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Having a headache is very common and may be due to stress, tense muscles, colds, anxiety or visual disturbance. Usually the headache is over by itself, but sometimes it can last for a while or come more often. Although unusual, headache may in some cases be due to a serious disease such as brain bleeding, meningitis or brain tumor. The most common type of headache is tension headache. Migraines are also common. Over two million Americans get tension headache once a week, and as much as half the population sometime a month.
Different types of headache
The name of tension headache is that it was previously thought that there are muscle tension around the skull or in the neck that causes headache. Recently, it has been shown that not everybody who has it has tense muscles, and so the pain is now also called the headache of stress type. Often, stress, anxiety or incorrect posture lies behind the headache. Other common causes are visual disturbances and problems with teeth or clothing.
If you have migraine, you get recurring seizures of severe blistering or throbbing headaches in one or both of the main halves. At the same time, you feel ill and are insensitive to noise and light. If migraine is not treated, it can remain for two to three days, but usually for 12-18 hours. Triggers can be stress, hormone changes during the menstrual cycle and some foods.
It’s not uncommon for you to get a headache at heavy physical exertion, like heavy lifting. The pain usually releases after a few hours, but can last for up to a day and is usually harmless. However, if you get an intense and sudden headache associated with exercise, it may in rare cases mean that you have a brain bleed.
Headache caused by drugs
If you are taking headache tablets for more than 15 days a month, chronic headache may occur after a while due to the frequent use of the medicine. There is a risk that you developed a reliance on some medicines against pain, and then it can be difficult to stop them without help. Often this type of headache is dull, diffuse spread throughout the head and sometimes you also have ringing noise in your ears. There are also many other medicines that can cause you to get headache as a side effect, such as nitroglycerin. The headache usually then depends on the medicine affecting the blood vessels.
Typical for sinusitis is that while having a headache, you also have a thick, gröngul snout. The headache is in the cheek, forehead or neck and becomes worse if you move your head quickly or lean forward.
Horton’s headache is manifested by periods of seizure of a one-sided and almost unbearable blistering or cutting pain that sits in or around the eye. The attacks occur regularly for a certain amount of time, often at night. Often the eye becomes red and teared during the attack, while the nose can drain on the affected side.
If you get a blow to your head you may suffer from bleeding on or under the brain’s minds. It is not always noticeable because you get a lot of pain in your head, but often through other symptoms such as fatigue or difficulty in getting in touch. Symptoms may be mild at first but usually increase slowly over a couple of weeks. Since the brain can damage the increased pressure, contact a healthcare center for a survey if you have had a stroke against the skull and have diffuse symptoms.
Symptoms can be a headache that occurs very suddenly, and which quickly becomes more intense and often pulsating. The pain often radiates to the neck, back, or sometimes to the bones. Brain bleeding may occur in, for example, pulmonary artery fractures in the brain’s vessels or bleeding under the bones.
Inflammation of the temporal artery
This is a rheumatic disease that can affect vision if it is not treated in time. The symptoms are a long lasting pain in one thinning and tenderness of the scalp, while you are getting tired and getting light fever. It hurts when cheating is a fairly common warning signal for this condition. You then get treated with cardiac tablets. The disease is also called temporal artery and is more common in women than men. You get rarely sick before the age of fifty years.
When you get meningitis you have a headache that increases for a few hours up to a day. At the same time you feel drowsy, often get high fever and difficulty bending your head forward. Sometimes blistered dots that are due to small bleeding can appear on the skin.
A brain tumor is a very unusual cause of headache. Almost all Swedes have a headache sometime in a year. About a thousand people each year get a brain tumor that started in the brain itself.
Headache can be as one of many other symptoms in several diseases. If you feel anxiety, anxiety, stress, fatigue or depression you often also get a headache. You may also get headache due to flu, colds and many other infections caused by viruses or bacteria. As a side effect, some medicines may cause pain in the head.
You may also get headache for example because of:
- Refractive errors
- Heavy effort
- Hangover after a lot of alcohol
- If you stop drinking coffee, or decrease your coffee consumption for a few days
- If head has been exposed to cold
- A sharp increase in blood pressure
- Withdrawal after you have stopped using drugs, alcohol, nicotine or drugs.
When should you apply for care?
Usually you do not need to seek care because the headache usually passes by itself. But sometimes you may need to seek care, for example, if the headache is difficult or prolonged. You should seek care directly at a healthcare center or emergency department for example:
You can do quite a lot yourself, for example, you can try to reduce stress and change bad workplaces. If the headache is because you look bad, it may help if you get glasses. The pain does not get worse, but can be relieved by the fact that you exert yourself physically.
If the headache is mild, it often helps with non-prescription pain reliefs. For more severe pain, you may sometimes get prescription drugs. You should be careful with pain relief because you may have a headache of using too much.
In order to find reasons for the headache, it may be helpful to write down when you have your attacks, how they express themselves and what relieves or aggravates. It is also important that you write down all medicines you are taking to the pain. A headache diary can make it easier to see possible patterns and reasons. Once you have an idea of what causes the pain, you can more easily prevent it by learning to recognize and avoid those situations.
If you have an upsurge with tension headaches, your muscles are often tense without knowing about it. Being tense can sometimes become a normal condition and you will not even relax when you sleep.
In order for your inconvenience to improve, it’s most important that you learn to relax. Often, you need to take the time and start new routines to make it better. Relaxation exercises and exercises in mindfulness can be helpful. For example, you can try to start or end the day with the exercises. Some are relaxed by, for example, yoga or massage, while others are helped by long walks.
