
Prophylactic medications inhibit or increase neurotransmission and often prevent interpretation of pain signals from the brain. Drugs like gabapentin, topiramate and tizanidine are some of the commonly used preventive medications. They are found to be effective for the treatment of episodic and chronic migraines and also for cluster headaches. They are taken on a daily basis, irrespective of the presence or absence of a headache. Presently this is a widely recommended medication as they have been proven to reduce severity, frequency and disability associated with headaches, thereby improving the overall quality of life.
Non-medicinal treatments
Non-medicinal treatments are used together with medicinal treatments as part of a combined therapy program.
- Physiotherapy
Physiotherapists perform an initial evaluation of the chronic headache patient including assessment of posture, range of motion, muscle tightness and presence of myofascial trigger points. The goal is to determine the underlying structural cause of the headaches and then focus their treatment in this area. Treatment involves educating the patient regarding posture while standing, proper positioning while working at a desk, therapeutic exercises and stretching along with manual physical therapy. Physiotherapy can help diminish the frequency, intensity and duration of the chronic headache sufferers and has proven effective in the treatment of migraines.
- Change in lifestyle (diet, trigger avoidance)
Alteration in meal timings and triggering factors (like caffeine and mobile phone signals) are often responsible for migraines. Try to avoid triggers that may bring on a headache by eating regular meals, avoiding alcohol and caffeine, getting plenty of rest and exercising regularly.
- Relaxation (sleep, stress management and meditation)
Changes in sleep patterns, such as disturbed sleep or sleeping longer are some of the confounding factors associated with migraines. Effective stress management, good sleep and meditation has found to improve the conditions of chronic headaches.
- Cryotherapy and Thermotherapy
This is the use of cold and heat to relieve headache symptoms. This type of therapy can provide great relief to patients suffering from chronic headaches.
- Psychological therapy
Mood disorders are commonly considered as a comorbid condition with headaches. Cognitive behavioral therapy is a widely recommended psychological intervention for the treatment of people with chronic headaches.
- Biofeedback
This evaluates the effectiveness of relaxation training. It provides feedback information of the “body’s (biological) current state” to the patient with chronic headaches. Electromyograph (EMG) and Electroencephalograph (EEG) are used to evaluate electrical activity.
Headache and Age
The management of headaches depends upon the age of the patient. Adults and elderly people are more prone to chronic headaches as compared to children. Establishing the proper diagnosis is of prime importance in order to implement an appropriate treatment plan.
Migraine in Pregnancy
The change in the level of hormones in women is the most common trigger for those prone to migraines. The sex hormone level demonstrates profound changes during pregnancy which in turn has an effect on migraines. Fluctuation in the levels of hormones has shown varied effects on migraines, from betterment, to no change, to worse. Pharmacological treatment is not advised during pregnancy and breast feeding as it might have an adverse effect on the mother as well as on the baby. Keeping in mind the risks of pharmacological treatment, non-pharmacological treatment (such as relaxation, acupuncture and massage) are widely preferred for their beneficial effects during pregnancy and breast feeding.
