When is Headache a Warning of a More Serious Condition?
Like other types of pain, headaches can serve as warning signals of more serious disorders. This is particularly true for headaches caused by traction or inflammation.
Traction headaches can occur if the pain-sensitive parts of the head are pulled, stretched, or displaced, as, for example, when eye muscles are tensed to compensate for eyestrain. Headaches caused by inflammation include those related to meningitis as well as those resulting from diseases of the sinuses, spine, neck, ears, and teeth. Ear and tooth infections and glaucoma can cause headaches. In oral and dental disorders, headache is experienced as pain in the entire head, including the face. These headaches are treated by curing the underlying problem. This may involve surgery, antibiotics, or other drugs.
Characteristics of the various types of more serious traction and inflammatory headaches vary by disorder:
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Brain tumor . As they grow, brain tumors sometimes cause headache by pushing on the outer layer of nerve tissue that covers the brain or by pressing against pain-sensitive blood vessel walls. Headache resulting from a brain tumor may be periodic or continuous. Typically, it feels like a strong pressure is being applied to the head. The pain is relieved when the tumor is treated by surgery, radiation, or chemotherapy.
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Stroke. Headache may accompany several conditions that can lead to stroke, including hypertension or high blood pressure, arteriosclerosis, and heart disease. Headaches are also associated with completed stroke, when brain cells die from lack of sufficient oxygen.
Many stroke-related headaches can be prevented by careful management of the patient’s condition through diet, exercise, and medication.
Mild to moderate headaches are associated with transient ischemic attacks (TIA’s), sometimes called "mini-strokes,"which result from a temporary lack of blood supply to the brain. The head pain occurs near the clot or lesion that blocks blood flow. The similarity between migraine and symptoms of TIA can cause problems in diagnosis. The rare person under age 40 who suffers a TIA may be misdiagnosed as having migraine; similarly, TIA-prone older patients who suffer migraine may be misdiagnosed as having stroke-related headaches.
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Spinal tap. About one-fourth of the people who undergo a lumbar puncture or spinal tap develop a headache. Many scientists believe these headaches result from leakage of the cerebrospinal fluid that flows through pain-sensitive membranes around the brain and down to the spinal cord. The fluid, they suggest, drains through the tiny hole created by the spinal tap needle, causing the membranes to rub painfully against the bony skull. Since headache pain occurs only when the patient stands up, the "cure" is to remain lying down until the headache runs its course – anywhere from a few hours to several days.
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Head trauma. Headaches may develop after a blow to the head, either immediately or months later. There is little relationship between the severity of the trauma and the intensity of headache pain. In most cases, the cause of the headache is not known. Occasionally the cause is ruptured blood vessels which result in an accumulation of blood called a hematoma. This mass of blood can displace brain tissue and cause headaches as well as weakness, confusion, memory loss, and seizures. Hematomas can be drained to produce rapid relief of symptoms.
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Temporal arteritis. Arteritis, an inflammation of certain arteries in the head, primarily affects people over age 50. Symptoms include throbbing headache, fever, and loss of appetite. Some patients experience blurring or loss of vision. Prompt treatment with corticosteroid drugs helps to relieve symptoms.
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Meningitis and encephalitis headaches are caused by infections of meninges-the brain’s outer covering-and in encephalitis, inflammation of the brain itself.
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Trigeminal neuralgia. Trigeminal neuralgia, or tic douloureux, results from a disorder of the trigeminal nerve. This nerve supplies the face, teeth, mouth, and nasal cavity with feeling and also enables the mouth muscles to chew. Symptoms are headache and intense facial pain that comes in short, excruciating jabs set off by the slightest touch to or movement of trigger points in the face or mouth. People with trigeminal neuralgia often fear brushing their teeth or chewing on the side of the mouth that is affected. Many trigeminal neuralgia patients are controlled with drugs, including carbamazepine. Patients who do not respond to drugs may be helped by surgery on the trigeminal nerve.
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Sinus infection. In a condition called acute sinusitis, a viral or bacterial infection of the upper respiratory tract spreads to the membrane which lines the sinus cavities. When one or more of these cavities are filled with fluid from the inflammation, they become painful. Treatment of acute sinusitis includes antibiotics, analgesics, and decongestants. Chronic sinusitis may be caused by an allergy to such irritants as dust, ragweed, animal hair, and smoke. Research scientists disagree about whether chronic sinusitis triggers headache.
What Causes Headache in Children?
Like adults, children experience the infections, trauma, and stresses that can lead to headaches. In fact, research shows that as young people enter adolescence and encounter the stresses of puberty and secondary school, the frequency of headache increases.
Migraine headaches often begin in childhood or adolescence. According to recent surveys, as many as half of all schoolchildren experience some type of headache.
Children with migraine often have nausea and excessive vomiting. Some children have periodic vomiting, but no headache – the so-called abdominal migraine. Research scientists have found that these children usually develop headaches when they are older.
Physicians have many drugs to treat migraine in children. Different classes that may be tried include analgesics, antiemetics, anticonvulsants, beta-blockers, and sedatives. A diet may also be prescribed to protect the child from foods that trigger headache. Sometimes psychological counseling or even psychiatric treatment for the child and the parents is recommended
Childhood headache can be a sign of depression. Parents should alert the family pediatrician if a child develops headaches along with other symptoms such as a change in mood or sleep habits. Antidepressant medication and psychotherapy are effective treatments for childhood depression and related headache.
Conclusion
If you suffer from headaches and none of the standard treatments help, do not despair. Some people find that their headaches disappear once they deal with a troubled marriage, pass their certifying board exams, or resolve some other stressful problem. Others find that if they control their psychological reaction to stress, the headaches disappear.
