What Type of Headache do You Have?

When you are looking at headaches, it is important to look at location, quality, severity, duration, and unique features of that headache. There are many types of headaches.  They are caused by cough, cranial nerve inflammation, infection, Injury, substance abuse, bone structure of the head or face, blood flow to and from the brain, changes in brain chemistry, tumors, and seizures.

Ice cream headaches cause brief, stabbing head pain when you eat, drink, or inhale something cold. “Brain Freeze” occurs when the blood vessels constrict (narrow) to prevent heat loss, and then dilate (open)to let blood flow rise.

There are 4 Main Types of Headache:

  1. Sinus– Sinus infections may erode through the bones of the sinus and structures in the face. The pain and tenderness is frontal, at the brow, and/or below or behind the eye. The sufferer may also experience bilateral pressure and fullness of cheeks, fever, fatigue, sore throat, cough, and decrease ability to smell.
  2. Cluster– is a stabbing or sharp pain, which may cause swelling around eyes or to eye lids. Cause is unknown
  3. Tension– This type of headache may be caused by fatigue, bad body posture, stress, and extreme exertion. The discomfort felt is bilateral head tightening. Complications include dependence on analgesics, and the risk of epilepsy is 4 times greater.
  4. Migraine– tends to start in childhood or adolescence. Women are 3 times more likely to get a migraine headache. Menstrual migraines are often treated by taking oral contraceptives. Researchers find there may be an imbalance of the brain chemical- serotonin. Complications include chronic migraines, seizures, migraine infarction (symptoms of stroke with blood loss to an area of the brain), medication over use (rebound headache), and abdominal complaints. Serotonin syndrome is when the body has too much serotonin due to taking migraine meds along with antidepressants called SSRI’s (Zoloft, Prozac, Paxil) or SNRI’s (Cymbalta, Effexor). There is a genetic predisposition to migraines. 80% of migraine sufferers have a family history.                                                                                                              Migraines have 4 phases:
  1. First- Pro-drome- up to 48 hours before the migraine. The sufferer may experience emotional changes, yawning, urinary frequency, fluid retention, stiff neck, and thirst or food cravings.
  2. Aura-warning, flashes of light or wavy vision, tingling on one side of face or body, speech disturbance.
  3. Headache- Throbbing, sensitive to light, noise, odors, movement, nausea, vomiting, blurred vision. Severe, debilitating head pain.
  4. Post-drome- after pain resolves, fatigue, irritability, euphoria that lasts a day or longer, and feels drained.
  1. Seek immediate medical attention:Sudden, severe headache that feels like a thunderclapHeadache after a head injuryNew headache after the age of 50.
  2. Persistent headache after straining, or exertion
  3. Headache with fever, seizure, confusion, difficulty speaking, double vision, numbness.
  4. THE WORST HEADACHE OF YOUR LIFE- This is a medical emergency and needs Emergency Room evaluation.
  5. Triggers- foods that contain tyramine-in aged foods like deli meat, aged cheeses, avocado, bananas, dried fruit. Foods that contain MSG. Also, chocolate, aspartame, beer, and wine. Environmental- stress, irregular sleep patterns, odors, weather changes, bright light. Women- notice migraine pattern with hormonal changes, and worsens at time of period, and improvement during pregnancy and menopause.
  6. Treatment works best when symptoms are treated early. Medication over-use headaches can occur when treatments for more than 3 days a week. Over use can worsen an underlying condition and decreases response to treatment. Prevention Treatments- for 1 or more headaches a week or for those with severe headaches that interfere with normal activities. Useful for 6 months and then begin to taper.
  7. Natural remedies to prevent headaches include Vitamin B2, Magnesium, Co-enzyme Q10, butterbur, and feverfew. First check with your doctor as there may be drug-drug interactions with other medicines.
  8. Diagnosis- Blood Tests and Spinal Tap to look for infection or toxins, CT Scan and MRI to look for tumors, infection, brain damage, and bleeding.
  9. Treatment:
  1. Pain- Relief
  1. Aspirin, Acetaminophen, Ibuprofen, Excedrin, indomethacin.  Use with caution as over use can cause liver and kidney damage.
  2. Triptans- block pain in the brain, constrict blood vessels. Pill, Nasal spray, injection. Imitrex, Maxalt, Axert, Amerge, Zomig, Frova,Treximet (Imitrex with Naproxen), and Relpax. Side effects: nausea, dizzy, drowsy, muscle weakness. Do not take if at risk of heart attack or strokes.
  3. Ergots- Ergotamine and Caffeine combination- can cause nausea and vomiting, Migranal- ergot derivative with less side effects than ergotamine, and people respond better to it. It comes in nasal spray and injection.
  4. Anti-nausea- helps to take with migraine medication
  5. Opioid meds- narcotics, but are habit forming.
  6. Glucocorticoids- prednisone or dexamethasone
  7. Pain- Prevention- reduces the frequency, severity, and length of migraine.
  8. Cardiac drugs- beta blockers- Inderal, Lopressor, betimol. ACE Inhibitors- lisinopril,  calcium channel blockers- calan
  9. Anti-depressants- amitriptyline, Effexor
  10. Anti-seizure- Topamax
  11. Botox- injected every 12 weeks.
  12. Alternative Medicine
  1. Acupuncture, biofeedback- how to control physical responses to stress, massage therapy, cognitive behavioral therapy- teaches you how behaviors and thoughts affect how you perceive pain.
  2. Herbs, Vitamins, Minerals
  3. Muscle relaxation exercises- meditation or yoga, Reduce Stress
  4. Get enough sleep
  5. Rest and relax- dark quiet, cool room
  6. Headache diary, don’t skip meals
  7. Preventive therapies-
  1. Transcutaneous supraorbital nerve stimulation (t-SNS)- FDA approved
  2. Learn coping strategies.
  3. Consistent daily schedule with sleep, meals, and medications
  4. Reduce intake of estrogen
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