If you have been tense for the body for a long time, your tense muscles may become stiff. By exercising, so that blood circulation increases, you can prevent stiff muscles and strengthen your neck and back muscles. In this way, the body posture can also be improved and the neck relaxed. If you have a sedentary job, you should vary your work position and try to put in small breaks. Remember to always have good lighting when working and reading. Try to have regular sleep habits and make sure you get enough sleep.
If you go to a doctor because you have a headache, the doctor first tries to find out as much as possible about the pain.
You may, among other things, answer questions about:
- how the headache began
- how it feels
- where it sits
- if it has changed
- what relieves or aggravates the pain.
The doctor also asks you if you have other symptoms at the same time, if you have or have had fever, what medicines you take, and what you have eaten and drank. Often a conversation and a quick examination of the body’s functions are sufficient for the doctor to diagnose, but sometimes samples need to be taken.
For example, the doctor measures the blood pressure and assesses the nervous system, the neck, the neck and jaw muscles, the nasal sinuses, the eyes, the heart and the lymph nodes. Examples of samples that can be taken are blood value, decrease and body temperature. Having a headache may have many different causes.
The pain may come from different parts of the head, like:
- muscles and joints
- blood vessels
- nasal sinuses
- teeth, jaw and upper back muscles
- brain and bone membranes.
Different types of headache have different causes. In sections that follow we will talk about each type of headache separately.
Cranial neuralgia, facial pain and other headaches
Cranial neuralgia is a group of headaches that occurs basically due to inflammation of the cranial and / or cervical nerves, which become the source of head pain. For example, trigeminal neuralgia is a symptomatology that affects the nerve endings localized in the face, in the anterior part of the skull and in the oral cavity, and is responsible for the transmission of motor and sensory stimuli to the brain and vice versa. Also different forms of facial pain and a variety of other causes of headache are included in this category.
Cluster headache is a condition characterized by intense unilateral head pain, i.e. located on one side of the head. The painful attacks associated with this form of primary headache occur regularly, with a periodic character: the active phases last from weeks to months and alternate with long periods of spontaneous remission, without pain.
These active phases are called ‘clusters’, precisely because the attacks are frequent and close together (they occur at rather short intervals of time), and tend to occur at certain times of the day and year. Individual episodes of cluster headache can last from 15 minutes to three hours (in most patients they last less than an hour); the disturbance can occur with a crisis every two days or with more attacks within twenty-four hours. Although there are numerous hypotheses, the etiology is still unknown.
Cluster headache is less prevalent than tension-type headache and migraine, but still represents the third most common type of primary headache. Unlike the other two forms, however, it affects men more frequently and it is unclear whether genetic predisposition plays an important role in its appearance. Treatments can help make the active phases of cluster headaches shorter and less severe. Two forms of cluster headache are distinguished:
- Episodic form occurs when the cluster lasts from seven days to several months, with disease-free intervals of more than two weeks.
- Chronic form, occurs when the attacks occur every day for more than a year consecutively, without significant intervals without pain. About 10% of cluster headache cases are chronic.
The intense pain arises as a result of the excessive dilation of the cranial blood vessels, which exert pressure on the trigeminal nerve. The causes of cluster headaches have not yet been fully clarified, but there are some hypotheses.
Research has shown that during a cluster headache attack, there is much more activity at the level of the hypothalamus. The painful stimulus could originate from this area, and then involve the nerve pathways that extend from the base of the brain to the face (trigeminal-autonomic reflex path). The trigeminal is the main cranial nerve responsible for the transmission of sensory information of the face, such as the perception of pressure (touch), heat or pain. When activated by the hypothalamus, the sensory terminations of the trigeminal nerve provoke the characteristic ocular pain associated with the cluster headache, and in turn involve another group of nerve fibers, which induce nasal congestion, tearing and redness of the eye nerve.
Furthermore, the hypothalamus is responsible for our ‘internal biological clock’, as it regulates sleep-wake cycles. It is therefore believed that there may be an imbalance in the management of circadian rhythms by the hypothalamus; probably it is for this reason that the cluster headache attacks and the cycles themselves tend to occur with a precise cadence.
Finally, some think that the responsibility is a malfunction of the spheno-palatino ganglion terminations, a nervous structure connected to the trigeminal nerve and the nerve pathways that lead the stimuli to the lacrimal glands and to the nasal mucosa. This would explain some of the symptoms that accompany the painful crisis, such as intense tearing and nasal congestion.
It seems that these factors act in the active phase of the disease, that is during the period of painful crises (the bunch), and not in the remission phase (between a bunch and the other). Furthermore, it should be noted that cluster headache tends to appear more frequently during the period of climate change, especially in spring and autumn. The attacks are presented, however, with frequency, duration and intensity extremely variable from person to person.
Anyone can be affected, but this type of headache mainly affects men. The age range most affected is between 20 and 50 years. Apparently the most affected economic classes are medium-high and most of the patients are smokers. Cluster headache seems to start earlier when needed in the female sex. Cluster headache causes extreme pain. The attacks cannot be predicted and generally reach their full strength within five to ten minutes after the start.
Type of pain. The pain of cluster headaches is almost always unilateral (it always affects only one side of the head) and during an attack it remains tightly on the same side. When a new episode of cluster headache occurs, it rarely occurs on the opposite side of the head.
Intensity of pain. The pain of a cluster headache is generally very intense and severe and is often described as piercing and excruciating. It can be episodic or constant. During an intense attack, most people feel restless and frustrated: to seek relief, they are moved to move, to walk back and forth and to press the suffering side of the head with their hands or objects. The lying position worsens the pain and sometimes prolongs the attack.
