Headache can be a sign of another underlying disorder

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Headache can be a sign of another underlying disorder

Around half of the world's adult population have an active headache condition at some phase in their lifetime. Similar to fever, which is just a symptom or manifestation of an underlying disease, headache itself is not a diagnosis. It permits a thorough medical and neurological investigation when the headaches are severe, recurrent, intractable and poorly responsive to medication.

Multiple problems like medical, neurological, psychiatric or local craniofacial can lead to an indication of headache. Migraine, tension headaches and cluster headaches are examples of primary headache disorders. These are the neurological conditions where patients experience recurrent headaches but there is no underlying structural origin. These are generally benign and potentially treatable but are recurrent in nature. Few more examples of primary headache disorders inculcate migraine with and without aura, such as tension type headache, cluster headaches, hemicrania continua (HC), primary thunderclap headache and hypnic headache etc.

Out of these, specifically migraine come to medical attention after months to years of recurrent episodic headaches which were being often managed with over the counter medications. Often, these episodes diminish with sleep, analgesics and after vomiting.

Simple lifestyle changes serve as a crucial part of migraine management focusing on adequate sleep, regular meals, minimizing exposure to triggers and relaxation methods.

Cluster headaches commonly observed in males are marked by intense unilateral pain around the eye concerned with redness, watering from eyes and rhinorrhea (nasal congestion). Duration of each attack can be up to 180 minutes and often induces severe distress to the patient which mostly paces up and down during the episode. It may last days to weeks and then attenuate only to recur again periodically after a headache free interval. Oxygen inhalation and triptans are used to manage the acute attacks.

Tension headaches are often characterized by bifrontal or occipital/neck dull aching, continuous headaches with a band like steady tightness. The episode may last from days to months.

Secondary headache disorders possess various subcategories and comprise headaches due to the head or neck trauma, headaches due to stroke, infection, tumors, headaches due to the eye, ear, sinus or dental problems and headaches due to psychiatric conditions like depression. Red flags in headache disorders which warrant an early evaluation comprise of recent onset headache, recent change in character of headache, sudden onset worst ever headache, early morning headaches, headaches in young children, elderly, pregnant women or post-delivery, headaches associated with fever and other neurological symptoms example seizures and paralysis and post-traumatic headaches.

As per the clinical diagnosis, routine haemogram, erythrocyte sedimentation rate (ESR) and C-reactive protein and other blood investigations may be required. According to an index of suspicion of a secondary headache disorder, the computed tomography (CT) scan or magnetic resonance imaging (MRI) of the brain is indicated in some cases.


Khaleej Times

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The original title of the article:

Headache, a manifestation of underlying disorder

Exploratory, Triptans, Headache, Tryptamine-based Drug
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