Melomed Articles

4 October 2019 - Dr. Jean-Paul Kanyik


What causes headache?
There are many causes depending on the type of headache. In general, headache can have a primary (unknown) or secondary (known) cause.

Primary headache
-Tension headache: is the most common type of headache, but not well understood. It is precipitated by emotion and anxiety and manifests as dull, tight or pressure like pain.
-Migraine: is a benign and recurrent syndrome which is associated with headache, nausea/vomiting and other varying neurologic dysfunctions (Numbness, tingling, speech or visual disturbances which can precede headache).

Migraine start before middle age, more prevalent in female than male. 
The cause is unknown and often it runs in families. Sometimes it is associated with warning symptoms (Preceding symptoms).
Triggers can be Chocolate, cheese, contraceptive pills, caffeine, alcohol, anxiety, travelling and exercise.
-Cluster headache: are less common than migraine and more prevalent in men. Typical scenario: A man in his 30's is a smoker and heavy drinker. 
Headache start at the same time every day for weeks. It is an excruciating unilateral (one sided) headache, lasting 30 min to 3 hours, this may be associated with one sided running nose, redness or tearing of an eye.

Secondary causes
Headache which is caused by other illnesses such as head injury, bleeding in the brain or outside the brain, meningitis, glaucoma, temporal arthritis. Frequently asked question: Doctor is it dangerous? Yes, this type of headache is dangerous and need urgent treatment

How do I know if it's serious?
  • New onset headache
  • Associated symptoms like fever and neck stiffness
  • Deep and dull headache which disturbs sleep
  • Changing in the character of the headache

What will the Doctor do?
Take detailed history and establish whether there is secondary cause or not. He may use a scoring system to establish the difference between tension headache and migraine.

Do I need Blood tests or a CT Brain?
Depending on your doctor's assessment. Investigations are done to exclude secondary causes. Brain hemorrhage or brain tumor will easily be seen on CT scan. For Meningitis, although a CT scan may be required, the key investigation is the lumbar puncture.

What is the treatment for headache?
Tension headache: counselling, physiotherapy for muscle relaxation and amitriptyline for prevention. In this category over use of pain killers, can worsen headache leading to a vicious cycle.
Migraine: Identifying triggers and exacerbating factors, will help to prevent attacks. Pain killers usually provides some relieve. Many drugs can be used, but caution should be taken with medication overuse. Researches are being done for new drugs (e.g Rimegepant) that promises better control and prevention of migraine for millions of people. 
Cluster headache: Acute attacks can be treated with sumatriptan or 100% inhaled Oxygen. Migraine therapies are ineffective in treating cluster headache.


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