Localization of pain. The pain is located around the eye and the cheekbone, with possible irradiation to the temple, jaw, nose, dental arch or chin. In some cases the whole side of the skull is affected by pain, even involving the scalp.
Duration of pain. Headache attack in cluster headache occurs without warning and quickly reaches its maximum intensity within 5-10 minutes. A single episode can last from 15 minutes to three hours (but often less than an hour), and then suddenly decrease, as it began, with a rapid decrease in intensity, until it disappears altogether. After the attacks, most patients are completely pain free but exhausted.
Headache frequency. Cluster headache occurs periodically: usually 1 to 3 attacks per day are required (up to eight daily attacks). These epidemics occur every day for several weeks or months and are followed by a period without headaches, which lasts for months or years (the average is one year). In many cases, cluster headache occurs at the same time of day, especially between nine in the evening and 10 in the morning, mainly during the sleep phase Rem (Rapid Eyes Movement).
The diagnosis of cluster headache is mainly based on the patient’s description of the symptomatology. Cluster headache presents a characteristic type of pain (for position and intensity) and with a precise pattern of attack (frequency and duration): it is necessary to report this information to the doctor to define the extent of the disorder.
If the physical examination is performed during an episode of cluster headache, it is sometimes possible to highlight the oculopupillary syndrome of Bernard-Horner (unilateral lowering of the eyelid, shrinking of the pupil, etc.). These symptoms are not generally present at other times. No evidence is available that can provide diagnostic confirmation, but the patient is sometimes subjected to further investigation to rule out other causes that may be at the base of headache or to look for more serious pathological conditions. Eg:
Computed tomography (TAC) and magnetic resonance imaging can exclude benign or malignant expansional lesions, such as a pituitary adenoma or a brain tumor.
The lumbar puncture (rachicentesis, a technique that involves the extraction of the cephaloracidian liquid) is performed to obtain the differential diagnosis with respect to conditions such as an infection, meningitis or another neurological condition.
Cluster headache treatment
The goal of treatment is to help reduce the severity of headaches, shorten their duration and prevent future attacks. Pain associated with cluster headache may occur suddenly and may subside within a short time, so painkillers such as acetylsalicylic acid, paracetamol or ibuprofen are not effective, as the disorder may disappear before the drug exerts its therapeutic effect.
For this reason, cluster headache can be managed with specific pharmacological therapy, which can be of two types:
1. Attack therapy, to relieve cluster headache
The most successful treatments involve the administration of sumatriptan (Imigran) or other triptans, which can act on pain within 10-15 minutes. Even the inhalation of pure oxygen, through a mask for about 15 minutes, is a measure that has proved to be really effective for relieving the cluster headache. Other options for the fast-acting symptomatic treatment include: intranasal lidocaine (with local anesthetic effect) and dihydroergotamine (pain reliever effective against acute attacks of cluster headache).
2. Prophylactic therapy, to prevent cluster headache attacks
Preventive medications can be prescribed to reduce the frequency and duration of attacks, as well as to decrease the intensity of headaches. They are included in a therapeutic protocol that begins with the onset of cluster headache and must continue for the entire period in which it is needed. Preventive treatments should be administered only under the guidance and careful supervision of a specialist. Some drugs used in the prevention of cluster headache include: verapamil (calcium antagonist, acts on blood pressure), lithium carbonate (adopted for the chronic form), sodium valproate (anticonvulsant) and prednisone (steroidal anti-inflammatory, only for preventive treatments) short term).
All drugs used to prevent or manage cluster headache present with potential side effects and may not be suitable for people with other conditions. As with any medication, it is important to follow the directions given by your doctor carefully. Rarely, for patients with chronic form and refractory to drug treatment, surgery may be recommended, which involves the partial inhibition of conduction of pain mediated by the trigeminal nerve.
Ophthalmic headache is a form of headache accompanied by changes in vision. Usually, pain affects only one side of the skull and appears within one hour of the onset of visual symptoms (also with unilateral involvement). Ophthalmic headache is of a pulsating nature and has a moderate to severe intensity. This form of headache can get worse with movement (for example, walking or climbing steps). In addition to visual problems, ophthalmic headache may be associated with transient neurological manifestations, such as increased sensitivity to sounds, nausea and vomiting.
Ophthalmic headache is a particular form of headache accompanied by visual symptoms and / or neurological phenomena. This condition is not considered serious, but all of these disorders can temporarily interfere with some daily activities, such as reading or driving.
Visual symptoms of ophthalmic headache are completely reversible and include: photophobia, phosphenes (flashes and flashes of light), scotomas (vision of dark or colored spots) and transient loss of vision. In addition, headaches can be associated with nausea, dizziness and tingling in the upper limbs.
The causes of ophthalmic headache are not yet fully understood. However, it seems that this form of headache may depend mainly on the vasoconstriction of the blood vessels supplying the eye and its structures, which results in a temporary reduction of the local blood flow. Among the factors that can trigger this form of headaches are also incorrect vision defects (refractive vices, such as myopia, hypermetropia or astigmatism) and the neuralgia of the trigeminal nerve. Ophthalmic headache may also be favored by anasthenopia (eye strain) or by diseases that make vision difficult (such as cataracts).
Diagnosis is based on an accurate collection of clinical history and objective examination. In subjects with episodes of infrequent ophthalmic headache, the treatment is exclusively symptomatic and involves the use of analgesics and anti-inflammatory self-medication, such as ibuprofen and naproxen. In the case of recurrent or particularly severe attacks, a prophylaxis therapy is indicated instead.
