Have you had days when your head just bangs, and it is like almost everything is working against your comfort? At that point, Every sound looks like 150 decibels horn, every movement looks like a collision of vehicles, and every ray of light go straight into almost making you blind. Just because of a simple bang in the head? Headaches can be mild or acute, and it cannot be taken with levity. There are times when a lot of us develop headaches, and we start to worry if we aren't falling sick, or as a result of an underlying condition. In this post, I will do the honors of explaining headache to you like you would want to know about it.
What Is Headache?
In layman terms, headache, as the name implies, is pain in the head. To go a little extensively, according to an article dated 2017, which was published in the Frontiers in Neurology journal, the cause of primary headache is still being debated. Some say it has a neurogenic origin, and others say it has a vascular origin. In this post, I will be using the neurovascular origin, which is widely accepted. Headache is a result of irritation, inflammation, stimulation of certain blood vessels in the head. These blood vessels include, the blood vessel in the Dura mater, blood vessels in the muscles of the head and neck, and vessels in the cranial nerve (fifth cranial nerve).,,.
With the simple definition of headache above, it will be important that we identify the various types of headaches, which are the Primary Headaches and the Secondary Headaches. So you know, most of the headaches periods you have are basically classified into primary headaches, secondary headaches are usually as a result of underlying disease which triggers headache.. Statistically, about 95% of the entire population has experienced a headache at one time or the other in their lifetime . According to WHO, 50% of all adults globally suffers headache disorder at least once a year, over 30% of the population have been reported to suffer from migraine, and 1.7 - 4% of the adult population suffers headache for 15 or more days every month.. In this post, I will be focusing on primary headache. In my next post, I will deal with Secondary hearache. This said, let's go into the Headache classes in proper.
Primary Headache Pathophysiology and Diagnosis
Primary headaches can be divided into Three (3) types, the Tension headache, cluster headache, and Migraine. Without wasting any much time, let me give a simple explanation of these headache types.
If you had a headache as a result of lack of sleep for about 48 hours, or a long walk or run, cases when you are dehydrated, and stressed out (physical or emotional), then you just experienced the most common type of headache in the world, which is the Tension Headache. This headache is as a result of tightening and stiffness of the head and neck muscles (pericranial muscles), causing the vessels in the cranial nerve to send the information to the trigeminal nucleus in the brain stem, which sends the pain information to the ventral posteromedial thalamus which interprets it as pain. , . The pattern of this headache is bilateral, within the frontal and temporal areas of the skull. It is the bandlike headache you usually have, and it can last from 30 minutes to 1 week if serious. When the action causing this pain isn't stopped to allow the muscles to relax, it could lead to a process known as Hyperalgesia a situation where the body starts to experience severe pain.
Migraine, which is the second most common type of primary headache. Its cause hasn't been fully understood, only except for cases where it is genetic (in the case of Familial Hemiplegic Migraine). It is believed to be a brain disorder as a result of alterations in the sub-cortical aminergic sensory modulatory systems (cortical spreading depression theory) which would lead to auras, starting with Scotomas (the usual visual fogging experienced before migraine). During this process, pain receptors in the cranial nerves are triggered, which leads to the release of Substance P, calcitonin gene-related peptide (CGRP), and vasoactive intestinal polypeptide (VIP) which are common mediators in migraine, allowing neurogenic inflammation, vasodilations of blood vessels thereby causing the pain receptors around the meninges region to pick up the pains and send it to the Thalamus which interprets the pain and, send to the Cerebral Cortex. , . Migraine is often triggered by Red Wine, Smoking, in some cases chocolate, Glaring or flickering lights and so on. In some cases, low serotonin or estrogen levels could result in a migraine.. Migraines are Pulsatile causing photophobia, and phonophobia in nature, the headache usually last up to one day (4 to 72 hours), It could cause Nausea, and vomiting, and could cause a full breakdown in activities. Migraine is usually a Unilateral type of headache, usually a gradual onset, location is towards the frontal area of the head. When Migraine attacks with preceding aura such as scotoma occur at least twice or more, diagnosis is can be easily concluded. When Migraines do not come with Aura, attacks should have occurred at least 5 times to be regarded as a migraine.
Coming to Cluster Headaches, Smokers are usually the patients (not using the word victims). Also, wines (red wines), and just being male could actually trigger the development of cluster headaches, but its pathophysiology has not been fully clear. A theory say it is as a result of vasodilation around the conjuctiva, the fifth cranial nerve, circadian effects, trigeminal nerve stimulation. . Cluster headaches are usually unilateral, at the orbital frontal region of the head. The headaches are usually sharp and burning, with a duration of up to 15 minutes to 4 hours, occurring in clusters/episodes on a daily. Other associated symptoms would be ipsilateral conjunctival injection, eyelid edema, lacrimation, nasal congestion, rhinorrhea, forehead and facial swelling, or ptosis.. With cluster headaches, a 5 times attack with the symptoms of cluster headaches coupled with autonomic symptoms such as Lacramation or rhinorrhea, would be needed to confirm diagnosis.
Clinical Treatments for Headache
One first aid for migraine would be staying in a dark, and quiet room for a while, to enable the patient to rest. Most times migraines are as a result of stress including noise and sharp light. Treatments for Migraines with cases of Nausea will be metoclopramide (to stop the vomiting), and Non-steroidal anti-inflammatory drugs (NSAIDs) would help. TripTans medications would also help increase seratonin and to help reduce vasodilation. Drugs such as Dexamethasone can also be administered, helping to reduce inflammation and reoccurence of the migraine. Migraine Prophylactic Therapy should be considered to chronic cases.
In cluster headaches, Cluster Prophylactic Therapyis also a very good treatment therapy in chronic cases. Other medications includes Sumatriptan, and Intranasal capsaicin. For tension headaches with episodes, Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to treat.
Reference
National Library of Medicine - Headache disorders: differentiating and managing the common subtypes
BioMed Central Journal - The fifth cranial nerve in headaches
BioMed Central Journal - Secondary headaches: secondary or still primary?
National Library of Medicine - Muscle Contraction Tension Headache
NCBI - Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis
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