"I had migraines for several years," says one woman, "and then they went away. I think it was because I lowered my personal goals in life. Today, even though I have 100 things to do at night, I don’t worry about it. I learned to say no."
For those who cannot say no, or who get headaches anyway, today’s headache research offers hope. The work of NINDS-supported scientists around the world promises to improve our understanding of this complex disorder and provide better tools to treat it.
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Where can I get more information?
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:
BRAIN
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424
http://www.ninds.nih.gov
Information also is available from the following organizations:
| American Council for Headache Education 19 Mantua Road Mt. Royal, NJ 08061 achehq@talley.com http://www.achenet.org Tel: 856-423-0258 800-255-ACHE (255-2243) Fax: 856-423-0082 Non-profit patient-health professional partnership dedicated to advancing the treatment and management of headache and to raising public awareness of headache as a valid, biologically-based illness. |
National Headache Foundation 820 N. Orleans Suite 217 Chicago, IL 60610-3132 info@headaches.org http://www.headaches.org Tel: 312-274-2650 888-NHF-5552 (643-5552) Fax: 312-640-9049 Non-profit organization dedicated to service headache sufferers, their families, and the healthcare practitioners who treat them. Promotes research into headache causes and treatments and educates the public. |
angiography-an imaging technique that provides a picture, called an angiogram, of blood vessels.
aura-a symptom of classic migraine headache in which the patient sees flashing lights or zigzag lines, or may temporarily lose vision
basilar artery migraine-migraine, occurring primarily in young women and often associated with the menstrual cycle, that involves a disturbance of a major brain artery. Symptoms include vertigo, double vision, and poor muscular coordination.
benign exertional headache-headache brought on by running, lifting, coughing, sneezing, or bending.
biofeedback-a technique in which patients are trained to gain some voluntary control over certain physiological conditions, such as blood pressure and muscle tension, to promote relaxation. Thermal biofeedback helps patients consciously raise hand temperature, which can sometimes reduce the number and intensity of migraines.
cluster headaches-intensely painful headaches-occurring suddenly and lasting between 30 and 45 minutes-named for their repeated occurrence in groups or clusters. They begin as minor pain around one eye and eventually spread to that side of the face.
computer tomography (CT)-an imaging technique that uses X-rays and computer analysis to provide a picture of body tissues and structures.
dihydroergotamine-a drug that is given by injection to treat cluster headaches. It is a form of the antimigraine drug ergotamine tartrate.
electroencephalogram (EEG)-a technique for recording electrical activity in the brain.
electromyography (EMG)-a special recording technique that detects electric activity in muscle. Patients are sometimes offered a type of biofeedback called EMG training, in which they learn to control muscle tension in the face, neck, and shoulders.
endorphins-naturally occurring painkilling chemicals. Some scientists theorize that people who suffer from severe headache have lower levels of endorphins than people who are generally pain free.
ergotamine tartrate-a drug that is used to control the painful dilation stage of migraine.
hemiplegic migraine-a type of migraine causing temporary paralysis on one side of the body (hemiplegia)
inflammatory headache-a headache that is a symptom of another disorder, such as sinus infection, and is treated by curing the underlying problem.
magnetic resonance imaging (MRI)-an imaging technique that uses radio waves, magnetic fields, and computer analysis to provide a picture of body tissues and structures.
migraine-a vascular headache believed to be caused by blood flow changes and certain chemical changes in the brain leading to a cascade of events – including constriction of arteries supplying blood to the brain and the release of certain brain chemicals – that result in severe head pain, stomach upset, and visual disturbances.
muscle-contraction headaches-headaches caused primarily by sustained muscle tension or, possibly, by restricted blood flow to the brain. Two forms of muscle-contraction headache are tension headache, induced by stress, and chronic muscle-contraction headache, which can last for extended periods, involves steady pain, and is usually felt on both sides of the head.
nociceptors-the endings of pain-sensitive nerves that, when stimulated by stress, muscular tension, dilated blood vessels, or other triggers, send messages up the nerve fibers to nerve cells in the brain, signaling that a part of the body hurts.
ophthalmoplegic migraine-a form of migraine felt around the eye and associated with a droopy eyelid, double vision, and other sight problems.
prostaglandins-naturally occurring pain-producing substances thought to be implicated in migraine attacks. Their release is triggered by the dilation of arteries. Prostaglandins are extremely potent chemicals involved in a diverse group of physiological processes.
serotonin-a key neurotransmitter that acts as a powerful constrictor of arteries, reducing the blood supply to the brain and contributing to the pain of headache.
sinusitis-an infection, either viral or bacterial, of the sinus cavities. The infection leads to inflammation of these cavities, causing pain and sometimes headache.
sumatriptan-a commonly used migraine drug that binds to receptors for the neurotransmitter serotonin.
status migrainosus-a rare, sustained, and severe type of migraine, characterized by intense pain and nausea and often leading to hospitalization of the patient.
thermography-a technique sometimes used for diagnosing headache in which an infrared camera converts skin temperature into a color picture, called a thermogram, with different degrees of heat appearing as different colors.
temporomandibular joint dysfunction-a disorder of the joint between the temporal bone (above the ear) and the lower jaw bone that can cause muscle-contraction headaches.
tic douloureux-see trigeminal neuralgia
traction headaches-headaches caused by pulling or stretching pain-sensitive parts of the head, as, for example, when eye muscles are tensed to compensate for eyestrain.
trigeminal neuralgia-a condition resulting from a disorder of the trigeminal nerve. Symptoms are headache and intense facial pain that comes in short, excruciating jabs.
vascular headaches- headaches caused by abnormal function of the brain’s blood vessels or vascular system. Migraine is a type of vascular headache.
"Headache: Hope Through Research," NINDS.
NIH Publication No. 02-158
Tags: migraines, reflexology for migraine, syptoms for headaches