The causes of ophthalmic headache have not been definitively identified. However, it is known that this form of headache depends on the triggering of particular mechanisms, including an alteration of the pain regulation system and an abnormal neurological response to certain stimuli. This altered reactivity is common to almost all those affected by ophthalmic headache and is favored by conditions of various types (e.g. dehydration, visual fatigue, stress, etc.).
Ophthalmic headache causes
At the base of ophthalmic headache, a combination of genetic and vascular factors seems to be implicated ►
- Genetic causes: in some subjects suffering from this form of headache, specific hereditary anomalies have been identified;
- Vascular causes: the disturbance may result from a temporary reduction of blood flow (vasoconstriction), caused by the sudden narrowing of the vessels that supply the eyeball and related structures.
- Ophthalmic headache may also be associated with specific eye conditions such as:
- Incorrect visual defects (myopia, hypermetropia or astigmatism);
- Eye strain (asthenopia);
- Ocular diseases that make vision difficult (as in the case of cataracts).
- Occasionally, ophthalmic headache may originate from an inflammation of the trigeminal nerve.
Factors that can favor or aggravate an episode of ophthalmic headache are numerous ►
- Excessive heat:
- High altitudes;
- Anxiety and emotional tension;
- Stressful lifestyles;
- Fluctuation of hormone levels (menstruation, intake of oral contraceptives and menopause);
- Bad posture;
- Excessive stimuli (e.g. flashing lights, smells and loud noises);
- Sun exposure;
- Consumption of particular foods, fasting or unbalanced diet (e.g. sodium excess or abuse of sausages, aged cheeses, nitrites, glutamate, aspartame and chocolate);
- Poor quality of sleep or changes in the rhythms of sleep / wake.
Ophthalmic headache may also be the result of systemic diseases of various kinds, such as atherosclerosis, systemic lupus erythematosus or sickle cell anemia. In other words, headache is a symptom that is induced by a concomitant pathology. People who tend to develop ophthalmic headache are mostly young women (usually, up to 40 years of age). Furthermore, the disorder most commonly occurs in individuals who have a personal or family predisposition to manifest a migraine with aura.
Ophthalmic headache occurs with repeated attacks of migraine headaches associated with visual disturbances. Each episode lasts from a few minutes to several hours. Ophthalmic headache may temporarily interfere with some activities, such as reading or driving.
Ophthalmic headache: visual disturbances
The visual symptoms that accompany ophthalmic headache attacks are completely reversible. Usually, these events last from 5 to 20 minutes (they never last longer than one hour). Headache persists, however, longer (from 4 hours up to limit cases of 2-3 days).
Headache in ophthalmic headache: characteristics
Headache that accompanies the ophthalmic headache affects only one side of the skull. Pain appears within an hour from vision problems and is usually of a pulsating and severe-moderate intensity.
Ophthalmic headache may be aggravated during daily activities (e.g. walking or climbing steps) and may be associated with:
- Repulsion for food, nausea and / or vomiting (in particularly strong crises);
- Hypersensitivity or annoyance due to odors (osmophobia) and noise (phonophobia);
- Decreased muscle strength;
- Tingling, numbness and reduced sensitivity of a limb or half of the body (typically, paresthesias begin in one hand, spread to the arm and may involve the ipsilateral release);
- Loss of sensitivity of the palate;
- Difficulty expressing verbally and articulating words (aphasic language disorders);
- Impetus in the movements of an extremity.
In case of ophthalmic headache, it is advisable to carry out a very thorough eye examination. The diagnosis of this type of headache is often considered ‘exclusion’; other conditions can cause, in fact, similar visual problems. The most important aspect to take into consideration is that, during an episode of ophthalmic headache, the visual symptoms are monolateral, i.e. they involve only one eye. A doctor can diagnose ophthalmic headache by examining the personal and family history, collecting information about the symptoms experienced by the patient.
Before formulating the diagnosis of ophthalmic headache, it is important to exclude other possible causes of transient monocular blindness (amaurosis fugax), such as:
- Serious eye problems (e.g. retinal thrombosis);
- Consequences of a stroke or those of a head injury;
- Carotid dissection;
- Optical neuritis.
Therapy for ophthalmic headache
Properly coping with ophthalmic headache helps reduce the frequency of attacks and limits associated discomfort. The first step to be taken to manage and prevent episodes of ophthalmic headache is to reduce or, if possible, eliminate the triggering factors, implementing some lifestyle modifications (e.g. sleep-related habits or diet). If the control of these stimuli is ineffective, it is possible to resort to drug therapy.
In any case, the most appropriate approach to ophthalmic headache must always take into account the individual indications established by the doctor, formulated in relation to the extent of the disorder, the symptoms and the personal needs of the patient. In subjects who experience few episodes of ophthalmic headache over the course of a year, pharmacological treatment is aimed at relieving pain and rapidly controlling the symptomatology associated with the attack of headaches. Among the most used drugs in symptomatic therapy are non-steroidal anti-inflammatory drugs (NSAIDs, such as aspirin or ibuprofen) and triptans (vasoconstrictive active ingredients).
In some cases, against the ophthalmic headache it is useful to resort to a pharmacological therapy of prophylaxis or preventive. When the disorder often occurs (at least 5 seizures a month) or the symptoms are very serious, a neurologist specializing in the treatment of headaches may indicate prophylaxis therapy, aimed at reducing the frequency and severity of attacks. This type of drug treatment involves regular medication intake, often on a daily basis.
The main classes of medicines are:
- Beta-blockers and calcium antagonists: modulate the tone of blood vessels and regulate the mechanisms involved in pain;
- Tricyclic antidepressants: such as amitriptyline or nortriptyline, they mainly act on serotonin receptors;
- Anti-convulsants: like divalproex sodium and topiramate, they act on the threshold of pain and on cerebral hyperexcitability.
The doctor will choose whether to prescribe them both according to the frequency of attacks of ophthalmic headache and the age of the patient; following his instructions helps to tackle the problem in the best possible way. A useful strategy to counter ophthalmic headache is the use of glasses to correct any disorders or prevent excessive eye strain. Another effective intervention to prevent the disorder is to act on all those that may be environmental factors.
In the case of ophthalmic headache caused by stress, for example, it is possible to resort to natural remedies, such as the intake of valerian infusions, chamomile and lemon balm with a calming effect, as well as the practice of yoga.
Certain dietary-behavioral measures can help to alleviate the symptoms of ophthalmic headache.
- Avoiding factors that may favor the appearance of headaches, such as cigarette smoke, poorly ventilated environments, alcohol consumption, excessive heat and exposure to intense noise;
- Limit the consumption of foods that may contain monosodium glutamate, nitrite and lactose involved in the onset of headache attacks: dairy products, aged cheeses, Chinese food, eggs, chocolate, citrus fruits, tomatoes, etc.
- Undergo periodic checkups with a trusted ophthalmologist, just to avoid that the lack of awareness of a given disorder (e.g. myopia, astigmatism, hyperopia, etc.) can cause an ophthalmic headache or any other type of problem.
Tension headache is the most common form of headache and, relatively, the least painful. Tension headache The disorder mainly depends on the involuntary and continuous contraction of the muscles of the neck and shoulders, associated with fatigue and tension. Tension headache is more common in females and mainly affects people who spend a lot of time sitting in bad positions or accumulating stress.
Even bad dental occlusion, lack of rest, cervicalgia and asthenopia (visual fatigue) can contribute to the appearance of tension-type headache. The disorder may also be related to depression or anxiety: currently, a form of headache not associated with muscle tension has been recognized, therefore probably only of psychological origin.
Tension headache often has variable characteristics in the same person who tends to suffer from it. In many cases, however, this form of headache causes a persistent, mild or medium intensity, which is localized in the occipital region, i.e. in the back of the skull, above the nape. In some subjects, on the other hand, constrictive pain (often referred to as a ‘head circle’) is mainly concentrated in the eyes and temples (frontal region), or it is widespread throughout the head. The tension headache is frequently bilateral, i.e. it affects both the right and the left side.
Pain attacks can last from half an hour to 5-7 days. Tension headache may be episodic or chronic (if crises occur every two to three days). This form of headache does not result in other symptoms such as functional disability, nausea or light aversion (photophobia), which are typically associated with migraine. Furthermore, tension-type headache does not affect the patient’s normal daily activities and movement appears to help alleviate the disorder.
Causes and triggers of tension headache
To properly manage this form of headaches, it is necessary to identify and treat potential triggers. Tensile headache affects up to 75% of the population, with a higher prevalence in the female gender. The causes of the disorder are not entirely known, but most of the specialists agree that this form of headache depends on an involuntary and continuous contraction of the muscles of the neck, the forehead, the temples, the neck and the shoulders. The tension headache is in fact more common in people who, for reasons of study or work, tend to assume an incorrect position (more biased forward); this forces the neck and head muscles to stiffen more to find the ideal balance.
At the origin of this form of headache, however, there may also be more strictly neurological causes, such as alterations of the cerebral centers that control pain perception and tolerance to stress.
The main factors that trigger tension headaches are stressful events, nervous disturbance, anxiety and depression; for this reason, the condition is often considered a psychosomatic disorder. It is not by chance that people who find themselves in these situations tend to discharge the tension accumulated at shoulder level, contracting the neck and head muscles; this involuntary but continuous effort results in a headache attack.
Furthermore, it is necessary to consider that the subjects who are going through a period of psychophysical exhaustion have a lower pain threshold than the average, due to the decrease in the level of endorphins. If the level of these substances is low, even a simple muscle contraction can be felt in a more painful and intense way.
In addition to stress, the other factors that trigger tension headaches include:
- Bad postures that favor the continuous tension of the neck muscles;
- Drug abuse, which causes addiction;
- Problems with the articulation of the jaw;
- Hormonal imbalances;
- Alterations of the sleep-wake rhythm.
Tension headache symptoms
Tension headache is characterized by a mild or moderate intensity pain, often described as constrictive. Headache is persistent and not pulsating. This form of headache originates in the occipital region (nape) or frontal (temples and forehead) and spreads all over the head: the disturbance manifests as a sense of heaviness or a grip that tightens the head, giving rise to the famous ‘circle’ or ‘band’.
Unlike migraine, tension headaches are not accompanied by functional disability, nausea or light aversion (photophobia), and are not exacerbated by physical activity, light stimuli, sounds or smells. The potential triggers of chronic tension-type headache include sleep disturbance, stress, temporomandibular joint dysfunction, asthenopia and cervicalgia. As a rule, headache attacks begin several hours after waking up and worsen throughout the day; patients rarely wake up from sleep. Chronic forms may vary in intensity throughout the day, but are almost always present.
Tension headache may be episodic or chronic. In the first case, headache crises occur for less than 15 days a month. Episodic tension headache is very common; most patients take relief from taking over-the-counter analgesics and do not contact their doctor. In chronic tension headache, however, headache manifests itself overall, for at least six months a year, for more than 15 days a month.
The duration of the crises is very variable. In episodic forms, the tension headache occurs for a period ranging from 30 minutes to 7 days. Chronic tension headache can last for hours, days, weeks, months or years and be continuous. In milder forms, the disorder often occurs in stressful situations, while in the more severe and chronic pain usually appears in the morning on waking and continues until evening.
Other symptoms that may be associated with tension headache may be: pain in the pericranial muscles (regulate the movement of the jaw) and anxious manifestations. Vomiting and nausea rarely appear.
Tension headache diagnosis
The diagnosis of tension headache is based on the characteristic symptoms and on the negativity of the clinical objectivity (including the neurological one).
The most appropriate measures to combat tension headache should be indicated by the doctor, who must first collect some information on the presentation of the disorder (medical history), including:
- Place of pain (unilateral, bilateral, frontal, occipital, etc.);
- Severity (mild, moderate, severe or disabling) and quality of headaches (constrictive, pulsating, intermittent, constant, oppressive or piercing);
- Mode of onset (e.g. sudden or gradual);
- Duration of painful crises and times when they occur;
- Any concomitant symptoms;
- Lack of rest or activities that may have contributed to the onset of pain (e.g. due to physical exertion or after having maintained a particular posture for a long time).
- For recurrent tension headache episodes, we must investigate:
- Age of onset;
- Frequency of episodes and temporal references according to specific situations (such as, for example, any correlation with a phase of the menstrual cycle);
- Response to treatments (including over-the-counter medications).
To facilitate the formulation of the diagnosis of tension-type headache, it may be useful to compile a ‘headache diary’, in order to help your doctor to better understand which situations more easily predispose to headaches (e.g. activity carried out, consumed foods and any drugs taken before its appearance) and the progress of attacks over time. The compilation of this sort of register also allows to monitor and determine the effectiveness of any therapeutic approach taken.
Tension headache treatment
To limit the frequency of stress headaches, it is good to intervene on the triggering factors, both by taking drugs and correcting any incorrect behavior. For most mild to moderate forms, analgesics (such as paracetamol) and non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen, naproxen, diclofenac and acetylsalicylic acid are used; these drugs help to combat pain and provide relief. Opiates or narcotics are rarely used, due to their side effects and the potential development of an addiction.
In some cases, the doctor may indicate the use of muscle relaxants, which decrease muscle contraction or, if this form of headache is associated with particularly stressful events, anxiety and depressed mood, may prescribe anxiolytics. Antidepressants (tricyclics or selective serotonin recovery inhibitors, SSRIs) can also sometimes be used in the prevention of tension headache attacks (to reduce their frequency and severity), especially if they occur with frequent or chronic headaches that are not relieved of other treatments.
Behavioral and psychological interventions (e.g. cognitive behavioral therapy and stress management techniques) can be helpful among complementary therapies for this form of headache. Furthermore, biofeedback, which induces relaxation of muscles through the use of electrodes, and massage therapy, a manual technique that can help reduce muscle tension, can contribute to managing tension headaches. Yoga, like any other relaxation technique, has also proved to be effective in tension headaches.
Prevention of tension headache or the reduction of the frequency of attacks is possible by adopting a healthy lifestyle and respecting some rules of behavior:
Headache in pregnancy (gravidic headache)
Headache is a disorder that can also occur during pregnancy. Most of the time, the cause of this manifestation is due to the hormonal changes that occur after conception. The combination of various factors, such as anxiety, fatigue, worsening of sleep, morning sickness, wrong eating habits and dehydration can also contribute to the onset of pregnancy headaches.
Usually, gravidic headache can benefit from rest and recourse to simple non-dangerous remedies for the unborn child, such as applying cold compresses on the forehead or performing massages at the nape of the neck to relieve muscle tension.
If acute or recurrent, however, headache in pregnancy is not to be underestimated, as it can signal the presence of some complications that may affect the gestation. For example, the disorder may be associated with a mild state of anemia, respiratory infections and increased blood pressure.
Furthermore, when headaches occur suddenly, they are particularly intense, last for more than three hours and are associated with other manifestations, such as vision problems and sudden swelling of the hands or face, they could be the ‘spy’ of a pre-eclampsia. This complication requires immediate medical intervention.
Headaches – in particular, migraine – is a disorder that affects women more frequently: women are affected 2-3 times more often than men, especially during the fertile period. In part, this greater susceptibility is attributable to the fluctuations of female hormones that occur during the menstrual cycle and during certain particular events of reproductive life (menarche, pregnancy and menopause).
For example, the drop in estrogen levels that occurs between the three days preceding the cycle (premenstrual period) and the last day of menstruation can induce episodes of migraine. These hormones, in fact, cause a reduction of endorphins, substances produced in the brain that play a decisive role in reducing the sensitivity to painful stimuli. In addition, estrogen reduction causes an increase in nitric oxide and prostaglandins, substances that are involved both in induction and in the maintenance of headaches and vascular changes that underlie migraine attacks. Progesterone, on the other hand, seems to have a more protective role against headaches.
Wine: sulfur dioxide, sulphites and headache
We begin by specifying that, despite the sulfur dioxide is a food additive, as anticipated its presence in the wine can also be induced by the metabolic action of some bacteria. Having clarified the concept, we continue with the exposure of real side effects and attributable to the intake of sulphites with wine and food. Sulphites, being an additive, are subject to a specific regulation of use; in wine, the maximum allowed limit is 200mg / l. However, we should remember that sulfites are widely used, both as an antioxidant and as an antiseptic, also in many other preparations of the food industry; therefore, research institutions had to estimate a maximum tolerable dose of sulfites for humans.
Side effects due to excessive intake of sulphites are irritation of the gastric mucosa, pain and vomiting. However, the research has justified the onset of these manifestations only by administration of concentrations equal to 3500 mg / kg of body weight (SO2 poisoning), which induce (in the presence of acidic pH of the stomach) the conversion of food sulfites into anhydride sulfur dioxide SO2.
It is however necessary to specify that sulfites are potentially hypersensitive (or allergenic) molecules to more than 5 persone; based on these data, the competent commissions have imposed in the vinification the wording on the label ‘contains sulphites’ for concentrations> 10mg / l. In hypersensitive subjects, sulphites can trigger the manifestation of some side effects including: asthma, difficulty breathing, shortness of breath, shortness of breath and cough. On the other hand, from a nutritional point of view, sulphites appear to have a relatively low impact as they only damage thiamine (vitamin B1) and do not seem to have a negative effect on other molecules.
That said, it seems obvious that among the most common side effects mentioned above are missing the most popular: headache. But is there really a correlation between sulfites contained in wine and headaches? Or is it only a subjectively determined reaction in which, above all, other variables intervene? Recall that ethyl alcohol is a nerve, and as such, acts directly on the nervous system. In any case, we try to frame with more accuracy the so-called ‘post-hangover’ symptom most common among people dedicated to ethylism.
Other types of headaches are connected to obvious and repeated causes, so as to arouse the interest of the medical sector. Headaches are classified into 2 types: cluster headache and migraine. In the most important cases, headache, although considered a benign condition, is an extraordinarily disabling disorder.
Headaches affect 98% of the general population at least once in their life and, fortunately, most people complain of sporadic episodes mostly related to inflammation of the nasal or sinus mucosa, or to symptoms typical of dental disorders, but also to excessive consumption of alcohol.
In the texts there is no mention of headache induced by excessive intake of sulfites; on the other hand, headache is commonly associated with indiscriminate alcohol abuse (beer, spirits, etc.); this means that headache induced by wine is probably triggered by an excess of alcohol consumption and perhaps by individual hypersensitivity, but (for the moment) there is no scientific evidence to show the involvement of sulphites in the onset of headache or migraine.
Pregnancy headache causes
Pregnancy represents a period of changes, this is also true for headaches. During gestation, it may happen that women already habitually suffering from migraines find a marked improvement in the disorder or even stop having attacks. The reason is to be found in the level of estrogen, which remains high and constant during the second and third quarters. In fact, thanks to these hormones, endorphins increase, which act to relieve pain. In a small percentage of cases, however, the opposite phenomenon may occur: in the first three months of gestation, some women, who normally do not suffer from headaches, are subject to recurrent headache episodes, which begin for the first time in this period.
At other times, pregnancy can make headache or headaches of which the woman suffers habitually worse. The explanation of this phenomenon is not yet fully understood, but head pain probably depends on both hormonal changes and changes in blood circulation (such as increased blood volume) at the beginning of the first trimester. of pregnancy. Typically, headache episodes that occur during the first trimester resolve spontaneously once you enter the second trimester, i.e. when hormone levels start to stabilize.
In addition to the hormonal changes that occur during pregnancy, several predisposing factors may be involved in the appearance of headaches, such as:
- Excessive tiredness;
- Insomnia and lack of rest;
- Anxiety and stress;
- Deficiency of some vitamins and minerals (including folic acid and magnesium);
- Wrong postures that favor the continuous tension of the neck muscles;
- Low blood sugar level (hypoglycemia);
- Abstinence from caffeine;
- Some foods and food preservatives (such as chocolate, cheese, shellfish, hazelnuts and bananas);
- Stay in crowded and noisy places.
Situations to watch out for with pregnancy headache
In pregnancy, manifesting headaches is absolutely normal. However, it is important not to underestimate the disorder and to address it with particular attention, as it may represent a symptom of other pathological conditions.
Migraine. Migraine is characterized by recurrent headache attacks, moderate to severe intensity and pulsating in nature. The pain tends to begin slowly, often on one side of the head, generally involving the frontal region above the eye and the temple. Headaches can also spread to both sides and usually get worse with movement. This obviously limits the carrying out of the usual daily activities.
Migraine is associated with disorders such as: nausea, vomiting, aversion to light (photophobia), hypersensitivity to sounds and odors. For this reason, many people with migraine prefer to rest in a dark and silent room. Sometimes, headache is preceded by the aura (a series of transient and reversible symptoms that include tingling, blurred vision and drowsiness). The pain can last from a few hours to a few days.
Tension-type headache. Pregnant women can experience a dull and constant pain, usually bilateral, similar to a vice that tightens the head (giving rise to the famous ‘circle’). This form of headache depends on the involuntary and continuous contraction of the neck and shoulder muscles. Postural vices, stress, anxiety and depression associated with pregnancy are considered the main triggers.
Sinusitis. Sinusitis is a disease that can easily be confused with a headache. Paranasal sinuses are cavities located within the bones of the skull, above and to the side of the nose. When these structures are involved in inflammation, they can manifest themselves: severe headache, stuffy nose, cough with phlegm, secretion of yellow mucus and pain in the forehead or cheeks that gets worse when lying down or during a sudden movement of the head. The most common causes of sinusitis include viral or bacterial infections and allergies.
Headache during pregnancy may be accompanied by other symptoms, such as nausea, dizziness, light aversion (photophobia) and excessive sensitivity to sounds and noises (phonophobia). Sometimes, the vomit associated with morning sickness can lead to dehydration. This condition is a risk factor for headaches and can lead to dry mouth, constipation and dark urine emission.
The most appropriate measures to counter headache in pregnancy must be indicated by the doctor, who must first collect some information on the presentation of the disorder, such as the duration of attacks and the times in which they occur, the concomitant symptoms, the lack of rest or activities that may have contributed to the onset of pain.
During gestation, the doctor must be consulted urgently in the following cases:
- Extremely severe headache with sudden onset;
- Chronic headache of unknown cause;
- Abdominal pain (may indicate an infection of the urinary tract);
- Drowsiness or loss of consciousness;
- Persistent headache after an injury.
Pregnancy headache treatment and natural remedies
When headache manifests itself during pregnancy, it is advisable to intervene with caution to try to alleviate the discomfort naturally and, if possible, without taking medication. First of all, we must try to rest: sleeping, lying down and relaxing, possibly in a dark environment, can help to resolve the problem. Massages can be used to reduce tension area of the cervix, shoulders and back muscles.
Another remedy that can be useful when pregnancy headache occurs is to apply a wet cloth with fresh water to the forehead and aching temple. If the pain is particularly intense, before taking any type of medication, it is advisable to contact your doctor. Generally speaking, during pregnancy, paracetamol can be used to treat occasional headaches. In the course of gestation, however, it is not recommended to resort to most of the drugs that are used to combat migraine.
To avoid the occurrence of headaches during pregnancy it may be helpful to follow a healthy diet, trying to make regular and light meals. In addition, exposure to strong odors or the ingestion of foods that could trigger the disturbance or worsen the symptoms should be avoided, including: chocolate, cured meats, shellfish, aged cheeses and dairy products, bananas and hazelnuts. As a precautionary measure, foods containing monosodium glutamate, artificial sweeteners (such as aspartame) and nitrates (common in processed meats, cured meats, etc.) should also not be consumed. Other triggers to avoid may include strong lights or bad lighting, noise, excessive heat or cold, intense odors and smoke.
To prevent headaches during pregnancy, remember to maintain a good hydration, drinking even if you are not thirsty, at least one and a half liters of water a day. Even a light and regular physical activity (such as a thirty minute walk outdoors) can help prevent and fight headaches during pregnancy. Other interventions that may prove useful include better stress management (for example, by delegating some activities to other people) and the practice of relaxation techniques (such as yoga and biofeedback in specialized centers). In pregnancy, it is important to get enough sleep, as sleep deprivation can contribute to headaches.
Headache in children
Headache in children (or headache, if you prefer) is a more widespread disorder than you might think; in fact, it is estimated that at least 30% of school-aged children suffer from it. Fortunately, in most cases headaches are a passing and easily treatable disorder. However, it can sometimes be a symptom of very serious underlying diseases; for this reason, headaches in children should never be underestimated.
Although there are numerous forms of headaches, these can basically be divided into two large groups:
- Primary headaches, which are considered as real diseases and whose cause is often not immediately identifiable. Usually, they are caused by environmental or hormonal factors, or they may be related to incorrect lifestyle habits. Tension headache and migraine are part of this group.
- Secondary headaches that are, instead, triggered by other diseases and that, as such, are one of the symptoms of these same diseases.
However, the most common forms of headaches in the pediatric population are primary ones, such as migraine with or without aura (which mainly affects children during early childhood) and tension headache (which occurs mainly in adolescents)..
Headache is a disorder that affects both male and female children. However, after the age of ten, the incidence of this disorder is greater in females than in males. One of the main risk factors that favor its onset is familiarity. In fact, the children of people suffering from headaches are more likely to develop the disorder in question.
Causes of headaches in children
As mentioned, the most common forms of headache in the pediatric population are migraine and tension headache. The symptoms of these two types of headaches are slightly different.
Headaches in children can lead to important consequences and negatively affect the child’s life. In fact, this disorder can cause behavioral problems, difficulty in concentration (making school learning difficult), agitation and anxiety disorders. The severity of the consequences of headaches in children strongly depends on the intensity of headache attacks and the frequency with which they occur.
Pharmacological therapy of headaches in children
For the treatment of headaches in children, first of all, it is essential to determine from which type of headache the pediatric patient is affected (primary or secondary). In the case of secondary headache, it is very important to identify and treat the primary cause that caused it. For this reason, in case of headache, it is good to bring the child to the pediatrician, who – once discovered the triggering cause – will provide the indications to be followed to counter this disorder and, eventually, will also provide adequate therapy.
For the treatment of primary headache, however, the pediatrician may decide to prescribe the administration of analgesic or non-steroidal anti-inflammatory drugs to appease the pain, such as paracetamol (Tachipirina) or ibuprofen (Antalfebal). The dose of medication to be administered to the child depends on his age and body weight; therefore, the exact dosage of the medicine will be established by the doctor on a strictly individual basis.
As we have seen, headache in children is a disorder that has a very negative effect on their daily life. In addition to the possible drug therapy that the pediatrician can decide to prescribe, the parents of the child can follow some simple advice aimed at the prevention and reduction of headache attacks.
- To set up the child with a regular lifestyle, characterized by healthy eating;
- As far as possible, put the child to sleep every night at the same time, always resting the same number of hours;
- Do not overload the child with activity, so as not to subject it to excessive stress and stress.